NS COVID-19 Update for 2 April 2020

Daily briefing

Dr. Robert Strang, Nova Scotia’s chief medical officer of health, announced 20 new cases of COVID-19 in the province, bringing the total number of confirmed cases to 193.

Strang says 91% of confirmed cases are related to travel or a known case while 9% remain under investigation and are expected to be attributed to community spread. Officially, the province still has only one confirmed case of community spread.

There are nine people in hospital with COVID-19 and 16 who have recovered.

The chief medical officer made it clear in response to several questions that the goal is to find a balance between testing broadly enough (especially now that community spread is known to have occurred) and not overwhelming the microbiology lab in Halifax which performs the tests. The lab has succeeded in quadrupling the number of tests it can perform in a day and is prepared to operate 24/7 if necessary.

That said, the lab is putting in an “enormous” effort to keep up with the current volume of tests and the province has only recently broadened its testing criteria, which now includes people directed to an assessment center by 811; healthcare workers with a fever or cough who are assessed and for whom testing is deemed “necessary,” and any close contacts of confirmed cases.

 

Test local?

This actually ties into something I looked into today, so I’m going to interrupt my account of the press conference to tell you about it.

I was curious about how specimens collected in Cape Breton were transported to the microbiology lab in Halifax, so I asked the NSHA which told me:

Specimens are transported using the existing NSHA Provincial Transportation System. Additional runs have been put in place to expedite transport to the QEII Virology Laboratory to ensure samples are processed as quickly as possible.

I don’t know how many runs have been put in place or precisely how long transport takes, but it’s ground-based, so specimens must take four to five hours to get to Halifax — which is roughly the amount of time it takes to run a test.

As of yesterday, 889 (11%) of the 8,269 tests completed in the province originated from Cape Breton.

I asked if there were any way tests could be done at the Cape Breton Regional Hospital. The NSHA said:

Pathology and Laboratory Medicine (PLM) has successfully kept up with demand for COVID-19 testing thanks to the enormous effort put forth by our team. Currently, all testing is being performed at the QEII Virology Laboratory with results available within 24 hours of arriving in the lab. The equipment used for this specific COVID-19 test is highly specialized and designed for large volumes of testing. Acquiring, installing and validating this type of equipment is lengthy and requires specialized technical and medical staff to support the testing.

Okay, perhaps this is not something to be accomplished in the short term, but might it not be one of the lessons we learn from this pandemic? If we come out determined to install the necessary equipment and train the necessary staff in Sydney, wouldn’t that relieve the pressure on the Halifax lab the next time we face a situation like this?

Fortunately a new, rapid COVID-19 test has been approved on an instrument that Cape Breton Regional Hospital and several other sites already use. This will enable distributed testing for urgent clinical decisions. Tests for this platform have been ordered and are expected to arrive soon. While not able to handle large numbers of screening tests, this will still enable distributed testing for urgent clinical decisions  Global competition for any commercialized testing is at unprecedented levels and this is a challenge all provinces are facing together.

Again, this may work for now (especially if testing for “urgent clinical decisions” in Sydney is now being done in Halifax) but when the global competition for commercialized testing has eased, wouldn’t it make sense to share the testing burden between facilities? (I stand to be corrected on this — maybe it’s a truly terrible idea. Please feel free to let me know what you think — especially if you work in the lab at the CBRH.)

 

 

Numbers, please

Here are the states presented on Wednesday:

Total new cases: 20

Total cases: 193

Total hospitalized: 5

Total recovered: 16

Total positive and negative tests: 7,639

Age range of patients: under ten to over 80

 

Banks

Dr. Strang said he’d been hearing complaints about people failing to observe social distancing at banks — particularly at ATMs.

He first encouraged everyone who could bank online to do so and then advised those who had to use an ATM to wash their hands before and after and respect the six-foot social distancing rule and the five-person-maximum rule for gatherings even if it meant waiting outside the actual building (and thinking of meeting strangers at an ATM as a “gathering.”)

 

Masks

Strang addressed the issue of masks again, noting that had been a lot of media coverage of the issue. He said he’d been informed that morning that the Public Health Agency of Canada was conducting a comprehensive review of the literature on the efficacy of masks for the general public and if the evidence warranted it, the guidance from the agency would likely change.

Two reporters asked about a call from the Nova Scotia Nurses’ Union to allow its members to decide when they should wear N95 respirator masks in treating COVID-19 patients.

CP reported earlier today that union president Janet Hazelton wanted a written commitment from the government like the one signed recently by Alberta healthcare workers:

“What we don’t know with the N95 masks is: How many do they have? How long will they last? A month, two months? Give us your best guess.”

The union leader said it’s currently standard practice to issue N95 masks to nurses in situations where particles of the virus could be projected in aerosol form, such as during intubations and CPR.

However, the nurses also want access to the masks at their discretion for other situations where they’re exposed to patients with COVID-19, she said.

Strang said the province has “robust guidance” in place, including for long-term-care and homecare workers, and that Infection Control and Public Health are “aware of the union’s position on masks,” and are having a “conversation” with  infection control experts to “determine the validity” of what the unions are asking.

Strang was also asked about a case in which five homecare workers were required to self-isolate after coming into contact with a COVID-19 patient. The reporter wanted to know if he was worried by the loss of five healthcare workers. Strang said he knew there was a possibility of healthcare workers in both acute and continuing care being exposed. But he said that while, “in normal times we tend to act as a disparate system,” he had seen people work together to ensure residents at Magnolia, a long-term care residence that has lost four staff members to COVID-19, were cared for.

In related news, the Prime Minister announced today that 11 million masks had recently arrived in Canada and were being distributed to the provinces and territories.

 

$50M

Premier Stephen McNeil said that small businesses and the self-employed have long been the backbone of our economy (mom and pop operations, like DOSCO). To help them weather the crisis he announced a $50 million fund, to be administered by Dalhousie University, that would provide the following supports:

• a $20 million Worker Emergency Bridge Fund to help the self-employed and those laid-off workers who do not qualify for Employment Insurance. Government will provide a one-time, $1,000 payment, to bridge the gap between layoffs and closures and the federal government’s Canada Emergency Response Benefit;
•  $20 million to fund a new program — the Small Business Impact Grant. Eligible small businesses and social enterprises will receive a grant of 15% of their gross revenues — either from April 2019 or February 2020, up to a maximum of $5,000. The grant may be used for any purpose necessary.

Eligibility for the programs is “not affected by a person or business being enrolled in another provincial program or the federal initiatives.”

An announcement on when the programs are ready for applications will come early next week and details will be available on the province’s coronavirus website.

The remaining $10 million will be used to fund future initiatives.

 

Homeless shelters

Asked about concerns about people in homeless shelters and the impossibility of maintaining social distance in such environments, the premier said the province was working with the federal government to deal with these issues and would be making an announcement in the coming days.

 

Fishermen

Two reporters asked about the apparent arrival in Cheticamp of out-of-province fishermen who are not required to self-isolate because the industry is considered essential. The premier said he had asked the Department of Fisheries to look into it. He also expressed concern about the effect the pandemic was having on the industry in general and indicated the province was working with the federal government in this area.

 

Modelling

Asked if the province had done any modeling of likely COVID-19 outcomes for the province, Strang said the work was in progress, but that Nova Scotia didn’t have access to the resources larger provinces have for this “fairly sophisticated work.”

The question of modeling is a hot one today, after the prime minister told reporters that Canada was not yet ready to release statistical models predicting the impact of the pandemic. Ontario Premier Rob Ford announced today he would release the data showing the worse-care scenario for that province because:

“You deserve to know what I know when you’re making decisions for yourself, your family and your community,”

I think it would be good to see the government’s models simply to understand what the government thinks is going to happen and why it is taking the actions it is. But I think it’s also important to understand what these models are and their limitations. As The Atlantic reported today (after US President Donald Trump’s model moment yesterday), epidemiological models are not “snapshots of the future.”

They always describe a range of possibilities—and those possibilities are highly sensitive to our actions…

The most important function of epidemiological models is as a simulation, a way to see our potential futures ahead of time, and how that interacts with the choices we make today. With COVID-19 models, we have one simple, urgent goal: to ignore all the optimistic branches and that thick trunk in the middle representing the most likely outcomes. Instead, we need to focus on the branches representing the worst outcomes, and prune them with all our might. Social isolation reduces transmission, and slows the spread of the disease. In doing so, it chops off branches that represent some of the worst futures. Contact tracing catches people before they infect others, pruning more branches that represent unchecked catastrophes.

 

The Kid’s Table

The premier ended by addressing the province’s kids and, in fact, addressed a few — including the Cape Breton brothers, Luke and Liam Sakalauskas, who have launched their own newscast, East Coast Kids News — by name.

 

Data you can see

The government has launched a “data visualization” page for COVID-19 testing that breaks the positive tests down by Health Zone. The NSHA notes that the zone location is based on where the sample was collected, not were the individual resides. The map, as of 2:30 p.m. on Tuesday, looked like this: Liam and Lucas, ECKN

 

 

Potential exposure

The Nova Scotia Health Authority released the following advisory today:

NSHA Public Health is advising of potential exposure to COVID-19 on Sunday, March 15 at Eagles Funeral Home in Westville, and the Alma Fire Hall.

This notification is being made out of an abundance of caution as Public Health now starts contact tracing 48 hours before symptom onset. These events fell within that 48-hour period.

People who may have been exposed at the funeral home or fire hall are just past the 14-day period where they should self-monitor for signs and symptoms of COVID-19. If you were at those locations and you have developed any symptoms of COVID-19 since then, please call 811. This will help NSHA Public Health to identify any connected cases and will aid in containment efforts.

Full details here.

 

Tomorrow’s Distraction

Dolly Parton is reading bedtime stories to kids but I don’t think there’s any rule against adults listening in…