COVID-19 orders weigh personal and economic impact, effect on health outcomes, Manitoba's top doctor testifies

Manitoba's chief public health officer refuted a suggestion in court Friday that he hasn't properly weighed the harms of the pandemic restrictions he's imposing, just hours before announcing the latest round of orders intended to curb the spread of COVID-19.

Testifying Friday at a court challenge to Manitoba's pandemic restrictions, Dr. Brent Roussin said he's always considered the effects of his orders on non-COVID health outcomes, such as mental health.

"We're required to make decisions during levels of crisis when our hospital capacity was strained and so we're certainly aware of the potential harms … of the importance of these activities to Manitobans," Roussin said in response to questioning from Jared Brown, a lawyer representing the group that launched the legal challenge.

"We've never taken this lightly. This is a crisis." 

Roussin's testimony was part of a legal fight questioning his right to implement restrictions that have limited personal freedoms and economic activities. Later Friday, he unveiled a new round of pandemic restrictions.

The court challenge pits religious freedoms against public health measures the province says are reasonable and necessary to keep people safe during a pandemic that has so far killed nearly 1,000 Manitobans and resulted in 40,940 COVID-19 cases.

Seven churches and three individuals behind the challenge argue those public health orders violate Charter rights to freedom of conscience, religion, expression and peaceful assembly. 

On Friday, the fifth day of the hearing on the legal challenge, Roussin told Manitoba's Court of Queen's Bench he understands the "unintended consequences" of his public health orders — but maintained they're necessary to save lives.

Skeptical 'downstream costs' being considered: lawyer

Brown, however, said he saw no evidence in court submissions of any risk assessments or risk-benefit analysis being conducted.

He said he received only one provincial report that cited some non-COVID health outcomes.

"You can see why I'm skeptical when we see such comprehensive reporting on issues related to COVID virus and disease, but there's nothing on the other side" aside from that one document, Brown said.

"You can understand why I'm skeptical that these harms, these downstream costs are being considered by you." 

Roussin responded that he is "privy to this entire range of this pandemic," and speaks with health-care providers across the system.

"To me, I think we've continually reviewed the impact on the health-care system as a whole."

He said any resulting harms from the health orders must be balanced against the societal disruption that would occur if COVID-19 transmission was left unchecked.

Many essential workers, including health-care workers, first responders and people who work in critical infrastructure, would call in sick if the spread of the virus wasn't contained, he warned.

The detrimental effects of the restrictions are considered by everyone involved in discussions around them, said Roussin. That includes special and technical advisory committees, public health officials, and representatives from different government levels, he said.

Roussin, who has a master's degree in public health, along with legal and medical degrees, has been the public face of Manitoba's public health measures, announcing new restrictions when he felt rising COVID-19 case counts made them necessary.

Use 'least-restrictive means': Roussin

Under cross-examination by Brown — a lawyer for the Justice Centre for Constitutional Freedoms, which launched the challenge on behalf of the group of churches and individuals — Roussin said his goal in imposing restrictions has never been to eliminate the virus entirely, but to minimize the impact on high-risk communities and a stressed health-care system.

Other medical professionals have criticized the "incremental approach we've taken," he said, "but I'm bound to use that least-restrictive means."

Roussin said public health has balanced restrictions with the understanding the coronavirus that causes COVID-19 is most likely to spread from close, prolonged contact. He said the risk of transmission is greater in a place of worship where people are seated close together than a big-box store with a limit on capacity.

He said he was aware of 22 COVID-19 clusters in faith-based settings so far. Some outbreaks in churches infected half of the attendees, Roussin said.

Pressed on testing

Brown also pressed the doctor several times on the effectiveness of PCR tests for COVID-19, which can detect old but since resolved infections.

Roussin said PCR tests have accurately predicted future levels of hospitalization in Manitoba. In the pandemic's second wave, seven per cent of all individuals in Manitoba who tested positive presented to hospital and 1.4 per cent were admitted to an intensive care unit. 

The vast majority of cases detected through PCR test are infectious, as Manitoba's COVID-19 testing protocol has focused predominately on symptomatic people, Roussin testified.

Asymptomatic contacts have, in large part, been discovered by testing the close contacts of symptomatic cases, he said.

"There's too much being made of the limitations of very, very good [PCR] tests, especially how we're using it," said Roussin.

The court hearing, which began Monday and was scheduled for nine days, continues next week. Dr. Joel Kettner, formerly Manitoba's chief public health officer, is slated to testify next Monday.

Chief Justice Glenn Joyal is presiding over the court case, which may have national repercussions. The Calgary-based Justice Centre for Constitutional Freedoms is launching similar hearings in B.C. and Alberta.