As the 4th wave picks up steam in Manitoba, the window is closing to avoid another ICU crisis

If COVID-19 continues to spread in Manitoba at the current rate, the daily case count in this province will be above 500 by the middle of November.

This is not inevitable. It's not even a projection.

It's just arithmetic, based on COVID case counts since the third week of September, when the fourth wave of the pandemic began in earnest in Manitoba.

On Sept. 21, the seven-day average daily case count in Manitoba was 60. One week later, on Sept. 28, the running average had risen by 30 per cent to 78.

On Tuesday, after another week went by, the case count had risen an additional 35 per cent to 105.

If the running average continues to rise 30 per cent a week, Manitoba will cross over the 300-case-a-day line shortly after Halloween and hit the 500-case mark a few sleeps after Remembrance Day.

While this progression is not inevitable, the growth in COVID cases over the past two weeks is enough to justify the chief provincial public health officer's contention the province is seeing COVID growth along the lines of the "severe" fourth-wave scenario included in public health projections back in August.

"Right now, we're tracking on the severe scenario. We are seeing case numbers going up. We are seeing significant increases in hospitalization and ICU, and certainly some regions are contributing more to that than others," Dr. Brent Roussin said during a news briefing on Monday.

In fact, the COVID growth rate is a little worse than that assessment. We're actually tracking somewhere between the "severe" and "extreme" scenarios, in terms of the number of cases the province could be seeing in the coming weeks.

This is depressing, considering the way life has returned to some semblance of normalcy in Manitoba since early July, when the third wave finally receded and most businesses reopened, not to mention the fact the vast majority of us have our COVID shots.

But this dark near-future is just a possibility. Five hundred cases is not inevitable. 

On Tuesday, the province enacted new public health restrictions aimed primarily at restricting the social opportunities for the roughly 164,000 Manitobans who are eligible to get their shots but remain unvaccinated.

While this suite of targeted restrictions may not have any appreciable effect in towns and rural municipalities where people routinely thumb their noses at provincial public health rules, it's possible they could have some effect in more compliant places like Winnipeg.

If that effect is minimal, public health authorities will have little choice but to enact more sweeping measures to blunt the growth of COVID's fourth wave.

This will only deepen the divisions between the vaccinated majority, who by and large are not getting sick, and the unvaccinated minority of Manitobans, who for the most part are keeping the pandemic going. 

The unknown factor in this equation is the number of COVID patients who will get sick enough to wind up in hospital and require intensive care. The proportion of COVID cases that become severe has become less predictable.

For starters, the handful of fully vaccinated people who contract COVID rarely develop severe symptoms. On its own, the "dimmer switch" effect of vaccination reduces the acuteness of the average COVID case.

On the other hand, the increasing tendency for Manitobans to avoid COVID testing when they develop symptoms may be masking the true number of cases. Dr. Roussin said last week as many as half the COVID patients admitted to hospital in recent weeks first got tested for the virus only after a nurse affixed a plastic bracelet to their wrist.

Transmission within schools adds even more uncertainty, as elementary classrooms now serve as the single largest collections of unvaccinated Manitobans.

Ultimately, case counts are less important than the number of COVID patients that wind up in ICUs. As awful as acute COVID is on patients, the diversion of hospital resources away from all other forms of medical treatment constitutes the primary threat to the quality of life for all Manitobans.

The province learned this the hard way in May and June, when our hospitals were so overwhelmed by COVID treatment demands, 57 patients had to be flown to intensive care wards in Ontario, Alberta and Saskatchewan and thousands of serious medical procedures had to be placed on hold.

At the worst point of the third wave, on June 1 and 2, there were 109 Manitoba COVID patients in ICU wards somewhere in Canada.

Under the "severe" fourth-wave scenario unveiled in August, Manitoba will end up in a similar position by the middle of December. Something between the "severe" and "extreme" scenarios would bring back this ICU nightmare even earlier.

It is not realistic to expect 164,000 vaccine holdouts to suddenly relent and sign up for their shots. It is just as unrealistic to expect widespread compliance to restrictions from the same constituency.

The challenge for this government is to mitigate the fourth wave of COVID without punishing the majority of Manitobans, who got their shots and followed the rules.

The window for achieving both goals is getting narrower by roughly 30 per cent each week. 

That isn't a projection. It's just arithmetic.