In our study, we examined the entire Manitoba population of approximately 1.38 million Manitobans. Manitoba reported the first confirmed COVID-19 case on March 12, 2020 and the Premier of Manitoba declared a state of emergency for 30 days on March 20. From March 13 to March 31, 2020, several mitigation strategies were applied, including physical distancing, limiting the number of gatherings on March 13 to 250 people and then to 50 on March 20; and lastly to 10 people on March 30. Additional provincial orders were provided to businesses, communities, and health-care services including closure of universities and suspending classes for school’s kindergarten-12, non-urgent medical care restriction, limiting one-month supply of drug prescriptions, non-essential travel limitations, and closure of the Canada–US border to non-essential travel (Additional file 1: Table S1). On April 17, 2020, the government issued new public health orders, which prevented travel to Northern Manitoba and implemented a mandatory 14-days self-isolation for people entering Manitoba who travelled inter-provincially. Following the implementation of these restrictions, the infection rate/100,000 Manitobans decreased from 2.4 (April 1) to 0.07 infections (May 1, 2020) (Fig. 1).
Between May 4 and July 17, 2020, the reported cases stabilized, and some restrictions were lifted. During this phase, retail businesses, museums, libraries, gyms, barbers, restaurants, and bars were reopened and travel restriction to Northern Manitoba was removed. Additionally, gathering restrictions were eased; up to 100 people outdoor and up to 50 indoor were permitted, but physical distancing continued to be mandatory.
As the beta variant of COVID-19 began emerging, the infection rate increased from 0.43 on July 17 to 1.1 infections/100,000 Manitobans on August 18, 2020. Additional restrictions were implemented, with compulsory 14-day self-isolation to those who tested positive or were exposed to COVID-19 through close contact on August 28 and mandatory use of masks on public transport as of August 29. Before August 29, the use of masks was not enforced. On August 31, public health officials and Manitoba Education revealed a plan to safely return children to school in Fall 2020 (Fig. 2).
The province extended the state of emergency for the sixth time on September 10. On September 28, Winnipeg was declared at the restricted level (one level below the highest), public gatherings were limited to 10 people and the use of masks was mandatory in public spaces. During September and October, there were several outbreaks in Personal Care Homes and Long-Term Care in Manitoba. In addition, as of October 30, the ICU capacity of hospitals has almost reached the full capacity of COVID-19. During the second wave, the infection rate increased from 4.2 on October 7 to 11.5 infections/100,000 Manitobans on October 14, 2020. Since October 19, Manitoba had three-digit daily cases for three consecutive months, with a peak achieved during November 4–27, 2020 (ranging from 227 to 593). (Fig. 2).
The surge in COVID-19 infection rate prompted the province to implement additional restrictions from October-January 2021. Public health orders limited social contacts to household members, non-essential items could not be purchased in-store, closure of gyms and restaurants, with all of Manitoba placed in the highest response level (“critical”) in November 2020. The daily reported cases stabilized during December 18 through January 29, 2021 (ranging from 64 to 257), and the infection rate consequently reduced from 7.5 (January 30) to 2.75 infections/ 100,000 Manitobans (February 28, 2021).
Manitoba announced a new phase on February 12 that eased some restrictions including a plan to reopen gyms, museums, libraries, malls and allowing reopening of restaurants at 25% capacity. However, physical distancing and use of masks were still mandatory. Updated guidance from the public health officials extended these measures while expanding the capacity to 50% and outdoor gatherings to 10 people on March 5, 2021. The COVID-19 daily reported case count remained relatively low ranging from 50 to 121 cases during March 2021.
During April and May 2021, the gamma variant was reported in Manitoba, and the infection rate peaked on May 12 at 42.5/100,000. The COVID-19 vaccination rates were low with only 5.85% of the eligible population fully vaccinated and 34.66% partially vaccinated, as of May 15. Further restrictions were implemented from April 20 to May 22, limiting gatherings to only household members and retail capacity to 10%. Additionally, as ICU numbers surged, Manitoba sent ICU patients to hospitals in other provinces, including Ontario and Saskatchewan (Fig. 3).
Between June 19 and September 17, 2021, the reported cases stabilized, some restrictions were eased, and Manitoba started the 3 phase re-opening plans on June 26. During the re-opening phase, the strategy was to lift public health orders based on meeting pre-set immunization targets (phase 1 both doses target is 25% and 75% for phase 3). Among Manitobans 12 years and older, 31.46% received both doses on June 26 and increased to 62.77% on August 7. Accordingly, the province entered phase three of the re-opening plan that lifted restrictions on gatherings, and visiting restaurants, retail capacity, gyms, and libraries. To boost vaccination rates among unvaccinated Manitobans, proof of double vaccination was required for provincial employees, restaurants, gyms, indoor activities, and sport events as of August 28, 2021.
By October 1, more than 70% of eligible Manitobans were fully vaccinated, but around 400,000 individuals were unvaccinated, and the number of Delta variant cases and hospitalizations increased. The province moved into “restricted” level and new public health orders were announced that restricted multiple activities to those who were unvaccinated residents but were eligible to be vaccinated.
The infection rate per 100,00 Manitobans increased from 8.6 (November 1) to 128 (December 31), and additional prevention strategies were implemented. On November 18, 2021, children aged five years and older were eligible for the pediatric Pfizer-BioNTech vaccine. The province reported its first Omicron variant on December 7, with peak omicron cases reached on January 7, 2022 (202.2 infections/100,00). Mitigation measures were extended through January and by January 28, 38.31% were vaccinated with a booster dose while 82.55% received at least one dose of vaccine. Following the extension of the restrictions, the infection rate dropped to 21.8/100,000 on February 15, 2022, and Manitoba moved to the second lowest restriction level (“caution”), however, proof of vaccination was still required for most activities (Fig. 3).