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A COVID-19 vaccine is administered at a mass vaccination clinic in Mississauga, Ont., Dec. 24, 2021. As Omicron continues to escalate, a patchwork of policies around testing, tracing and isolating is emerging across the country.Chris Young/The Canadian Press

Manitoba, facing a skyrocketing rate of positive COVID-19 tests and the possibility that its health care system could once again be overwhelmed, has introduced fresh restrictions to reduce the number of attendees at large events.

Health care officials and governments across the country are closely watching for how frequently Omicron infections turn into severe cases. Because the variant is so transmissible, health care systems could be strained if only a small percentage of people with COVID-19 need to be admitted to hospital.

Admissions are growing in Ontario and Quebec, two provinces that reported record new daily case counts over the holidays. Canada on Boxing Day surpassed two million cases of COVID-19, a significant milestone for a country with a relatively small population.

Now, as Omicron continues to escalate, a patchwork of policies around testing, tracing and isolating is emerging across the country. British Columbia, Alberta and some other provinces have restricted the general population from accessing sensitive lab tests.

Manitoba on Monday said access to tests will vary depending on vaccination status. For example, a vaccinated person with COVID-19 symptoms, but otherwise healthy, will be given a take-home rapid test; if it is positive, the person must return for a lab test.

Under the province’s revised rules, restaurants and other licensed facilities must stop selling liquor at 10 p.m. daily and are subject to Manitoba’s new capacity expectations. Gatherings for vaccinated individuals and those under 12 are capped at 50-per-cent capacity, or 250 people, whichever is less.

The capacity restrictions apply to faith services, weddings, ticketed entertainment events, gyms, casinos, indoor and outdoor public gatherings, and other places where people interact. The new rules kick in Tuesday, just one week after Manitoba’s most recent round of tightening. The province did not adjust the rules for retailers or private gatherings.

Manitoba, which earlier in the pandemic shipped critically ill patients to other provinces after running out of ICU capacity, said the restrictions are necessary to protect its health care system as the Omicron variant sweeps the province.

Brent Roussin, Manitoba’s Chief Provincial Public Health Officer, on Monday stressed that people who are sick must stay home, recognizing that this can be difficult to do during the holidays. The province is struggling to contact a “significant” number of people who have COVID-19, indicating that they are not abiding by the isolation requirements.

“We’re phoning people who are ill, who came for testing, tested positive, but no one is at home,” Dr. Roussin told reporters Monday. “I understand it is a difficult time, but if you are ill and needed to get testing, you need to isolate until you get your results.”

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Meanwhile, the U.S. Centers For Disease Control and Prevention on Monday eased the isolation requirement for people with COVID-19 to five days, if asymptomatic, followed by five days of wearing a mask around other people. Previously, the CDC recommended 10 days of isolation for positive cases.

The CDC said the science shows the majority of transmissions happens one or two days prior to to the onset of symptoms, and two to three days after.

In Canada, isolation expectations vary. For example, fully vaccinated people in British Columbia who test positive for COVID-19 must isolate for at least seven days from the onset of symptoms; in Alberta, positive cases must isolate for 10 days, regardless of vaccination status.

Experts warn that official case counts significantly underestimate the true spread of the virus. This was exacerbated last week when several cities and provinces asked people with mild symptoms to forgo lab testing to ensure there is enough capacity for high-risk cases.

Manitoba counted 2,154 new COVID-19 cases since Christmas Eve, with a province-wide positivity rate of 19 per cent. It has a backlog of about 11,500 tests, Dr. Roussin said.

B.C. said it added 6,288 new cases over the previous three days. In Ontario, Health Minister Christine Elliott reported on Monday a one-day total of 9,418 new cases. Alberta will provide preliminary data of how COVID-19 unfolded over the holidays on Tuesday.

Another sign of undercounting is the escalating positivity rate. In Quebec, the positivity rate for tests processed on Dec. 22 was 15 per cent. For tests processed on Dec. 26, the positivity rate was 25 per cent. From those tests, the province reported 8,231 new confirmed cases Monday.

In Quebec and Ontario, daily hospital admissions have started to grow. Quebec Health Minister Christian Dubé said on Twitter Monday that there 141 more people in hospital because of COVID-19 since Dec. 22. “Admissions are on the rise. We must limit contacts,” he urged in the message to Quebeckers.

Hospital admissions in Ontario are also accelerating and data tracking from the Ontario Hospital Association shows that intensive-care admissions are gradually increasing; from a seven-day rolling average of 156 people in ICUs to an average of 166 on Monday. However, so far ICU admissions are still below the best-case scenarios forecast by modelling from Ontario’s COVID-19 Science Advisory Table.

Quebec has already delayed the return to in-person classes for high-school students by a week, but left the return date for younger students unchanged.

In Ontario, no change has been made to the scheduled Jan. 3 return to class. On Monday, a spokesperson for Education Minister Stephen Lecce did not directly answer The Globe and Mail’s questions about whether the return date in Ontario would change. However, Mr. Lecce’s office directed The Globe to comments from Chief Medical Officer of Health Kieran Moore on Dec. 21.

Last week, Dr. Moore told reporters that he has consulted experts on whether to delay a return to class and, at that point, they didn’t see a need to delay classes.

Because most Atlantic provinces did not report any new COVID-19 numbers over the Christmas weekend, many reported figures for three days on Monday. They show that cases are also climbing on the East Coast. Newfoundland and Labrador reported 357 new cases over the past three days, including setting a new daily record with 135 cases on Sunday. The province urged people to reduce their contacts and get their booster shots.

New Brunswick reported 639 new cases in the past three days. On Monday it said 35 people were in hospital and 14 of them in intensive care. Effective Monday night, New Brunswick reduced its private gathering limits to a household plus 10 people and capacity limits for malls, stores, restaurants and businesses is 50 per cent.

Prince Edward Island reported 156 cases since Friday and Nova Scotia reported 581 new cases on Monday and a hospital outbreak in Halifax that so far affected less than five patients.

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