'COVID mortality has been unacceptably high': How Sask. has fared since virus landed 1-year ago
'Vaccination is not a panacea. We still have to protect each other,' epidemiologist says
Saskatchewan's COVID-19 story is not yet finished. Over the last 12 months, case numbers have risen and fallen and risen again.
People have been forced to stay apart to prevent the virus from spreading. Now they are allowed to gather in smaller numbers as they await vaccination.
Saskatchewan has led the country in active case rate per 100,000 since January, except for a handful of days. While the rate of COVID-19 has declined overall in Canada, Saskatchewan's has gone down at a slower pace.
"We haven't been really trying to try to get ahead of the virus and to put it away. And that is really unfortunate," said University of Saskatchewan epidemiologist Nazeem Muhajarine.
CBC Saskatchewan spoke with four Canadian epidemiologists about the province's response and what the near future holds.
March 12, 2020
On the morning of March 12, 2020, Saskatchewan Premier Scott Moe released a statement ending speculation about a spring election. Moe was stranded in Ottawa at the time, as a meeting of premiers had been cancelled.
Less than one hour later, organizers of the JUNO Awards cancelled the event, which was set for March 15 in Saskatoon.
Ten minutes later, the Saskatchewan government announced the province had its first case of COVID-19.
The mantra was to keep your distance, cough into your elbow, wash your hands and stay home if unwell.
On March 16, the government moved schools to remote learning. Two days later it declared a state of emergency.
By the end of the month, restaurants were ordered to close, as were businesses and services deemed non-essential.
University of Ottawa epidemiologist Raywat Deonandan said he could tell in February that the pandemic was going to be serious and long-lasting.
"I did the math and I curled up in the fetal position," he said.
"I realized I don't know how we are going to manage this as a people. People haven't been prepared psychologically, economically or scientifically for what has got to happen. We have to stay away from each other for months, perhaps years, because I didn't foresee us getting a vaccine in less than four years."
Deonandan said jurisdictions were slow to react because of the "almost invisible pandemic."
"Unless you personally know people who have suffered and died, it doesn't affect you directly. So it requires a psychological leap, a feat of imagination to put yourself in the shoes of people you don't know."
Saskatchewan people were forced to stay home and stay apart.
On April 22, Premier Scott Moe addressed the province.
"Saskatchewan has reduced the spread of COVID-19. We have flattened the curve."
Saskatchewan had 61 active cases and five people in the hospital. There had been 326 known cases and four deaths. The following day Moe and chief medical health officer Dr. Saqib Shahab announced the province's reopening plan.
Quiet summer
Outbreaks in the province's far north in the spring and in communal living settings further south in the summer caused case numbers to surge. At the end of July, Saskatchewan's case rate led the nation, albeit briefly.
Cases and hospitalizations remained stable into October.
"We did manage over the summer to keep those little peaks and valleys at a fairly low rate and keep things under control. Testing rates were fairly high. So test positivity rates were low. So all of those were indications that we were doing a decent job," said Dr. Cory Neudorf, a public health and epidemiology professor at the University of Saskatchewan.
Cynthia Carr, a Winnipeg-based epidemiologist, said the summer was quiet across Canada. People were able to stay outdoors and distance while cases stayed low.
"This summer was sort of a weird place of trying to feel normal but feeling worried about letting our guard down too much and we go into the fall," Carr said.
The summer was evidence of people being "lulled into a false sense of complacency because you think you're always going to be safe," Deonandan said.
"The human brain is not set up to understand and digest exponential growth."
In Saskatchewan, Shahab and others warned of a potential second wave in the fall.
"I think you heard most of us saying early, fairly early, even in the spring, that a second wave was highly likely," Neudorf said.
"Almost every pandemic we've ever seen in 100 years has had large second waves. And so there was no reason to think this one would be any different, especially come fall or winter."
Neudorf's colleague Nazeem Muhajarine, a University of Saskatchewan epidemiologist, said the province did not stamp out COVID-19 when the opportunity arose.
"When you get the numbers down low to the handful, a couple of dozen in the province of 1.1 million people, we are near zero at that point. We need to build on that very good position. We did not do that, I think, through a lack of foresight, miscalculation, perhaps stubborn political ideology," Muhajarine said.
Saskatchewan's second wave, which Shahab has referred to as the "first true wave," was on the way.
Fall 2020
Saskatchewan's attention turned to the provincial election coming on Oct. 26.
During the campaign. Moe vowed not to implement a second lockdown in the province.
In the leaders' debate on Oct. 14, neither Moe nor NDP Leader Ryan Meili committed to a provincewide mask mandate.
The mask mandate eventually came, but in three stages. The entire province was covered as of Nov. 19.
WATCH: Moe announced a provincewide mask mandate in November
In the preceding days, Saskatchewan had set records in cases and hospitalizations.
The province rejected NDP calls for a three-week circuit breaker, and similar requests from doctors and other health organizations. It did implement a five-person cap on home gatherings.
At the time, Manitoba led all provinces in active cases per 100,000 with 570. Saskatchewan was third with 182.
On Nov. 12, Manitoba declared a "Code Red" lockdown due to the high case number.
"I think one of the things that could have helped us to deflect the second wave in Canada faster would have been if more places would have moved to mandatory masking earlier on," Neudorf said.
Muhajarine said the province enacted several incremental measures, compared to neighbours to the west and east that imposed stricter measures sooner.
After Manitoba entered its lockdown, Alberta closed restaurants (for in-person dining), gyms and personal service businesses on Dec. 8.
Alberta had surpassed Manitoba in active case rate. Saskatchewan moved into second.
Moe announced households could not mix indoors effective Dec. 17. The government further restricted retail capacity and shut down bingo halls and casinos.
The province saw a dip in cases over the Christmas break but cases began to spike again in mid-January. Saskatchewan became the leader in Canada for rate of active cases.
WATCH: Moe announced restrictions on gatherings in December, prior to the holiday season
Second Wave
The province's second wave, which started in November and peaked in January, has not slowed at the same rate as other provinces.
"Saskatchewan decided to stay the course with its sort of medium or moderate restrictions, and we paid the price for that," Neudorf said.
In 2020, there were 153 COVID-19-related deaths in the province. As of Thursday, there had been 248 in the 70 days of 2021, bringing the province's total to 401.
"I really think that political leadership, elected political leadership, I think has really failed us. It could be much better, even if we look at our neighbours, Alberta and Manitoba," Muhajarine said.
Saskatchewan has kept more businesses and activities open to the public than other provinces, including Alberta and Manitoba. As of Thursday, COVID-19 has claimed 911 people in Manitoba, 244 of them in 2021.
Saskatchewan has not seen the same level of transmission and deaths connected to long-term care facilities as Manitoba.
"One of the reasons that we have done as well as we have, that things haven't gotten worse, is we've been able to keep outbreaks in long-term care to a relative minimum compared to some other provinces," Neudorf said.
Of Saskatchewan's 401 deaths, 41 are tied to Parkside Extendicare in Regina. The outbreak at the facility accounts for 38 per cent of COVID-19-related deaths in Regina.
What lies ahead
Statistics show Saskatchewan did not act as strongly as its neighbours and that is why the case numbers have dropped at a slower pace than the rest of Canada, Muhajarine said.
"We continue to stay on top of the leaderboard of Canadian provinces in terms of new cases. COVID mortality has been unacceptably high," he said.
Neudorf said Saskatchewan's lighter restriction managed to "blunt the curve," but not flatten it.
"We didn't flatten it for many, many weeks, and now that we've flattened it, it's flattened at a fairly high, persistent level with continued outbreaks," he said.
On Tuesday, Moe announced the province would be relaxing restrictions that had prevented households from mixing indoors. The province now allows up to three households to form a bubble, with a maximum of 10 people allowed together at one time.
Saskatchewan has been among the national leaders in recent weeks for administering doses. It plans to get every adult at least one dose of vaccine by the end of June.
"Vaccination is not a panacea. We still have to protect each other. We still have to uplift each other. We have people economically affected. We have devastated communities," Deonandan said.
The epidemiologists who spoke to CBC all said the public needs to stay cautious and that restrictions including those on gatherings should be maintained until mass vaccination protection can be reached.
Cynthia Carr said the focus needs to remain on reducing transmission while variants of concern are present.
"We might still see a slight increase in cases. But if we see those hospitalizations and deaths coming down, that's more of a clinically mild impact and that's exactly a sign that the vaccination program is working, because we did start with our most high-risk population."
Deonandan called the current moment an "in-between phase," with the vaccine signalling a potential end while threats that could "tip the scales too early" still remain.
"It's critical to go slowly and measurably. I don't think that nuance has been expressed."
Neudorf said there is a "real risk of a massive third wave."
"My fear is that once deaths and hospitalizations start dropping off and the summertime hits and people are able to spend more time outdoors, that that sense of urgency will disappear," Neudorf said.
"There's a real opportunity here to put a very hard brake on this pandemic. We can only do that by getting herd immunity. And that's going to require everyone to come out and get immunized."
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