Why reopening the U.S. border could spell trouble for Manitoba's sunny COVID-19 outlook

Reopening the Canada-U.S. border too quickly could jeopardize Manitoba's successful campaign to stem the spread of COVID-19, especially in light of the high numbers seen in the province's neighbouring states, a health expert says.

Community transmission rates and death tolls in North Dakota and Minnesota exceed those seen in Manitoba — even after accounting for population differences, a CBC News analysis shows.

"To have that undermined by opening the border would be a disappointment at the least for Manitobans — to have to go back to what we were doing because we reopened the border too early," said Dan Chateau, a community health research scientist with the Manitoba Centre for Health Policy.

The U.S.-Canada border is closed to all but essential travel — such as trucks carrying food — until June 21, though reports on Tuesday suggested it may be extended. As of Tuesday, immediate family members separated by the border closure could also cross the border.

Importation of the virus remains the greatest threat to Manitoba, with just 11 per cent of cases in the province linked to community transmission — or those with no known source, Manitoba Chief Public Health Officer Dr. Brent Roussin has repeatedly noted.

Meanwhile, both North Dakota and Minnesota have community transmission rates nearing 40 per cent. And while Manitoba saw its most recent COVID-19-related death over a month ago, fatalities linked to the illness in North Dakota and Minnesota continue to climb.

Chateau credits luck, timing and the early physical distancing efforts of Manitobans for its unshapely disease curve.

"They still haven't quite gotten there in North Dakota and they're not really close yet in Minnesota."

Then and now

Each region saw its first COVID-19 cases emerge in the first half of March, about a week apart. But in the following three months, the disease curves differed.

To date, there have been over 28,500 cases in Minnesota and 2,900 in North Dakota. By comparison, Manitoba has had 300 total — which is well below the daily average in North Dakota since it began reopening its economy on May 1.

"They've done a lot more testing and to a great degree it's because they needed to," said Chateau.

Minnesota's done almost twice as many tests as Manitoba, while North Dakota has tested about three times more of its population.

While Manitoba closed three of its Winnipeg testing sites this week, Minnesota opened four more.

State health officials are bracing for a COVID-19 surge associated with large crowds protesting police brutality, anti-Black racism and the death of George Floyd.

Minn., N.D. dwarf Man. death tolls

Differing standards and measurement quirks across regions make apples-to-apples comparisons a challenge but even the mortality rates — a better indication of rate of spread — are significantly higher in the U.S. states.

North Dakota's population is half Manitoba's, but there have been 10 times as many deaths there. Minnesota is home to four times as many people in Manitoba and has had about 170 times as many deaths.

About 80 per cent of Minnesota's more than 1,200 deaths were people living in long-term care facilities. In Manitoba, a single nursing home death has been linked to COVID-19.

Why are they worse off?

Stark differences between Manitoba and its neighbouring U.S. states are in part due to geography and timing, but culture and policy also have a role.

Starting March 27, Minnesota ordered residents across the state to stay at home. Those restrictions have gradually loosened since May, with most businesses now allowed to open with restrictions, and outdoor gatherings limited to 25.

North Dakota was one of the few holdout states that decided against a stay-at-home order.

"It was probably reasonable to not just knee-jerk and follow Minnesota's response, because their trajectory looks very different than ours," said University of North Dakota political scientist Robert (Bo) Wood.

Early on, North Dakota Gov. Doug Burgum said there was no need for an order because of a range of business and school closures, plus physical distancing guidelines already in place that were effectively slowing the spread. The state was in better shape than many states at the time, and still is.

Burgum would've also faced intense opposition from his Republican base, said Wood.

"There's such an independent 'you can't tell me what to do' streak in North Dakota," he said. "The more they clamp down, the more people would resist."

'Relatively quickly, it became polarized'

Just over a month after business closures there and in Minnesota, the first of several reopen protests occurred.

A month later, Burgum teared up during a news conference, pleading with North Dakotans not to make following public health recommendations — like wearing a mask — a divisive issue.

"The Trump supporters were not willing to wear masks, and [were] clamouring for opening it up really fast," said Wood. 

"I think that pushed us to take a risk and open up quicker than perhaps [Manitoba]."

Wood said it's also possible Manitobans have adhered to public health guidelines more closely.

Risk tolerance

North Dakota and Manitoba reopened segments of their economies at the beginning of May.

But North Dakota's May reopening was broader, including movie theatres, hair salons, and tattoo and piercing shops. School graduation ceremonies and gym reopenings, with proper distancing, were soon permitted.

Manitoba hair salons were able to reopen in early May, but large-scale high school grads are still cancelled or rescheduled. Gyms just reopened on June 1, and movie theatres remain closed.

North Dakota had roughly 600 active cases around the beginning of last month. While the caseload has started to drop, the death toll nearly tripled in that time.

Wood said the state may have a higher tolerance for risk.

"The same numbers that would have been perhaps alarming and triggered a stronger policy response in Canada would apparently be an acceptable tradeoff for further being able to retain some level of economic activity."

On the horizon

When it does come time to reopen more broadly, Manitoba and its U.S. neighbours should consider a phased approach and increase targeted testing of certain groups, said Erin Strumpf.

"Manitoba's been operating in this closed, hermetically sealed environment, so the fact that they haven't done a lot of testing has been OK," said Strumpf, an associate professor of health economics at McGill University.

"But if they open back up, they're going to have to potentially change their strategy."

Recent cases of truckers who tested positive after returning from the U.S. have prompted Manitoba to offer voluntary testing to all asymptomatic drivers.

That's one good step, said Strumpf. 

State and provincial health officials said recently they haven't begun co-ordinating with each other on a reopening plan. Strumpf suggested they might want to start talking specifics.

"At the end of the day, we don't want to be completely self-interested. We want to continue to be good neighbours."