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A visitor sits in one of the freshly painted circles at Trinity Bellwoods Park in Toronto, on May 28, 2020. Governments have begun taking steps to unravel the policies put in place at the start of the coronavirus crisis, restarting the economy and returning society to something resembling normal life.

Fred Lum

For the better part of three months, Canada has been in an economic and social holding pattern.

In Ontario, physically distant social gatherings are still limited to five people. Canada’s border with the United States is closed to non-essential travel. Coast to coast, millions have lost their jobs and are receiving government benefits.

In recent weeks, governments have begun taking steps to unravel the policies put in place at the start of the crisis, restart the economy and return society to something resembling normal life, but in all likelihood, reopening will be a highly regional affair, varying significantly across cities and provinces, said Lynora Saxinger, an infectious-disease specialist at the University of Alberta. “The Canadian epidemic is actually a complete patchwork, even within provinces,” she noted.

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As Canada looks to reopen, here’s where the provinces and territories are today, and the challenges that lie for the months ahead, with insight from Dr. Saxinger.

British Columbia

Flattening the curve

Some regions have fared better than others

in containing the spread of COVID-19. Each chart

below shows a region, scaled from zero to

their peak active cases each day.

British Columbia

case peak

March

April

May

Alberta

Sask. and Man.

Ontario

Quebec

Atlantic Canada

The North

March

April

May

March

April

May

THE GLOBE AND MAIL, SOURCE: PROVINCIAL AUTHORITIES

Flattening the curve

Some regions have fared better than others

in containing the spread of COVID-19. Each chart

below shows a region, scaled from zero to

their peak active cases each day.

British Columbia

case peak

March

April

May

Alberta

Sask. and Manitoba

Ontario

Quebec

Atlantic Canada

The North

March

April

May

March

April

May

THE GLOBE AND MAIL, SOURCE: PROVINCIAL AUTHORITIES

Flattening the curve

Some regions have fared better than others

in containing the spread of COVID-19. Each chart

below shows a region, scaled from zero to

their peak active cases each day.

British Columbia

case peak

March

April

May

Alberta

SASK. and Manitoba

Ontario

Quebec

Atlantic Canada

The North

March

April

May

March

April

May

THE GLOBE AND MAIL, SOURCE: PROVINCIAL AUTHORITIES

British Columbia’s COVID-19 epidemic arrived particularly early, and yet the province has arguably had the greatest success in containing the spread of the novel coronavirus that causes the disease, registering an average of 12 new cases a day over the past week.

The province unveiled its four-phase plan in early May and has already progressed to Phase 2, which allows for the scheduling of elective surgeries and the reopening of dine-in restaurants, retail, museums and libraries under strict protocols. Phase 3, slated to begin in June if transmission rates continue to decline, would see the reopening of the hospitality industry, parks, movie theatres and K-12 schools and postsecondary institutions, again with infection-reduction protocols in place. Finally, Phase 4 would allow for large gatherings and the restart of international tourism.

Dr. Saxinger credits B.C.’s success to its open data policies, its ability to quickly test and trace back cases, a community that’s mostly obeyed orders coming from public-health authorities and a strong co-ordinating health unit in the B.C. Centre for Disease Control.

Unlike other provinces, B.C. has managed to flatten its infection curve without having to test large swaths of the population. “They figured out a way to target it well,” she said.

B.C. has one of the lowest testing rates in the country, administering roughly 2.7 tests for every 100 people – only Nunavut and Newfoundland and Labrador have posted smaller testing figures. By comparison, Ontario, Quebec and Alberta have taken a far more aggressive approach, administering between 4.4 and 5.6 tests per 100 people.

But Dr. Saxinger warned B.C. is not yet clear of risk. “All it would take is one super-spreader,” she said.

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Premier John Horgan says he's pleased Vancouver is in the running for a possible NHL playoff hockey site, but the province is not prepared to waive rules requiring people to self-isolate for 14 days when arriving in B.C. from outside Canada. The Canadian Press

Alberta

Alberta has been marked by pockets of major outbreaks and large areas with almost no cases.

Though the province has had nearly 7,000 cases, the third-highest number in the country, they are concentrated in just a few areas, with more than two-thirds of cases centred in Calgary. Many of those are related to outbreaks in long-term care homes and plants, such as Cargill Ltd.’s meat-processing facility in nearby High River.

“The fact that there's that many outbreaks makes me think that there's been some low level of community transmission going on that’s sparking up in these areas,” said Dr. Saxinger.

The province’s Edmonton health zone, by contrast, has had nine times fewer cases than Calgary.

Alberta has stood out for administering 5.6 tests for every 100 people, the highest rate in the country. Unlike most other provinces, which delegate powers to regional health units, Alberta’s system is centralized under Alberta Health Services, which helped the province ramp up testing quickly during the early days of the crisis, according to Dr. Saxinger. This also helped them procure resources at scale, she said, as the province was able to act as a single buying unit.

Parts of the province have now been under the first phase of reopening for two weeks, allowing for some retail, museums, hair salons and half-capacity restaurants to return. Calgary and Brooks will be reopening more gradually because of their much-higher case numbers, however.

Manitoba and Saskatchewan

Alberta aside, the Prairies have had a small number of infections.

Saskatchewan and Manitoba have weathered the crisis relatively well, logging 933 cases and 17 deaths to date. “It does seem to be pretty stable and pretty safe,” said Dr. Saxinger, noting there is little evidence of active community transmission in either province at this point.

“People might be tempted to say, ‘Our community has never had a case, what is all this fuss about?’" she said. “But the past does not predict the future.” Dr. Saxinger warned that new cases could still be imported as the provinces reopen and people begin moving around again.

Given their low case numbers, both provinces have already begun reopening, and are now allowing certain businesses, such as hair salons and retail establishments, to resume operations.

The Manitoba government says phase two of the province’s reopening can be begin Monday with dine-in restaurants, bars, and gyms as well as pools, community centres, and seniors clubs. The Canadian Press

Ontario

Ontario’s case statistics haven’t budged much over the past several weeks, averaging more than 350 new cases daily.

While 10,000 tests are now administered in the province daily, the percentage of tests coming back positive – a crucial number – is far higher than in other parts of the country. In recent weeks, Ontario has seen a positivity rate between 3 and 7 per cent, compared to B.C.’s rate of 0.8 per cent and Alberta’s 1.5 per cent.

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“Places that have a per-cent positivity greater than two are kind of worrisome,” she said. To push these figures down, Ontario will have to be more focused. “It speaks to the need to customize.”

Ontario’s plan, still in its first phase, applies to the entire province. Instead, it may need to be tailored regionally, meaning less-affected areas such as Ottawa or Thunder Bay may get back hair salons and dine-in restaurants sooner than Toronto, Dr. Saxinger said. “You can have a provincial plan that has subplans that allow for some flexibility.”

Earlier this week, local public-health officials echoed her comments, calling on the government to regionalize the plan and set more specific guidelines for reopening, such as basing phases on the percentage of acute-care beds available.

Travel also poses a big risk for the province. Ontario is home to Canada’s busiest flight hub, Toronto Pearson International Airport, and shares a heavily trafficked border with the United States, which is deep in the throes of the world’s worst COVID-19 epidemic – more than 100,000 people have died in a four-month period.

“I feel like the U.S. is going to be in a state of waxing and waning severe epidemics for a long time,” said Dr. Saxinger, noting that until U.S. numbers improve, a border reopening would pose a “considerable risk.”

The U.S.-Canada border will be closed to non-essential travel until at least June 21, though the federal government, which has jurisdiction over border matters, could eventually negotiate a further extension with the Americans.

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Circles were painted on the grass at Toronto's Trinity Bellwoods Park on Thursday to encourage people to exercise physical distancing while enjoying the outdoors. The circles were prompted by large gatherings of people in close proximity at the park on the weekend. The Globe and Mail

Quebec

Quebec’s epidemic is the worst in Canada – it has logged more than 49,700 cases and 4,300 deaths – and it faces many of the same challenges as Ontario around travel and the dangers of a brisk reopening.

The province is still registering more than 500 cases a day, and has incurred the country’s highest death rate, with 50.4 deaths per 100,000 people. By comparison, Ontario has had 14.9 deaths per 100,000 people.

Experts think Quebec’s crisis may be partly due to its spring break in early March – two weeks earlier than Ontario and B.C.’s, which were cut short by a slew of provincial and federal travel advisories. That earlier break meant many Quebeckers travelled to parts of the United States and Europe where COVID-19 was already circulating in the community, likely bringing the virus back with them.

Roughly half of Quebec’s cases and deaths are in the Montreal area, which has become the centre of Canada’s epidemic. “People who are working in health care in Montreal are really facing a much more challenging position than anywhere else in Canada so far,” said Dr. Saxinger.

The health region of Laval has also had a large number of cases. But not all heavily populated areas have been as hard-hit by COVID-19. Quebec City’s health region of Capitale-Nationale, for instance, has managed a lower number of confirmed cases per capita than the national average.

Like in Ontario, many of Quebec’s cases are localized to long-term care homes.

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Parts of the province are already reopening. Outside of Montreal, Quebec resumed some child-care services and schooling in early May, and has taken down checkpoints meant to restrict non-essential travel within the province.

Premier Francois Legault says his government is looking to train up to 10,000 people to work as orderlies in the province’s hard-hit long-term care homes. About 65 per cent of Quebec’s COVID-19 deaths have occurred in the province’s understaffed public and private long-term care facilities. The Canadian Press

Atlantic provinces

Like the Prairies, Atlantic provinces have so far avoided a significant wave of infections.

New Brunswick, Newfoundland and Labrador, Prince Edward Island and Nova Scotia combined have had about 1,460 cases since the crisis began. Nova Scotia has been hit the hardest, with more than two-thirds of Atlantic Canada’s cases and 59 deaths. Newfoundland has counted three deaths, and PEI and New Brunswick have none so far.

This is likely partly because of the provinces’ interprovincial travel restrictions. All have enacted some type of control on non-essential travel from other provinces, and all travellers are required to enter a 14-day quarantine on arrival.

“It’s the equivalent of pulling up the drawbridge,” said Dr. Saxinger.

Atlantic Canada’s demography and geography may also have helped. The provinces’ smaller populations have made testing easier, and lower population densities may have curbed the amount of community spread. “In general, it looks quite feasible for them to keep a tight lock on things,” she said.

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Given their encouraging statistics, East Coast provinces are further ahead in reopening than most other parts of Canada, with certain areas now allowing for some retail and sports and recreation. Dine-in restaurants will likely soon return to Prince Edward Island, and New Brunswick has a “bubble policy,” allowing households to pair up and interact socially in close quarters.

Tourism, a very important industry for Atlantic provinces, remains a risk, however.

Dr. Theresa Tam, the chief public health officer, says the COVID-19 cluster that forced New Brunswick to roll back some reopening measures is an example of the caution – and flexibility – needed as jurisdictions across Canada begin to ease restrictions. The Canadian Press

The North

Canada’s territories have weathered the crisis well. Combined, the Yukon, Northwest Territories and Nunavut have had 16 cases of COVID-19, and haven’t registered any deaths.

Dr. Saxinger thinks this is because of their remoteness – which has limited how many cases have been imported – and the territories’ small population numbers and incredibly low population density, much like in Saskatchewan and Manitoba.

Summer should also pose fewer challenges, she said. In much of Canada, summer often means busy streets and packed parks, but people in the North are more likely to go camping, hiking or fishing – all fairly secluded activities.

Like in Atlantic Canada, tourism could pose a risk according to Dr. Saxinger, but so far travel into the territories is still largely restricted. The far-flung nature of the North’s residents could also strain the territories’ health care infrastructure if enough cases were introduced, she warned.

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