TORONTO — It was the news conference equivalent of a subtweet. And a reversal of sorts for Prime Minister Justin Trudeau, who a week earlier had said that he was not in the business of judging whether some provinces had mismanaged the coronavirus pandemic.

“I would hope that no leader in our country is easing public health vigilance because they feel pressure not to shut down businesses or slow down our economy,” he told reporters last week. “I urge premiers and mayors to do the right thing: Act now to protect public health.”

Which ones were doing the wrong thing? He wouldn’t name names.

Canada’s spring wave battered Ontario and Quebec, the two most populous provinces. Now, a spiraling resurgence is buffeting provinces once heralded as success stories, as cracks emerge in the “Team Canada” approach.

The seven-day average for new cases in Canada climbed to approximately 4,300 on Friday, up about 22 percent from the previous week and almost 45 percent from the end of October. Indicators in much of the country are blinking red. Several provinces in western Canada are setting hospitalization records.

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Theresa Tam, Canada’s chief public health officer, said new modeling projects that the country could see 10,000 new coronavirus cases a day by early December — five times what the country saw at the peak of its spring wave.

“Outside of the Atlantic bubble and the territories, fires are burning in so many different areas,” she told reporters in Ottawa last week. “Right now is the time to get those under control. … This situation is very worrisome.”

… fires are burning in so many different areas. Right now is the time to get those under control. … This situation is very worrisome.”
— Theresa Tam, Canada’s chief public health officer

Manitoba, which saw few cases in the spring, now has the most active cases per capita in Canada. In British Columbia, the chief medical officer of health said case counts are “stretching our ability to cope.” Quebec Premier François Legault is pondering a move considered a last resort: closing schools.

Health care in Canada is a provincial responsibility, but in the spring, the provinces and territories acted largely as a unit, closing nonessential businesses and urging people to stay at home. With some exceptions, they mostly deferred to their public health officials to drive decisions. The federal government has provided support to businesses shut down by public health measures.

Cases fell by mid-July but have since rebounded. The reasons vary by province but include gatherings indoors and at work. Nursing homes are again suffering deadly outbreaks, despite repeated promises from political leaders to protect what has been the country’s most vulnerable population.

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Infectious-disease experts say Canada squandered a summer of comparatively low case counts when it could have been beefing up testing and contact tracing, which is collapsing. They say politics is creeping into some provincial responses, and messaging is often muddled.

“In some parts of Canada this is being managed as a public health problem and those outcomes tend to be pretty good,” said Colin Furness, an epidemiologist at the University of Toronto. “In other provinces, it’s being managed as a political problem and we’re seeing a resurgence.”

The travel bubble formed by the Atlantic provinces has largely kept the virus out. Others have sought to avoid reimposing economically painful business closures, opting instead for targeted regional measures that they have sometimes hesitated to implement.

There are new challenges. Colder weather is driving more people indoors, where the virus can spread more easily. Officials are finding it more difficult to get pandemic-weary Canadians to comply with even light restrictions.

“In the spring, everybody was scared,” said Sumon Chakrabarti, an infectious-disease specialist at Trillium Health Partners, a hospital network outside Toronto. “They barely went for jogs. That’s not the case now. I’ve heard people say, ‘I don’t care if I get sick. I’d rather die than not see my grandkids.’ “

Restrictions or advice against social gatherings such as holiday dinners and sleepovers are a challenge to enforce, he said, and in places where they are what’s driving transmission, shutting down businesses might not be entirely effective.

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This surge has hit provinces that thought they would navigate the first wave well, providing a cautionary tale about the consequences of underestimating the virus.

Manitoba saw relatively few cases in the spring and went almost two weeks in the summer without recording a single case. It shut its COVID-19 command center.

Now it’s one of the hardest hit places in the country. The five-day test positivity rate exceeds 12 percent. The Red Cross is being dispatched to nursing homes to fill staffing gaps and to keep sick residents separated from the healthy. Hospitalizations jumped 27 percent in the past week.

After targeted restrictions did little to stem the spread, the provincial government announced last week that it would ban social gatherings and close most nonessential businesses, theaters, places of worship and gyms, as in the spring. Restaurants are limited to takeout.

Philippe Lagacé-Wiens, a medical microbiologist at Winnipeg’s St. Boniface Hospital, said a “sense of complacency” had taken hold in the province, and an incremental approach to restrictions didn’t help.

“We’re now moving people around in a nearly desperate attempt to try to get beds,” he said. “We’re scrambling to increase our testing capacity, and we’re scrambling to increase our contact tracing. The time to have done that was months ago when there were few cases.”

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In Alberta, dozens of doctors signed two open letters calling for a two-week “circuit breaker” lockdown. Premier Jason Kenney has rejected calls for sweeping business closures, which he has said were “indiscriminately violating people’s rights and destroying livelihoods,” and urged “personal responsibility.”

Kenney, who is in quarantine after coming into contact with someone who tested positive for the virus, announced new measures in hard-hit areas last week, including restrictions on alcohol sales and capacity limits on weddings and funerals for two weeks.

Lynora Saxinger, an infectious-disease specialist at the University of Alberta, said Alberta’s response to the pandemic is becoming “increasingly political.” She said she is “feeling a lot of anxiety” about upcoming shifts at an Edmonton hospital under strain.

“I personally think that the measures that they’re doing now would have been helpful a couple of months ago,” Saxinger said. “Doing them now will still help, but I’m not sure that it will help enough. If you do too little too late, you end up having to do a lot more for longer.”

If you do too little too late, you end up having to do a lot more for longer.”
— Lynora Saxinger, infectious-disease specialist, University of Alberta

Ontario reimposed curbs on indoor dining and gyms in hard-hit areas in early October. Provincial officials said they would lift them, even in the face of record-breaking daily case counts and modeling that showed the province on pace to exceed ICU-bed thresholds that in a best-case scenario would lead to surgeries being canceled.

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Some local health officials were so troubled that they instituted their own measures. The Toronto Star reported that the province ignored advice from its own public health officials when crafting a new framework for restrictions — in some cases setting thresholds for imposing new measures four times higher than what scientists recommended.

Amid the outcry sparked by the report, Ontario Premier Doug Ford tightened some of the thresholds, grimly warning that the province was “staring down the barrel of another lockdown.”

The hodgepodge of approaches has fueled calls for Ottawa to step in and to implement mandatory national measures, including by invoking emergency powers — a move Trudeau has said he doesn’t believe is “necessary right now” and one certain to provoke a backlash from premiers.

Some infectious-disease experts said a cohesive national strategy or long-term plan would be helpful. But others said there is such variation across the country that a national approach might do more harm than good and that public health works best when it is conceived of and implemented at the local level.

Saskatchewan Premier Scott Moe told the Regina Leader Post that Trudeau prodding premiers to “act now” was “extremely unhelpful.” Ford was a little more blunt when asked whether he would support the prime minister using emergency powers.

“We don’t need the nanny state telling us what to do,” he said. “He’d have a kickback like he’s never seen.”