OTTAWA — Last year the Canadian province of Manitoba seemed to be a model of how to handle a pandemic: Its case numbers were low compared to Europe and the United States, and deaths were rare.
But now the coronavirus is spreading faster in Manitoba than in any other province or state in Canada, the United States or Mexico, with Indigenous people and people of color hit disproportionately hard.
At a time when Canada’s vaccination program is hitting its stride after a slow rollout, with many provincial governments laying out plans for gradual reopenings into the fall, Manitoba is in crisis mode.
Over the past two weeks, the province has reported a daily average of 35 new cases per 100,000 people, far exceeding Canada as a whole, which is averaging about 10. Manitoba has more than twice as many new cases per day than the next-highest state or province.
The situation is a remarkable reversal. Manitoba once stood out as an example of the effectiveness of tight restrictions, like closing its borders to the rest of Canada, to curb the spread of the virus.
Manitoba later eased or lifted many of those restrictions. But as a third wave of infections struck, its premier, Brian Pallister, resisted the restoration of many of them.
“We’ve gone from being almost the best-case scenario — the way to do it right with almost no cases — to now the worst in North America,” said Mary Agnes Welch, a principal in Probe Research, a polling firm in the provincial capital, Winnipeg. “How did we get here? There’s a sense of sort-of bafflement about that among Manitobans.”
People of Southeast Asian descent, who make up a small portion of Manitoba’s population, are disproportionately affected, with an infection rate of 146 cases per 1,000 people, 13 times the rate among white people. Indigenous people, about 20 percent of the province’s population, are being infected at 1.75 times the rate of white people.
Some Indigenous people in Manitoba say that the disparity underscores racism within the health care system and longstanding problems in getting services.
The surge in Covid-19 cases has overwhelmed intensive care units in Manitoba’s hospitals, forcing some patients to be evacuated by air to other provinces. Twenty-six patients had been flown to neighboring Ontario by midday Thursday, including some to Ottawa, about 1,000 miles away. Saskatchewan was expected to accept its first I.C.U. patients from Manitoba later in the day.
On Tuesday, a group of doctors called on the province to follow the lead of Ontario and other provinces by introducing a stay-at-home order and closing nonessential businesses, particularly stores. Those steps have allowed other provinces to rein in their most recent waves of infections.
“The only thing that hasn’t happened really is shutting down areas where people congregate for work,” said Dr. Eric Jacobsohn, a professor of medicine at the University of Manitoba who is part of the group. “We saw last year when we had to have a complete shutdown, we got control of the situation.”
On Wednesday, Mr. Pallister extended for another two weeks rules that ban indoor and outdoor gatherings of people who are not from the same household. Health officials were given the power to close businesses with outbreaks, but the government did not elaborate.
Stores, including those selling nonessential goods, will be allowed to remain open, while limited to 10 percent of their capacity, a cap imposed several weeks ago. Ontario and other provinces have taken stricter steps.
“We need Manitobans to stay home as much as possible over the next two weeks,” Mr. Pallister said.
Mr. Pallister has repeatedly suggested that the worsening situation was caused, not by too few restrictions, but rather by people failing to comply with restrictions already in place.
“No restrictions work unless people work at them,” Mr. Pallister said on Thursday after being asked why he was not shutting nonessential stores.
Dr. Jacobsohn disputed that assertion.
“Are Manitobans so much more disrespectful of the public health laws than the rest of Canada, America and, in fact Mexico, that we have the highest rate of infection per 100,000 people in North America?” he asked. “It’s just not plausible to say that, it doesn’t make sense.”
Ms. Welch, whose firm does not do polling for politicians, said that most Manitobans fault Mr. Pallister for the surge, in particular for having kept businesses open.
“Perhaps more than other premiers that we’ve had in this province and other premiers in other provinces, the premier is the decider,” she said. “The common wisdom now is that he is very much a one-man show.”
Mr. Pallister, a Progressive Conservative, has not been shy at times about blaming other political leaders, particularly Prime Minister Justin Trudeau, a Liberal. Last weekend, Mr. Pallister chided President Biden for not responding to his request that the United States allow American states to send vaccines to Canadian provinces.
While vaccination programs on Indigenous reserves in Manitoba have generally gone well, the disproportionate effects on Indigenous people in the province, particularly those who do not live on reserves, underscored the inequities that Indigenous people face in getting health care.
Indigenous people who move from reserves fall under provincial health care systems. Dr. Marcia Anderson, the public health lead of the Manitoba First Nation Pandemic Response Coordination Team, said more than 20 years of research shows they have worse primary care and make less use of public health services than people who live on reserves.
Indigenous people in Winnipeg are close to large teaching hospitals and a wide array of other medical facilities, but Dr. Anderson, who is Cree and Anishinaabe, said that one factor above all prevents many from using those services.
“The experiences of racism within the health care system leads to people avoiding health care,” she said. “When First Nations people feel unwelcome, they are much less likely to go to access health care.”
Racism toward Indigenous patients is in the spotlight in Quebec, where a jury appointed by the coroner is examining the death of Joyce Echaquan, a 37-year-old Indigenous woman.
As she lay dying in a hospital bed, Ms. Echaquan live-streamed a video on Facebook in which hospital staff called her stupid and a burden on the health system who was better off dead. Nurses and patients at the hospital have testified that they also heard some nurses making racist and vulgar statements about Ms. Echaquan and Indigenous people generally.
Few medical experts in Manitoba expect that the province will soon join the rest of Canada in looking toward the pandemic’s end.
“We’re in this for a couple of months, for sure,” Dr. Jacobsohn said. “Many people in the scientific community felt that the shutdowns were really, really never as tough as they should have been.”