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The Health Sciences Centre in Winnipeg on May 21, 2021.

Shannon VanRaes/The Globe and Mail

Manitoba hospitals are transferring patients to intensive care units as far away as Thunder Bay, Ottawa and Windsor, Ont., and the Premier is asking the federal government and the White House for help to cope with a crushing third wave that is overwhelming the province’s health care system.

The province, one of the few places in Canada where infections are increasing, recorded more than 600 new COVID-19 infections in a single day last week – eclipsing previous records and cementing its position as the North American hot spot. Manitoba has surpassed Alberta in having the most active cases per capita.

Premier Brian Pallister has asked Ottawa for nurses and respiratory therapists. On the weekend, Mr. Pallister said North Dakota offered to send the province vaccines but he blamed U.S. President Joe Biden’s administration for preventing that from happening.

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The recent surge of infections follows months in which doctors urged the Manitoba government to implement far stricter public-health measures to prevent a third wave. Medical experts have criticized the province for waiting too long to act, failing to respond to infection rates that had prompted severe lockdowns elsewhere in Canada.

“This was avoidable,” said Dr. Anand Kumar, a Winnipeg intensive care physician and infectious diseases specialist.

“It’s mostly a consequence of the province’s decision to use a strategy that focuses on only intervening when health care capacity is threatened. And when you do that this is an expected consequence.”

More than 200 physicians signed a letter to Mr. Pallister in early May, pleading for tighter restrictions at a time when bar patios, gyms, schools, churches and beauty salons remained open – albeit with limitations – as infection rates climbed. All gatherings on public and private property are now banned, but small meetups in publics spaces such as parks will be allowed to resume on Wednesday. Malls and other non-essential retail outlets remain open at 10-per-cent capacity, although a temporary health order limits shopping trips to one family member on the long weekend.

Dr. Kumar noted provinces such as Nova Scotia went into lockdown when cases reached 8 per 100,000; Manitoba chose that benchmark to lift restrictions.

“Nobody wants to criticize in the middle of an emergency, but I’m just so tired of it,” said Dr. Kumar. “We could have done so much better. We should have done so much better. We owe our citizens so much better.”

Manitoba was also among the first in Canada to struggle during the second wave, when a spike in infections in November put similar strain on the health care system. The province’s current infection rates are now higher than the peak in the fall.

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There were 259 people in hospital with the virus as of Sunday – 74 of them in intensive care, which does not include people who have been transferred out of province. Manitoba added 461 confirmed infections on Sunday, bringing the number of active cases to 5,072.

The Manitoba government asked Ottawa on Friday to send 50 critical-care nurses and 20 respiratory therapists, though it’s not clear when, or if, that help will arrive. The federal government has so far only agreed to send 50 contact tracers and has not responded publicly to the request for front-line medical staff. Provincial officials said Sunday that discussions were under way, but no details had been finalized.

Health officials are also looking at the possibility of sending ICU patients into North Dakota or Saskatchewan. North Dakota had asked the White House earlier this year for permission to ship some vaccines to Manitoba for teachers and other school workers, but the request was denied, according to the Premier who told the White House to “get out of the way” during a weekend press conference.

Mr. Pallister has said he takes “all the responsibility” for the province’s current struggles with COVID-19 but he has nonetheless defended his government’s response. He rejected the suggestion that the government should have acted sooner with public-health measures and instead put the blame on people not following the rules.

“We moved earlier on our restrictive rules, which were already some of the most restrictive in Canada, than other provinces,” Mr. Pallister said on Saturday. “No restrictions will work unless people abide by them.”

Late last month, Deputy Chief Public Health Officer Dr. Jazz Atwal criticized neighbouring Ontario for being too slow to enact stricter measures, assuring Manitobans their province was on a different path. As Winnipeg’s test-positivity rate rose above 16 per cent, he defended those comments – along with the province’s COVID-19 strategy – and said early projections were based on scenarios where public-health orders saw greater compliance.

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“Every Manitoban needs to look in the mirror,” Dr. Atwal said.

Neil McArthur, a professor with the Centre for Professional and Applied Ethics at the University of Manitoba, said it’s the responsibility of elected officials to inform citizens and get individuals moving in the same direction during a public-health emergency, but he increasingly sees politicians trying to pass the buck to civil servants.

“The politicians are especially to blame in this case, because they had time. We’ve been later – just because of our geography – on every wave and we knew this wave was coming,” Prof. McArthur said. “It’s just so appalling.”

Prof. McArthur believes greater transparency as the third wave approached could have helped people make informed decisions about risk and provided strong incentives to reduce contacts, thereby slowing the spread of the virus.

Winnipeg Mayor Brian Bowman said he’s “disappointed” in the province’s handling of the crisis and said the third wave could have been mitigated by pro-active measures.

The Southern Chiefs Organization noted pre-existing nursing shortages and the 2019 closure of some emergency rooms has further contributed to strain on the province’s hospitals and ICUs.

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“Instead of learning from their mistakes in fall of 2020 and taking decisive action in the wake of the third wave of this pandemic, they have let political interests interfere,” said Grand Chief Jerry Daniels.

Darlene Jackson, head of the provincial nurses’ union, believes tighter restrictions, had they been implemented weeks earlier, could have reduced the third wave to a mere ripple. But with that opportunity lost, she is imploring people to get vaccinated, follow public-health orders and stay home.

“Nurses are exhausted, they are burning out at an incredibly rapid rate,” she said. “And they are terrified because they’re overseeing critically ill patients in numbers larger than they’ve ever had to do before.”

Under normal circumstances, ICU nurses are assigned to one patient, now they are being asked to care for two or even three, Ms. Jackson said.

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters and editors.

Editor’s note: (May 24) An earlier version of this story had an incorrect number of cases per 100,000 when other provinces went into lockdown and Manitoba lifted restrictions. This version has been updated.

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