A modest proposal: The calculated risk behind Manitoba's cautious reopening

If math and science were the only principles guiding Manitoba's public health decisions, the province wouldn't loosen up pandemic restrictions later this week.

This is not a damning statement. Mercifully, public health decisions are also guided by a third principle: logic.

On the basis of arithmetic and epidemiology alone, Manitoba's pandemic metrics don't look great at the moment.

For starters, the seven-day average COVID-19 case count in this province has been hovering around the same level for more than three weeks. On Tuesday, it was 173 cases per day.

While that's an immense improvement over the worst day of the fall surge — a seven-day average of 424 cases per day on Nov. 24 — we really haven't come that far since Dec. 27, when the average was 184.

When it comes to the percentage of tests coming back positive, Manitoba continues to hover around 10 per cent, while the Winnipeg health region has dropped to the seven per cent range.

Again, that's a huge improvement over late November. The caveat, though, is anything above three per cent is considered a worrisome indicator of community transmission.

The caveat to that caveat is during a lockdown, there's effectively no flu transmission and less opportunity for colds to jump from person to person. It stands to reason a highly infectious novel coronavirus is going to make up a greater proportion of what's giving people symptoms that prompt them to get tested.

Finally, the most important metric of all is still something of a concern. On Tuesday, 279 Manitobans were in hospital as a result of COVID-19 infections, including 37 getting intensive care.

Again, that's a vast improvement over late November, when COVID hospitalizations approached the 400 mark.  Yet the current caseload remains high enough to force the health-care system to divert resources from other areas.

The case for reopening

Given all this, it's fair to ask why Manitoba would risk creating conditions that would make it easier for the virus to spread. Neither the arithmetic nor the public-health science looks all that great at the moment.

The answer lies with logic. The province actually has no choice: Most Manitobans do not have the patience, let alone the economic means, to wait additional weeks or months to reduce the potential for a third COVID-19 wave to zero.

The relatively flat trajectory of the current pandemic metrics is good enough for the province to make what Dr. Brent Roussin called cautious changes to pandemic restrictions this coming Saturday.

All of the proposed changes, meanwhile, involve relatively few opportunities for mass exposures to COVID-19.

For starters, the reopening of all retail stores poses a relatively low risk.

"In the retail setting, remember, there's many people going in and out, but not many people spending much time in close proximity to each other," Roussin said on Tuesday.  "Prolonged indoor contact is where this virus spreads."

Provincial data bears this out.

According to an internal provincial summary of nearly 24,000 COVID-19 cases in Manitoba from Aug. 30 to Jan. 2, retail stores are suspected to be source of 3.6 per cent of all infections.

During the same period, close contacts are suspected of spawning 51 per cent of Manitoba's cases.

Retail visits were always relatively safe, but the absolute risk is lower now that community transmission is on the wane.

A second prospective change this Saturday involves increasing the maximum gathering at funerals to 10 people, plus an officiant. Again, the risk is low: The average Manitoban does not attend many funerals in a given year.

It may be logical to suggest officiants qualify for asymptomatic testing, however.

A third prospective change involves allowing people to have guests in their homes again: Up to two people indoors, and up to five outside.

This is a riskier proposition; many people will not visit two metres apart from their guests. But again, this is less risky now than it was in November, when a no-socialization order was imposed in a desperate effort to break the transmission chain.

The final proposed measure is the return of hair salons and non-regulated health-care professions. There's greater risk involved, given the close proximity and prolonged nature of the customer-client interaction in these businesses. 

The requirement to collect contact-tracing information, however, makes this more palatable. Contact-tracing capacity in Manitoba has improved vastly since October, when case investigations were taking as long as one week to get underway.

Survey says: Public relations!

The province has attempted to portray these proposed changes as the result of a public-engagement effort. This is somewhat misleading, as Manitoba made no effort to conduct a valid survey of public opinion.

Real surveys involve either random samples or statistical means to measure the age, gender, ethnicity, income and geographic location of survey respondents against the demographics of Manitoba's population overall. The province made no such efforts as part of its public-engagement exercise.

The engagement appears to serve merely as a backstop against unpopular decisions. In July, for example, the province floated the idea of eliminating the quarantine requirement for people coming from eastern Canada and then backed off when Manitobans objected.

In other words, Roussin is not crowdsourcing public health policy.

Instead, he's taking a calculated mathematical and epidemiological risk — necessitated by an urgent need to make at least a few small improvements to the quality of life for the majority of Manitobans, most of whom have suffered greatly for months.