What Manitobans need to know about COVID-19

Manitoba is under a state of emergency as the province fights the COVID-19 outbreak.

Provincial officials announced March 12 theyhad identified Manitoba's first probable cases of the illness caused by the coronavirus. On March 27, the province announced its first COVID-19-related death.

On Monday, officials announced the sixth COVID-19-related death in the province.

Public health officials announced two new cases ofthe disease on Wednesday.There are now 257 probable or confirmedcases in the province, and 154people have recovered.

That means the number of active cases those where patients are still experiencing symptoms is currently at 97.

Here's what Manitobans need to know about how the health-care system is responding, what to do if you think you're sick and how to help stemthe spread of the coronavirus.

Should I be worried?

You should be responsible and informed. You should not bepanicking, said Dr. Brent Roussin, Manitoba'schief provincial public health officer.

Manitoba's health-care system was expecting and prepared for the arrivalof COVID-19, hesaid.

"I want to be clear that we are not helpless against this virus," Roussin said on March 12, while announcing the first case.

"Fear and panic will not help against COVID-19, but our preparedness and credible information will," Roussin said.

The province asks you to wash your hands often, cough or sneeze into your sleeve, avoid touching your face and stay home if you're sick. You also mustpractise physical distancing;gatherings of more than 10 people are no longer allowed (as of March 30) and you should stay two metres away from others in public.

If you've travelled internationally or within Canada you must self-isolate and self-monitor for symptoms for 14 days. Some exceptions are made for truckers, people who live in border communitiesand cottagers, he said.

Public health officials are asking anyone with cottages or vacation homes to stay at their permanent residence.

How many confirmed cases are in Manitoba?

Manitoba now has 257 confirmed or probable cases of COVID-19.

As of Wednesday, 154 people in Manitoba have recovered from the illness, the province says. Seven people are in hospital, three of whom are in intensive care units.

On March 27, the province announced its first death related to the coronavirus. The patient was a Winnipeg woman in her 60s who had previously been admitted to an intensive care unit in critical condition.

The second death was announced on April 3. The patient was a Winnipeg man in his 50s who had been in an ICU. The man had underlying health conditions prior to his diagnosis with COVID-19, Roussin said.

The third death was announced on April 7. The patient was a Winnipeg man in his 60s, Roussin said. The patient had underlying health conditions and was in intensive care prior to his death.

A fourth death, involving a Winnipeg man in his 70s who was also in intensive care, was announced April 10. The fifth death, awoman in her 60s from southwestern Manitoba, was announced on April 15.

On Monday, officials announced a sixth death: a woman in her 80sfrom Winnipeg.

"None of this is a statistic for us," Roussin said on April 3. "These are Manitobans that we've lost."

Contact tracing for patientscontinues, the province said.

The provincemaintainsa web page with information about flightsthat carriedpassengers infected with COVID-19.

Is community transmission happening?

Yes.

Roughly 10 per cent of cases in Manitoba are attributed to community transmission, Roussinhas said.

Manitoba public health officials are defining community transmission as cases where transmission of the virus cannot be linked to a "known transmission chain," Roussin said on March 25 that is, where the virus jumped from person to person andpublic health officials don't knowwhere it started.

Those cases are called "pop-up cases."

"We knew to expect this. As more and more cases are introduced into a jurisdiction, community transmission is going to be inevitable," Roussin said on April 1, when he announced the first early signs of community transmission had been detected in five cases in Winnipeg.

"Now is the time to stay home. I can't stress that enough."

On April 16,Roussin saidabout 56 per cent of COVID-19 cases in Manitoba are directly related to international or domestic travel.

What should I do if I think I have COVID-19?

First of all, stay home.

If you are concerned, you can self-screenusing an online tool from the province, or over the phone with an interactive voice response tool. The phone survey isn't a replacement for Health Linksor a direct connection.

Both platforms will ask youa series of questions to let you know if you need to call Health Links. The phone survey can be reached at 1-877-308-9038.

If you do need to callHealth Links Info Sant, you can do so at 204-788-8200 or toll-free at 1-888-315-9257. The service is available 24/7 and staffed by nurses.

Staffing levels for Health Links havebeen quadrupled, with more staff being trained, in response to a spike in call volumes that's caused delays, Siragusa said.The phone line received approximately 2,400calls on March 23 alone, Siragusa said.

The service has added a dedicated COVID-19 phone line option in an effort to cut wait times, Siragusa said. Student nurses also havebeen brought in to help staff the phone lines.

The nurse will ask a series of six questions about your symptoms, your travel history and possible exposures to figure out whether you need to be tested or start self-monitoring.

Depending on your answers, they may advise you to monitor your symptoms on your own,stayin self-isolation or go get tested.

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If you have to go to the hospital, you or the Health Links nurse you're talking to must phone ahead to let health-care workers know you're coming.

When you arrive, you'll be given a mask to wear and put in isolation, to ensure no one else gets sick.

If it is an emergency, call 911 before you go to an emergency department or urgent care centre, provincial officials said.

Don't show up without calling ahead firstso the centre can get ready for your arrival.

Who is being tested?

Manitoba isnot conducting mass testing. The province can't do mass testing right now because of the need to use resources efficiently, Roussinhas said.

Testing in the province is only offered topeople who have symptoms.

On April 16, public health officials announced expanded criteria for who can betestedfor COVID-19: workers or volunteers from workplaces deemed essential services, as well as symptomatic people who live with health-care workers, first responders or someone who works in a "congregate setting," likecorrectional facilities, shelters, long-term care homes or residential facilities.

Testing is also offered to symptomatic health-care workers, people living in First Nations, people living or working in remote or isolated communities and people living ingroup settings, such as jails, shelters, long-term care homes andremote work camps, as well as symptomatic people whohave travelled or have hadknown exposure to the virus.

Testing is being done automatically on all samples taken from people for respiratory illness, whether or not they request testing for COVID-19.

The province can't do mass testing right now,Roussin said, partly due to alimited worldwide supply of the reagent needed to complete the test.

Manitoba'sCadham Provincial Lab has developed its own viral transport medium, which swabs get placed into after a test is done, and also hasdevelopeda "workaround" for the reagent to try to keep up, which has helped expand capacity, Roussin said.

If you don't have symptoms, don't get tested, Roussin said. If you head to a clinic without symptoms to try to get tested, health-care workers should decline to test you, he said.

How does testing work in Manitoba?

If you need to be tested, a health-care workerwill take a nasopharyngeal swab, which involves sticking a long, skinny cotton swab into your nose no special equipment or training required. They'll send thatto the province'slab, Cadham Provincial Laboratory, to be processed.

Previously, positive results from Cadham lab were sent to the National Microbiology Laboratory to be confirmed. Now, however, Cadhamcan confirm its own cases.

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Once the test gets to the lab, results are expected to comein 24 to 48 hours.

The province's lab has ramped up capacity to do testing, Roussin said.

As of April 22, the lab hadcompleted 21,601testssince early February.

If you test positive, you will be notifiedand given instructions for self-isolation. Health officials contact people who test negative, too, although those calls have been delayed due to the need to prioritize contacting positive patients, Siragusa said.

To speed up that process, Dynacare started helping health regions contact negative patients onMarch 27, she said.

While you're waiting for your results, you'll be asked to self-isolate and self-monitor.

Manitoba Health cautions that this process can be stressful, so don't neglect your mental health. Connect with friends and family by phone, email or social media, and focus on hobbies or tasks while you wait.

• Read Manitoba Health's guidelines about what to do while you wait for test results

Tests are offered at multiple dedicated spots in Manitoba; four of them are in Winnipeg:

• St. James Assiniboia Centennial Pool and Fitness Centre (644 Parkdale St.). also an assessment site.
• Sergeant Tommy Prince Place (90 Sinclair St.) also an assessment site.
• Manitoba Public Insurance Bison Drive Service Centre (15 Barnes St.) drive-thru site.
• Manitoba Public Insurance Main Street Service Centre (1284 Main St.) drive-thru site.

Two of the Winnipeg sites are also operating asCommunity COVID-19 Testing Site and Assessment Clinics. The clinics offer primary care services, by appointment,for anyone with respiratory symptoms as well as people with COVID-19.

The health-care centres willstay open for regular business, too, but patients there for testing will wait and get treated in separate areas from other patients.

If you're there for testing, you'll be given a mask when you arrive and asked to clean your hands.

You're also advised not to just show up call Health Links first, to give them time to notify the clinics so they can prepare for your arrival.

There are also additional testing sites in Thompson, Flin Flon, The Pas, Brandon, Selkirk, Steinbach, Winkler, Eriksdale, Portage la Prairie, Dauphin and Pine Falls:

• Thompson: Thompson Clinic in Thompson Plaza Mall at 50 Selkirk Ave.
• Flin Flon: Channing Auditorium in the Flin Flon Community Hall, 2 North Ave.
• The Pas:Royal Canadian Legion, 4 Veterans Way.
• Brandon:Brandon Town Centre, 800 Rosser Ave. drive-thru site.
• Selkirk:622 Superior Ave. drive-thru site.
• Steinbach:SteinbachCommunity Services building at 365 Reimer Ave. drive-thru site.
• Winkler: Winkler Centennial Arena at 600 Park St. drive-thru site.
• Eriksdale: Eriksdale Wellness Centre, 35 Railway Ave. drive-thru site.
• Portage la Prairie:Stride Centre, 245 Royal Rd. drive-thru site.
• Dauphin: MPIService Centre, 271 Industrial Rd. drive-thru site.
• Pine Falls:cole Powerview School, 33 Vincent St.

At drive-thru sites, patients who get referred to the site can drive up to be screened by health-care workers, and, if necessary, gettested and be given advice without leaving their vehicles.

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Remember, only people who require screening ortesting with symptoms of COVID-19 should head to these sites.People should be referred to these sites by Health Links, Roussin said.

The province is also working on validating a new, rapid testing option approved by Health Canada on April 13, Roussin said.The Spartan Cube from Ottawa-based Spartan Bioscience is a portable genetic test that can generate results in under an hour, for up to 10 to 15 swabs per day.

Right now, there are no home testing or mail testing options.

How can I protect myself?

Public health officials generally adviseeveryone to practise physical distancing techniques,which include these recommendations:

• Stay home as much as possible.
• No gatherings of more than 10 people (as of March 30).
• Minimizeprolonged contact (more than 10 minutes) and close contact(less than two metres)with people in public.
• Avoidgreetings that involve touching (likehandshakes).
• Disinfectfrequently used surfaces.
• Cancel all travel outside of the province (if you do travel, internationally or within Canada, you must self-isolate for 14 days).

All non-critical services must close from April 1 to 14in Manitoba to limit the spread of COVID-19, Roussin announced on March 30. The order is now set to be in place until May 1.

"These measures are yet another step to limit the transmission of this virus and to flatten that curve," Roussin said.

On April 6, Roussin said wearing non-medical masks in public may help prevent the spread of the virus by helping contain the droplets of whoever is wearing it.Wearing one of the masks is analogous to coughing into your sleeve, he said, and could protect others from the droplets of whoever's wearing it.

But a mask is no replacement forsimply staying home in the first place, Roussin said.

"I don't want [masks] to be a distraction," he said. "The real message is to stay home."

On March 27, the province announced more restrictive rules on gatherings, banning public gatherings of more than 10 people as ofMarch 30. Exceptions includeplaces where health care or social services are provided, like child-care centres and homeless shelters.

Shopping centres, food stores, gas stations and pharmacies can stay open, with physical distancing in place. Workplaces can also remain open, but are also encouraged to enforce physical distancing.

Follow standard flu or cold prevention techniques. That means washing your hands often, using soap and warm water, for at least 20 seconds before drying thoroughly.

Coughor sneeze into your sleeveor use a tissue (which you should then throw out, before washing your hands).

If you're sick, stay home, even if your symptoms are mild.

If you have kids, make sure they avoid sharing food or drinks, or anything that goes into their mouths, with others.

Don't organize play dates for your children, Roussin said on March 19.

Getting outside and staying active outdoors is a probably a good thing, Roussin said, althoughit's difficult to give general rules without knowing an individual's specific circumstances.

If you do go outside, don't forget about socialdistancing.

"I would encourage people, you know, get out to the park, stay active, stay healthy. There's more to our health than just avoiding this virus," he said. "But keep in mind those general social distancing strategies."

"All Manitobans have a role to play" in stopping the spread of the virus, he said.

If you recently travelled outside of Manitoba, you must self-isolate and self-monitor for 14 days after your return.

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He also cautioned Manitobans to be wary of phishing scams reported since the outbreak began, where scammerscall people posing as fake public health officials and ask for credit card information. Don't give any financial information out over the phone, Roussin said a real public health official would never ask for that.

Health Minister Cameron Friesen has previously said there's no need to start stockpiling groceries or other gear in preparation for isolation despite advice from federal Health MinisterPatty Hajdu, who said in February it would be wise for Canadians toset aside a week's supply of medicine and food.

Friesen has said, however, it's always smart to ensure you have a good supply of any medications you take.

The provincesaid on March 20 that prescriptions will be limited to 30-day supplies, to prevent the stockpiling of medications and ensure a continued supply.

Roussin cautioned Manitobans against "panic buying" in his March 13 news conference.

"We're certainly advising against fear," he said. "But I'm all for credible information, making informed choices and getting ourselves prepared for seeing this virus in our community, and really making those changes to our lives.

"If you're not making even the smallest change to the way you live your life, you're not playing your role in minimizing the spread of this virus."

The federal government also announced on March 16 it will barentry to all travellers who are not Canadian citizens, permanent residents or Americans.

The federal government later announced that the Canada-U.S. border would close to all butessential travel, trade and commerce as of March 21.

Prime Minister Justin Trudeau also announced no one who is displaying symptoms will be permitted to board a flight to Canada, and air operators will be required to complete a basic health assessment of every passenger based on guidelines from the Public Health Agency of Canada.

What's self-monitoring?

If you haven't shown symptoms yet but you were exposed to the virus, or potentially exposed, you might be asked to self-monitor. You could also be asked to do this while you're in self-isolation.

Self-monitoring means monitoring your general well-being to see if symptoms develop. It also means taking your temperature twice daily. You might be asked to avoid taking acetaminophen or ibuprofen, which could hide symptoms like fever.

If you develop a fever of 38 C or higher, or if you have any COVID-19 symptoms, you need to self-isolate right away avoid physical contact with others and get tested. That's when you'd call Health Links, to give them time to let the health-care facility know to expect you and prepare for your arrival.

The symptoms you need to be watching for are fever, cough, shortness of breath or breathing difficulties, muscle aches, weakness, headache, sore throat, runny nose or diarrhea.

What's self-isolating?

Manitoba Health says most people who get COVID-19 will have mild symptoms. Those people will be asked to self-isolate at home, instead of heading to the hospital (which will only be recommended for the severely ill).

Self-isolation means staying home and keeping yourself out of situations where you might infect other people. That means you can't go anywhere you might be in contact with people or, basically, anywhere.

• Read Manitoba Health's fact sheet on coronavirus self-isolation

You'll need to limit contact with people who haven't been exposed, even if they're family members or people you live with.If you need groceries or supplies, ask friends or family to pick them up for you,or use a grocery delivery or pickup service, and instruct whoever drops them off to leave the package at your door to avoid direct contact.

If you haveservice providers who comeinto your home, cancel their visits if you can. If they provide necessary care, like home care, you need to notify them. Otherwise, no visitors.

If youlive with someone, avoid situations where you could have close contact, avoid sharing household items and wash items thoroughly with soap and warm water after using them.

Stay in your own room or separated from others at least two metres (six feet)away. If you can, use a separate bathroom, flush with the toilet lid shut and clean everything frequently. Clean commonly touched objects like doorknobs and computers regularly, and wear disposable gloves while you clean. Ensure your home is properly ventilated by opening windows and doors if weather allows.

You still need wash your hands regularly and cover up coughs and sneezes.

What happens if I ignore instructions about self-isolation or physical distancing?

Public gatherings over 10 people are banned in Manitobaunder a public health order from the province.

The order allows shopping centres, groceries, pharmacies and other retailers to remain open, provided they keep people one to two metres apart.

People breaking those rules can face a fine of up to $486 for individuals and $2,542 for businesses.If the violation happens on property owned by the City of Winnipeg, the ticket could be higher up to $1,000 or you could face up to six months in jail for repeatedly flouting rules.

As of April 9, city-issued tickets can be challenged in front of a magistrate. The Manitoba Legislature is expected to meet next week to discuss further enforcement measures.

It also applies to public transportation, which must allow passengers to remain at a distance from one another.

Public health inspectors and peace officers may be used to enforce the order, Roussin said on March 20.

At first, violators would be asked to comply. If they do not, successful prosecutions could result in penalties of up to six months in jail or $50,000 for individuals who fail to comply with the order.

The Public Health Act allows the province to take action to protect the healthof the public, including "coercive means," Roussinhas said.

"It could include a communicable disease order under the act, to order them to self-isolate. And it could go all the way to an order to apprehend that person, if we felt they were an immediate risk to public health."

What's been closed so far?

The province declared a state of emergency on March 20. Schools closed at the end of that day.Casinos also have been closed.

Gatherings are limited to 10 people atindoor and outdoor premises, family gatherings, places of worshipand events such as weddings and funerals,as of March 30.

The province also ordered that all non-critical businesses must close as of April 1.

Restaurants can deliver food or prepare takeoutif the business ensures physical distancing from customers.

Bars, hair salons and massage therapy offices will close as well.

Affected businesses can operate remotely, as long as employees are not working at the place of business.

Places where social services and/or health care are provided, homeless shelters, or workplaces can exceed that number, but are encouraged to ensure physical distancing. Grocery stores, pharmacies and other retail businesses can also stay open, but need to continue to ensurecustomers can keep a distance of one to two metresat all times, Roussin said.

Places like gyms, bingo hallsand fitness centres must be closed.

The City of Winnipeg declared a local state of emergency on April 3, after previously closingits playgrounds, recreation centres, pools and libraries until further notice.

Front-counter City of Winnipeg services have been suspendedfor the parking authority, animal services, community services and the assessment and taxation department, but you can still call 311.

Fire-paramedic stations are now closed to public access, but emergency services can be reached by calling 911.

Many other organizations have also made changes or announced closures or cancellations. You can find the latest on closures here.

How is the province reacting to COVID-19?

On March 20, the province declared a state of emergencyin order to enforce a public health order. It gives officials the power to enforce social distancing measures and give out penalties.

"This is to prepare us, to put us on that footing, so we're able to react and be nimble," Premier Brian Pallister said.

Under the state of emergency, Manitobans must observe alimits on the number of people who can gather (10, as of March 30).Thatdoes not apply to health-care or social services facilities, or workplaces.

Anyone breaking these orders can face a fine of up to $50,000 or months in jail however, they will first be asked to comply.

To help curb the spread of the virus, Manitoba schools suspended classes as of March 23, ManitobaEducation Minister Kelvin Goertzen announced on March 13.

On March 31, the province announced that suspension is now indefinite, and teaching will continue online for the time being.

Grade 12 provincial exams are cancelled, the province said.

Effective April 17, travel to northern Manitoba (north of the 53rd parallel) will be restricted under a public health order, Roussin said. That travel restriction will be in effect until May 1.

The province is working with Manitoba Health to make sure front-line health-care workers have access to child care, Pallister said.

Parents who are front-line health-care workers or emergency services providers who can't find alternative child careare asked to call204-945-0776 or 1-888-213-4754 (toll free).

• Read Manitoba Health's resources for the public online
• Read Shared Health's resources for health-care workers online

All casinos closed on March 17.

The province providesdailyupdates on the status of the virus.

The province also has asked all employers to help employees find ways to work from home, and to suspend their requirements for sick notes if people are ill.

"Our health-care system needs to be responding to the pandemic, not spending time writing notes for ill staff," Roussin said March 16.

What about hospitals and health-care centres?

Visitor access is suspended at all Manitoba hospitals. Exceptions for compassionate reasons will be made on a case-by-case basis, Roussin said.

For pediatric patients, one parent or guardian will be allowed to visit at a time.

A 30-bed isolation unit is being prepared at the former women's pavilion at Health Sciences Centre in case it's needed, provincial officials said on March 19.

Most COVID-19 patients can be put up in anysingle room for isolation, Manitoba Health said. However, hospitals also are preparing negative pressure rooms, Roussin said, which are special, private rooms that control ventilation to allow air in, but not out, to prevent cross-contamination. The rooms would be used to conduct any procedures that could generate aerosols from a person's airway, including intubation.

The province has dozens of negative pressure rooms in all five health regions, a Manitoba Health spokesperson said in a March 18 email. It also has positive pressure rooms, which are protective environments for patients with compromised immune systems.

In addition, some non-essential surgeries will be delayed in order to free up more resources to respond to the pandemic, the province said on March 20.

Hospitals will continue with scheduled surgeries that cannot be delayed, such as those for cancer and trauma.

Time-sensitive orthopedic, obstetrical, gynecology and ophthalmology surgeries will also continue, Siragusa said.

On March 24, Siragusa said non-essential diagnostic tests unrelated to COVID-19 also will be delayedunless they're deemed urgent. This includes imaging such as X-rays, and non-invasive cardiac services.

The same goes for non-invasive cardiac tests, she said, which will be postponed for the time being.

Patients whose surgeries or non-essential diagnostic tests have been delayed were being contacted starting March 20. If you haven't been called, you can assume your surgery will go ahead as planned, Siragusa said.

All elective surgeries for patients older than 70, patients with significant co-morbidities like diabetes or cardiovascular conditionsand immune-compromised patients will be postponed, according to directions to health-care workers on Shared Health's website.

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Visitor access at long-term care facilities is significantly restricted, including screening for visitors who have returned from travel outside the province in the last 14 days.

CancerCare Manitoba also advises patients who have symptoms of respiratory illness not to visit their sites. Instead, those patients should call their health-care team and follow their instructions on next steps.Cancer patients should check the website for regular updates.

Health-care workers who have travelled internationally must inform their organization's occupational health services. If they are deemed to be essential, they may be allowed to work with precautions in place, Roussin said March 16, though work is still being done to finalize guidelines for health-care staff.

The provincealso is working with Doctors Manitoba to offerappointments over the phone or by video chat. Patients can contact their medical clinic ahead of time to see whether their appointments can be done virtually. Clinics also may reach out directly to patients to offer the service as it gets underway.

Public health officials have sent a memo to health-care workers discouraging anynon-essential travel out of the province. All health-care workers who return from international travel must inform their management or occupational health teams.

Does the province have enough equipment to deal with COVID-19?

On March 25, Health Minister Cameron Friesen said the province has taken measures to get supplies into the province, and those are starting to arrive.

The province has received some orders of new personal protective equipment, he said, but much more is needed.

On April 4, Prime Minister Justin Trudeauaddressed concerns about the need forpersonal protective equipment, saying ashipment of millions of masks would be headed to Canada within the next 48 hours.

"We're also working with provinces to transport their medical supplies when possible," Trudeau said.

The province already has received 27 new ventilators ordered since the pandemic began, and 16 more are on the way, Friesen said March 25. Ten new chest compression systems are also on the way and will be distributed across the province.

The provincealso has brought in a nucleic acid extractor for its Cadham lab, and UV disinfection units to quickly clean spaces in health-care facilities, he said.

The province has called on local businesses to help provide products and supplies that could help fight COVID-19, Friesen said, including disposable N95 masks, surgical masks, medical-grade gloves, vinyl gloves, surgical and medical gowns, hand sanitizer, cleaning supplies, and the lab reagent required to test for the coronavirus that causes COVID-19.

Friesensaid he's not aware of any particular supplies that are in especially low supply, but the ask is intended to make sure nothing runs out.

"We're doing this out of an abundance of caution," he said.

As of March 17, the province had 85 ICU beds, a provincial spokesperson said.

Plans are underway to open 30 isolation beds in the previous women's centre pavilion at Health Sciences Centre to ensure capacity for COVID-19 patients, the health minister said.

The province spent roughly$35.2 million to buy supplies that can go toregional health authorities, service delivery organizations, personal care homes and fee-for-service clinics. The equipment ordered will also include disinfectant wipes and hand sanitizer.

Training and refresher lessons are being offered to staff on how to use the equipment properly, a provincial spokesperson said in anemail on March 18. Fit-testing for the N95 respirators, which need to be fitted to the wearer, is also ongoing.