Some changes are coming to Manitoba’s public health orders, ahead of what public health officials worry may be a fall surge in COVID-19 hospitalizations in some areas.

The province announced the changes Oct. 1, along with a move to “orange” on the province’s pandemic response system. The new health orders will take effect Oct. 5.

For people who are fully vaccinated, or for children ineligible to receive vaccine doses, the new orders won’t change much. Most of the new changes mention restrictions specifically for people who are eligible to be vaccinated, but who are not. Health officials, including provincial health minister Audrey Gordon and Manitoba chief provincial public health officer Dr. Brent Roussin, have said that while cases are low for the more than 80 per cent of eligible Manitobans who are fully vaccinated, about 400,000 people – most of whom are children under age 12 who cannot yet get COVID-19 vaccines – are unvaccinated and at a much higher risk.

“Case counts and hospitalizations are rising everywhere in Canada and we must be proactive in protecting our health care system and ensure we have hospital beds available to continue to provide care for patients in need,” said Gordon.

“As of Wednesday, people who are not fully vaccinated accounted for 75 per cent of new COVID-19 cases, 79 per cent of those admitted to hospital and 100 per cent of intensive care unit (ICU) admissions. Data also shows that hospital admissions related to COVID-19 have increased by 26 per cent in the past week with COVID-19 related admissions to ICU increasing by 17 per cent during that same period,” reads the provincial health order announcement.

“New public health orders will allow fully vaccinated Manitobans to continue to enjoy as much freedom and as few restrictions as possible. Unvaccinated individuals who are eligible to be vaccinated will now be more restricted in their activities,” said Roussin.

Indoor gathering limits have been lifted in Manitoba, in both public and private settings. for fully vaccinated people and kids under 12 years old. That changes if someone who can receive a vaccine dose but isn’t fully vaccinated shows up – in that case, group sizes are capped at 25 people or 25 per cent capacity in public spaces, whichever is lower. For private indoor meet-ups with at least one non-fully vaccinated adult, guests are limited to only a host household and a guest household.

Outdoor public gathering rules have changed as well, going from up to 500 people in outdoor public spaces to up to 50 people in what health officials describe as “uncontrolled” public spaces – in essence, a place where not all people are guaranteed to be fully vaccinated if eligible. Household gatherings outside are now capped at 10 people outdoors if an eligible but not fully vaccinated person is at the location, even if they live there – those gathering limits are also dropped for fully vaccinated people and for kids.

Retail facilities in four of Manitoba’s five health regions, including the Northern Health Region (NHR), can now reopen to full capacity. The only straggler is the Southern Health-Sante Sud region, where a high amount of Manitoba’s recent COVID-19 cases have been found and where the vaccine uptake rate is by far the lowest in Manitoba. Retail locations there will only be able to open to 50 per cent capacity.

“If we look at the estimated time for case numbers to double, in the southern region, it could take less than three weeks if everything remains the same. That could mean that region could see 93 cases per day in under three weeks. That alone could put the province’s hospital system at risk,” said Roussin, who said admissions to southern hospitals with COVID-19 had gone up by 17 per cent in the past week.

“A significant number of COVID-19 admissions were not tested prior to arrival in ICU. This says two-thirds of all admissions to the ICU this week were first diagnosed with COVID-19 upon admission to hospital. This tells us that non-COVID-19 care will be significantly affected by surges in COVID-19 activity, hospitalization and especially the demands made on ICUs. This is why we need to take action now, to continue to be proactive to protect Manitobans and our health care system. Any new public health orders need to reflect the increased risk to and from unvaccinated Manitobans.”

Retail locations across Manitoba still have to require mask use indoors, with physical distancing when possible.

No other changes are in store for restaurants, gyms, casinos and gaming facilities, museums, libraries, sporting events, movie theatres, personal services, outdoor sports and recreation, overnight camps or workplaces. Many of those settings will continue to be fully open for fully vaccinated people, with mask use still mandated in several areas.

Other events, like fairs and festivals, will also see limits, being capped at 50 people unless COVID-19 protocols are put in place and public health officials approve higher attendance. Weddings and funerals will see the same rules, with one exception – a cap of 25 people or 25 per cent capacity if eligible people who aren’t fully vaccinated are present. The province also announced a different deadline for the rules on weddings and funerals to take effect – those orders will start Oct. 12 “to minimize disruption” to events already planned.

Capacity limits for churches and worship centres have been lifted for fully vaccinated people and for kids – once again, for eligible people who aren’t fully vaccinated, there are tighter limits. The limit for indoor religious services with eligible people who aren’t fully vaccinated is either one-third capacity or 25 people – whichever is larger – while outdoors, a limit of 50 people for “uncontrolled” spaces will be in effect. Drive-in church services can still go on without restrictions or capacity limits.

The other big change to health orders is a change to Manitoba’s patient transfer protocol. Once changes take effect, if Manitobans are admitted to a hospital, they will be told that they may be transferred to another hospital within the province if the hospital is hit with an influx of COVID-19 patients.

“Patients will receive information upon admission that a transfer to another location in the province is a potential possibility so they can prepare. Care teams will confirm the receiving site is able to meet their needs, may occur at the direction of their care team and does not require their consent,” reads the health order change.

“Patients and their families will be advised of the decision to transfer when it is made and will be provided with information related to the supports available to them at their receiving station.”

Once a patient is discharged, a hospital care team will coordinate with health workers in their hometown to move them home as safely as possible. The moves will only take place if a surge in hospitalizations makes beds no longer available at the patient’s home facility.

“All efforts will continue to be made to avoid hospitalization for patients who can be cared for at home, in the community or elsewhere with appropriate supports including virtual care and at home monitoring options. This will help maintain needed ICU capacity for COVID-19 patients,” reads the health order.

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