Unravelling the mystery of Manitoba's May rise in COVID fatalities

When most of Canada's leaders decided to stop worrying and learn to live with the virus — please forgive the Dr. Strangelove reference — predictions about what would actually happen when pandemic restrictions disappeared were all over the place.

Some epidemiologists and medical professionals feared the worst. Some surmised it was time to move on, arguing the Omicron variant spreads too quickly to contain, anyway, and appeared to be less deadly than other strains of the virus that causes COVID.

The most clever collection of prognosticators were the agnostics who confessed they had no idea what was coming and simply warned politicians and public health authorities to keep a watchful eye on whatever pandemic data they still bothered to collect.

In Manitoba, infection rates are not important anymore because we no longer test for COVID in any systematic or reliable manner. The importance of COVID hospitalization numbers has been called into question by officials who dismiss a large proportion of those patients by suggesting their infections are merely incidental.

But there is one number that still gets everyone's attention: the number of COVID deaths.

In Manitoba, the number of COVID deaths continues to add up. Over the past two weeks, this province has been averaging four a day.

While that's down from the first six weeks of 2022, when Omicron was tearing across the province, it's still slightly higher than the overall 2022 average of 3.6 COVID deaths per day.

Even more importantly, Manitoba has been reporting more COVID deaths every week since the first week of April.

During the week ending April 2, the total number of COVID deaths in Manitoba rose by seven. The next week, it rose by eight, followed by weekly increases of 15, 22, 27 and 28 deaths.

The province does not profess to have an explanation for the rise of COVID deaths. Nor can it explain precisely why an average of 3.6 Manitobans are dying of COVID every day this year, up to May 7, while only 2.5 COVID deaths were reported each day during the same period in 2021.

"Manitoba Public Health is currently working to better understand these COVID-19 mortality numbers," the province said in a statement.

"Factors to consider include the changing dynamic of COVID waves and the recent change to COVID-19 death definition."

That definition change adds some COVID deaths to the official tally but removes others. There has yet to be any accounting for the net effect.

Five consecutive weekly increases

One thing that's clear is the one-time change of the COVID death definition in March can not explain five weekly increases in the number of COVID deaths in April and May.

For one reason or another, more Manitobans are dying of COVID than they were at the end of March. 

Virologist Jason Kindrachuk, the Canada Research Chair in emerging pathogens at the University of Manitoba, said emerging subvariants are one factor. While the initial version of Omicron was highly transmissable, the BA.2 subvariant spreads even more easily. 

As well, the initial hope that Omicron would be less deadly than the Delta variant before hasn't quite been realized.

"What we've seen is that distinction between Delta and Omicron is not quite as clear," Kindrachuk said. "They may actually both be close to the same severity."

Kindrachuk also said it's logical to suspect the end of all pandemic mitigation measures has led COVID to spread more widely and reach some vulnerable people who were not exposed before.

"The unfortunate reality is we're learning yet again the pandemic is not over with us. We want it to be — certainly we're in a different place than we were in 2020 and 2021 — but the virus is still out there," Kindrachuk said Thursday.

Waning immunity is also an issue, Kindrachuk said, as relatively few Manitobans have received their COVID vaccine booster shots and most are not eligible for fourth doses.

The province stopped publishing daily summaries of COVID deaths by vaccination status, age or geographic origin in March.

Epidemiologists have been left guessing who is affected the most by the recent rise in COVID deaths.

"We do not have a real sense of which populations are experiencing these severe outcomes, and if there is anything that can be done, from the prevention perspective," said Souradet Shaw, a Winnipeg epidemiologist.

"We've gone a bit dark, with respect to timely surveillance — at a time when I do think it is important to convey to the public who is at most severe risk. 

"Following this train of thought, communication and implementation of sound public-health policies … might be undertaken to decrease their risk."

Shaw is not calling for the return of public health measures. But there are avenues left for the province, such as promoting the benefits of getting booster shots.

With summer on the way, the urgency for this ought to diminish. But if there's no COVID vaccine booster push along with the push for flu shots this coming fall, it would be fair for Manitobans to wonder who precisely is driving this rocket.