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Duration of physical distancing still unknown

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Whether Manitoba's public-health orders were imposed early enough to effectively slow the spread of COVID-19 in this province is expected to become clear within weeks. But there isn't enough data yet to understand how physical distancing is working here, or when governments will be able to ease restrictions, a leading infectious disease expert says.

"That's the million-dollar question, is when will we be able to relax the measures? And I can't answer that," said Dr. Yoav Keynan, scientific director of the National Collaborating Centre for Infectious Diseases and an infectious-disease physician at the University of Manitoba.

"Those are questions that people are working on, trying to figure out what are the exit strategies of this epidemic, but I think we're ... in early days. We have the advantage -- I think (public health) responded early," he added.

"We are late to the party, so we will learn from good and bad experiences of other places."

"That's the million-dollar question, is when will we be able to relax the measures? And I can't answer that," said Dr. Yoav Keynan. (Mikaela MacKenzie / Winnipeg Free Press)

"That's the million-dollar question, is when will we be able to relax the measures? And I can't answer that," said Dr. Yoav Keynan. (Mikaela MacKenzie / Winnipeg Free Press)

Canadians are facing speculation they can expect several months of physical isolation (Prime Minister Justin Trudeau didn't confirm reports earlier this week the federal government is planning to keep distancing measures in place at least into the summer, according to Global News) but Keynan said he wouldn't make projections.

He did point to signs he and other public-health experts will watch for to better understand if distancing is working -- and the number of confirmed cases in Manitoba isn't one of them.

"They are interesting in understanding the big picture of transmission, but those are not the numbers that will determine if we're successful or not," Keynan said.

Instead, it's the number of hospitalizations that is critical; specifically, data on intensive care patients. Those numbers, indicators of the demand for ventilators, will guide officials' response to the ongoing crisis. Increasing numbers of diagnosed cases could be a good sign, he said, because they can lead to a better understanding of how the virus is spreading, and ultimately how to stop it.

Timeline of Manitoba’s COVID-19 response

March 12

 

The province announces

Manitoba’s first three

cases of COVID-19.

March 16

 

Hospitals, health centres,

and acute care centres

start limiting the number

of visitors. Recent

travellers and people with

symptoms are told they

shouldn’t visit those places.

Manitoba health-care

workers returning from

international travel are

told to report to their

occupational health office

before returning to work.

Canada halts most

international travel, and

Prime Minister Justin

Trudeau urges Canadians

abroad to come home. He

says other Canadians should

only go out for essentials.

March 17

 

Manitoba public health

officials recommend

cancelling all gatherings

of 50 people or more and

suspends visitors to

long-term care facilities

across Manitoba, except

for compassionate or

end-of-life reasons.

March 20

 

Manitoba declares a state

of emergency, allowing

public health officials to

issue orders. Gatherings

of more than 50 people

are banned, and many

businesses are ordered

to close. Limits are

placed on restaurants

and bars to reduce the

number of people who

could be inside. All licensed

child care centres are

ordered closed.

1

,

0

0

0

8

0

0

March 27

 

Manitoba’s first COVID-19

death is recorded.

6

0

0

4

0

0

2

0

0

0

4

5

6

7

8

9

1

0

1

2

1

4

1

6

1

8

2

0

2

2

2

4

2

6

2

8

3

0

1

4

5

6

7

8

9

1

0

1

2

1

4

March

2020

April

March 30

 

Gatherings of more than

10 people are banned;

grocery stores and other

retail businesses allowed

to remain open must

ensure customers stay at

least two metres away

from each other. The

order also applies to

public transportation.

March 31

 

Schools are to

closed indefinitely.

April 1

 

All "non-critical" businesses

are ordered to close, as per

a new public health order.

April 3

 

Manitoba’s second

COVID-19 death is

announced.

WINNIPEG FREE PRESS — SOURCE: MANITOBA HEALTH, SENIORS AND ACTIVE LIVING

Timeline of Manitoba’s COVID-19 response

March 12

 

The province announces

Manitoba’s first three

cases of COVID-19.

March 16

 

Hospitals, health centres,

and acute care centres

start limiting the number

of visitors. Recent

travellers and people with

symptoms are told they

shouldn’t visit those places.

Manitoba health-care

workers returning from

international travel are

told to report to their

occupational health office

before returning to work.

Canada halts most

international travel, and

Prime Minister Justin

Trudeau urges Canadians

abroad to come home. He

says other Canadians should

only go out for essentials.

March 17

 

Manitoba public health

officials recommend

cancelling all gatherings

of 50 people or more and

suspends visitors to

long-term care facilities

across Manitoba, except

for compassionate or

end-of-life reasons.

March 20

 

Manitoba declares a state

of emergency, allowing

public health officials to

issue orders. Gatherings

of more than 50 people

are banned, and many

businesses are ordered

to close. Limits are

placed on restaurants

and bars to reduce the

number of people who

could be inside. All licensed

child care centres are

ordered closed.

1

,

0

0

0

8

0

0

March 27

 

Manitoba’s first COVID-19

death is recorded.

6

0

0

4

0

0

2

0

0

0

4

5

6

7

8

9

1

0

1

2

1

4

1

6

1

8

2

0

2

2

2

4

2

6

2

8

3

0

1

4

5

6

7

8

9

1

0

1

2

1

4

March

2020

April

March 30

 

Gatherings of more than

10 people are banned;

grocery stores and other

retail businesses allowed

to remain open must

ensure customers stay at

least two metres away

from each other. The

order also applies to

public transportation.

March 31

 

Schools are to

closed indefinitely.

April 1

 

All "non-critical" businesses

are ordered to close, as per

a new public health order.

April 3

 

Manitoba’s second

COVID-19 death is

announced.

WINNIPEG FREE PRESS — SOURCE: MANITOBA HEALTH, SENIORS AND ACTIVE LIVING

Timeline of Manitoba’s COVID-19 response

1

,

0

0

0

March 20

 

Manitoba declares a state of emergency, allowing public health officials to issue orders. Gatherings of more than 50 people are banned, and many businesses are ordered to close. Limits are placed on restaurants and bars to reduce the number of people who could be inside. All licensed child care centres are ordered closed.

March 16

 

Hospitals, health centres, and acute care centres start

limiting the number of visitors. Recent travellers and people with symptoms are told they shouldn’t visit those places. Manitoba health-care workers returning from international travel are told to report to their occupational health office before returning to work. Canada halts most international travel, and Prime Minister Justin Trudeau urges Canadians abroad to come home. He says other Canadians should only go out for essentials.

8

0

0

6

0

0

March 30

 

Gatherings of more than 10 people are banned; grocery stores and other retail businesses allowed to remain open must ensure customers stay at least two metres away from each other. The order also applies to public transportation.

4

0

0

2

0

0

0

4

5

6

7

8

9

1

0

1

2

1

4

1

6

1

8

2

0

2

2

2

4

2

6

2

8

3

0

1

4

5

6

7

8

9

1

0

1

2

1

4

March

2020

April

March 12

 

The province announces

Manitoba’s first three

cases of COVID-19.

April 3

 

Manitoba’s second COVID-19

death is announced.

March 27

 

Manitoba’s first

COVID-19 death

is recorded.

March 17

 

Manitoba public health

officials recommend

cancelling all gatherings of

50 people or more and

suspends visitors to

long-term care facilities

across Manitoba, except

for compassionate

or end-of-life reasons.

March 31

 

Schools are to

closed indefinitely.

April 1

 

All "non-critical" businesses

are ordered to close, as per

a new public health order.

WINNIPEG FREE PRESS — SOURCE: MANITOBA HEALTH, SENIORS AND ACTIVE LIVING

Right now, although two people have died of the virus, the physical distancing measures and other public-health recommendations are still buying time in Manitoba. It's time that researchers are using to pursue clinical trials and study lessons learned in other parts of the world as they try to make sure our health-care system and ventilator supply are not overwhelmed by seriously ill COVID-19 patients, as has already happened in other countries. Canada had more time to tailor its emergency response, and "Manitoba even more so," Keynan said.

"Because we are learning from our colleagues and friends in Ontario and B.C. and Quebec, and the early information-sharing has been fantastic." Manitoba's geographic location in the middle of the country may have been another advantage.

"Most of the initial cases are travel-related, and provinces that have more connectivity with southeast Asia and Europe had earlier arrival of the COVID. So I think our central location has provided some buffering here," Keynan said.

With schools closed, many businesses shuttered, once-bustling neighbourhoods quiet, and the economy and human interaction in flux around the world, public health isn't the only factor in deciding how long physical distancing measures should go on. There have been suggestions widespread social distancing would need to last for 18 months to be effective, according to a report for the World Health Organization released by the Imperial College of London in mid-March. But Keynan said that doesn't mean restrictive measures will remain in place for the next year and a half. Public health officials don't take physical distancing restrictions lightly, he said.

"There are many considerations on the economic, emotional and mental-health impact of the long closures. Those are definitely factored in. But the point is, putting those measures in late doesn't work. I think Manitoba has been very proactive in measuring the pros and cons, with a degree of uncertainty of course, because it's a new virus for all of us."

Coping with the uncertainty is an issue in itself, said Ivy Bourgeault, director of the Canadian Health Workforce Network and professor at the University of Ottawa. Officials need to be looking at "unintended consequences" of the distancing measures, she said, including their effects on the wellbeing of health-care workers, isolation of older and vulnerable people, and women in violent relationships.

A narrow focus on capacity in the health-care sector doesn't take into account the human cost of health-care work in the midst of this pandemic, Bourgeault said.

"We're in the forest right now, and we're just focused on the trees, and so I think some of us need to take a longer-term view and lend our expertise to that longer-term view," she said.

"I'm trying to figure out, how do we create positive legacies that create more resilient systems so this doesn't happen again?"

katie.may@freepress.mb.ca

Twitter: @thatkatiemay

Katie May

Katie May
Justice reporter

Katie May reports on courts, crime and justice for the Free Press.

Read full biography

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History

Updated on Friday, April 3, 2020 at 7:11 PM CDT: Removes jumbo image

8:02 PM: Edits to graphic

12:18 AM: Updates ai2html and adds back JS

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