Why does Manitoba have nearly twice as many COVID-19 deaths as Saskatchewan?

The experiences of Manitoba and Saskatchewan have often been compared throughout the COVID-19 pandemic, and for good reason.

They have similar population sizes, demographics and geographies. 

Early in the first wave of the pandemic, Manitoba reported a fraction of the cases appearing in its western neighbour. And Saskatchewan got hit with a surge in the number of more contagious coronavirus variants long before Manitoba. 

But while the death toll from the virus crossed the 1,000 mark in Manitoba earlier this week, Saskatchewan has slightly more than half that. As of Friday, Manitoba had 1,002 confirmed COVID-19 deaths, compared to 515 in Saskatchewan.

What explains that stark difference in the number of fatalities?

One major factor has been the different experiences in long-term care facilities in each province, said University of Saskatchewan epidemiology professor Nazeem Muhajarine.

"I think, just like in Quebec, Manitoba has experienced, kind of, the worst outcome in COVID-19 in the long-term and personal care homes," he said.

Manitoba ranks second among the provinces, behind Quebec, in terms of COVID-19-related deaths per capita.

Nearly half of all deaths in Manitoba have been linked to long-term care facilities. According to the National Institute on Aging at Ryerson University, as of May 13, Manitoba had 486 deaths at care homes, stemming from 2,536 cases at 87 different facilities.

Saskatchewan, by comparison has had 117 deaths linked to care homes, arising from 651 cases at 116 facilities.

People living in long-term care home are the most vulnerable in a pandemic, Muhajarine said. 

"They're older and sometimes they are cared for in very close space," he said. "And the immune system, it's not strong, as, you know, the younger people. And they're more vulnerable to death, the worst outcome."

Population density

Another major factor — and related to the amount of transmission occurring in personal care homes — is the difference in how the populations of the two provinces are distributed. 

While more than half of the population of Manitoba lives within the city of Winnipeg, Saskatchewan's population is more dispersed. The combined populations of the two major cities, Regina and Saskatoon, only equal 43 per cent of the province's population. 

As of Friday, Winnipeg has reported 25,424 of Manitoba's 44,189 confirmed cases, and 698 deaths. Regina and Saskatoon have had a combined total of 21,522 cases and 251 deaths.

More concentrated populations lead to higher rates of community spread, Muhajarine said.

"When the community spread is so high, the prevalence of COVID-19 is so high in the cities, it will affect everywhere in the city, including among some of the most vulnerable people, people who might live in long-term care, personal care homes," he said.

Understanding the differences in outcomes between Manitoba and Saskatchewan requires going beyond the surface similarities, said University of Manitoba virologist Jason Kindrachuk.

"We have to look beyond just the total number of people that live in each province, but more so the variables, the socioeconomic demographics … certainly the differences in where those populations are and which populations were hit the hardest during each wave," he said.

Variant variance

Another difference has been the degree to which coronavirus variants — like the B117 variant — have spread throughout the provinces.

The B117 variant hit Saskatchewan, and particularly Regina, much earlier than Manitoba. But while it has become the dominant strain in Manitoba, it hasn't spread much beyond Saskatchewan's capital city, Kindrachuk said.

"Is it just the sense that, because you have a city like Winnipeg, and you have so many people in one area, that you have a better opportunity for transmission? I don't know," he said.

On Friday, the Manitoba Liberals issued a call for the provincial government to conduct a study to try to understand why the death rate is so different between the two provinces. 

"Clearly, Manitoba has something to learn from Saskatchewan, and we better learn it fast," Manitoba Liberal Leader Dougald Lamont said in a news release.

Kindrachuk says a study comparing the two provinces would be worthwhile.

"We have to view it beyond the idea of pointing fingers," he said. "Certainly we can say that, yes, we knew long-term care facilities and personal care homes have been hit extraordinarily hard … but what about the other spread that we're seeing?" 

Understanding which populations have been hit hardest and why will help Manitoba better prepare for the next pandemic, Kindrachuk said.