Manitoba has Canada's highest COVID hospitalization rate. Here are 5 possible explanations

Widespread Omicron transmission has created a massive burden on Canadian health care. Many hospitals are caring for the largest COVID-19 patient loads since the start of the pandemic.

While almost every jurisdiction in the country is struggling to care for COVID patients, Manitoba is getting slammed the hardest.

This province's COVID-19 hospitalization rate — on Thursday, 48 patients for every 100,000 Manitobans— is the highest among the provinces and territories.

It's also more than double the national hospitalization rate and nearly triple the rate next door in Saskatchewan.

There is no simple explanation for this phenomenon. It was also evident last spring, at the height of the pandemic's third wave, when Manitoba was forced to transfer 57 COVID patients to intensive care wards in other provinces.

Doctors and epidemiologists say they believe at least five factors led to Manitoba's nation-leading hospitalization rate:

1. Manitoba moved slowly to react

In early December, when Delta was still the dominant COVID-19 variant in this province, Manitoba hospitals were caring for about 150 COVID patients. That is a significant number of patients on its own.

When daily case counts started climbing, the province was relatively slow to react with additional measures to free up more hospital resources.

Despite Premier Heather Stefanson's repeated claim Manitoba has some of the toughest pandemic restrictions in the country, Manitoba chose not to place another pause on sit-down restaurant meals and other commercial activities involving people gathering indoors, as Ontario, Quebec and B.C. did, in various ways.

The province issued strong advice against having family gatherings right on Dec. 24 but enacted no more limits on private gatherings over the Christmas holiday. Stefanson later said she sought a balance between the advice she received from public health experts and other constituencies.

Winnipeg epidemiologist Souradet Shaw said the province did not do enough to reduce the burden on hospitals before Omicron took off.

 "The 'day late, dollar short' approach shown by our provincial government in their handling of COVID-19 has likely contributed to our higher hospitalization rates," he said. "But to be fair, it doesn't capture the whole story."

Sure enough, jurisdictions with fewer restrictions than Manitoba, including Alberta and Saskatchewan, have lower COVID hospitalization rates.

2. Manitobans are more vulnerable

Manitoba is particularly ill-suited to withstand widespread COVID transmission because of a high proportion of people — many of them Indigenous or other people of colour — who are either in poor health or have poor access to health-care services, said Dr. Philippe Lagacé-Wiens, a medical microbiologist at St. Boniface Hospital.

Prior to the pandemic, Manitoba had some of Canada's highest rates of obesity and Type 2 diabetes, two conditions that predispose people infected with COVID-19 to suffer from more serious outcomes.

Manitoba also has a larger Indigenous population than most other provinces, both proportionally and in actual numbers, and a higher-than-average poverty rate for people of all backgrounds.

These social determinants of health likely played a role in the third wave being so severe and they appear to be playing a role now as well. First Nations residents alone, who make up 12 per cent of Manitoba's population, account for 25 per cent of COVID hospitalizations.

"There is a deep societal component to why our rates are so high," Shaw said. "COVID is just another in a long line of conditions where Manitobans seem to fare relatively poorly."

Crowded and substandard housing, especially in Winnipeg, is another social determinant. So is the lack of access to clean water in remote Indigenous communities.

"Not to say that other provinces are not dealing with these types of issues, but in Manitoba, these issues seem to be especially concentrated, and severe, stemming from the legacy of colonialism, poverty, and ongoing stigma and racism," Shaw said.

"These issues have been known for decades, and I would argue that this knowledge should have motivated our government to be even more proactive in their responses."

3. Manitoba health care is less robust

On a similar note, residents of rural Manitoba and northerners have limited access to health care, thanks to the concentration of hospitals and other health-care services in Winnipeg and elsewhere in the provincial south.

"Manitoba possesses a vast geography. We have many remote and Northern communities where the full spectrum of healthcare options is not available and access to things like regular primary care is severely limited," Shaw said. 

That said, even Winnipeg residents may not have sufficient access to health-care services, given what Shaw describes as "decades of underfunding" by NDP and PC governments alike.

Manitoba Shared Health and Health Minister Audrey Gordon were unable to respond to requests for comment.

4.  Pockets of low vax uptake

A unique facet of the Omicron wave is the widespread nature of transmission among both vaccinated and unvaccinated people. The unvaccinated, however, continue to be widely over-represented among COVID hospitalizations.

Manitoba has a few large pockets of low vaccine uptake.

"As vaccines reduce risk of hospitalization, this might account for some differences, too," Lagacé-Wiens said.

5. Hospital screening and admission

As deputy provincial public health officer Dr. Jazz Atwal suggested last week, Manitoba may be inflating its COVID hospitalization numbers by counting some patients with incidental infections.

While some doctors have questioned this claim, Lagacé-Wiens and Shaw said there is merit to the idea. 

"Manitoba hospitals screen pretty well all admissions, even those coming in with completely unrelated conditions," Lagacé-Wiens said, listing off labour, appendicitis and cancer as examples.

"If other provinces don't follow the same testing practice, then we might catch more people in hospital with COVID."