NS Covid Update for Weekend of April 4-5

Nova Scotia announced 29 new cases of COVID-19 on Saturday and 26 on Sunday for a total of 55 new cases and 262 cases overall.  Nova Scotia says that six people are now in hospital and 53 have recovered from COVID-19.

(Remember, this is a look backward, we’re seeing people who were infected up to 14 days ago. Interestingly, 14 days ago was March 22, the day the province declared a state of emergency.)

The age range for confirmed cases has expanded to “under 10 to over 90.”

Media reported on Sunday that one case of COVID-19 has been identified among staff at the IWK Health Centre in Halifax and one case among staff at the Aberdeen Hospital in New Glasgow.

“Some” healthcare workers have been ordered to self-isolate because of close contact with their infected colleagues but the NSHA is not saying how many exactly. (Why not, I am not sure.)

Because community spread is now clearly taking place, Dr. Robert Strang, Nova Scotia’s chief medical officer of health, announced plans to expand testing. Strang says the province will now open “pop-up” assessment centers in areas where clusters of cases have been identified, if no assessment center currently exists there. The first such facility will be in Elmsdale. Nearby Enfield is home to a long-term care facility where three staff members and two residents have tested positive for COVID-19. Strang said once opened, such centers will remain open as long as necessary.

As with the province’s existing testing centers, you must be referred for testing by 811 or by a primary care physician.

There are now 22 primary assessment centers in Nova Scotia: 21 operated by Nova Scotia Health Authority (NSHA) and one operated by the IWK Health Centre. Two mobile assessment centers are being established by NSHA to do community-based testing.

Emergency Health Services operates two field assessment units, one in Halifax Regional Municipality and one in Cape Breton Regional Municipality

As of Monday, the microbiology lab in Halifax will be operating 24/7 and able to process 1,000 tests per day.

 

Numbers, please

Total new cases: 55

Total cases: 262

Total hospitalized: 6

Total recovered: 53

Total tests conducted to date: 9,772

Age range of patients: under ten to over 90

(Further data visualizations)

 

Workplaces

Strang took a moment during Sunday’s briefing to clarify the rules for workplaces. He said if someone tests positive for COVID-19 and there is a chance they may have exposed people at their place of work, the business owner will be notified by Public Health.

If you are an employer and one of your employees tests positive and you are not contacted by Public Health, Strang says that means the workplace has not been exposed and there is no need to shut down.

In fact, even if there is workplace exposure, Strang said it would be very “rare” that Public Health would recommend a complete shut down. Instead, it would test anyone exposed and advise on special measures, like cleaning.

It is important, he said, that all businesses that can remain open do. He said business owners with questions should use a new tool for businesses on the province’s dedicated COVID-19 site.

 

Privacy

Strang, in response to a couple of questions on Sunday, reiterated his concerns about privacy in explaining why the province is only releasing case information on a Health Zone level.

He’s also concerned that naming affected communities might give Nova Scotians in other communities a false sense of security.

How this jibes with opening temporary testing centers in areas where heightened disease activity has been detected, I do not know.

 

Limit movement

Strang again told Nova Scotians that they should leave their homes as little as possible. That means:

• Don’t open up the cottage unless you are going to move there permanently. You should not be traveling back and forth between two residences.
• Don’t go shopping for an item or two, try to shop once a week (or less). Strang said in his neighborhood, people take turns shopping for seven households, so only one person is making a trip to a grocery store.
• Don’t go for drives. Driving means stopping at gas stations and using shared equipment and it could mean a road accident which could add to the burden of our already “stressed” healthcare system.
• Don’t buy stuff for pick-up on Kijiji or other online sites — it involves non-essential driving and touching objects other people have touched.

 

The reckless 30%

Here’s a number for you: at least 80% of the population must follow the Public Health rules on social distancing for them to have an impact on the spread of the virus.

Strang said he’d been looking at modeling that said that if this slips, even to 70%, a jurisdiction will derive no benefit from the social distancing measures.

I can’t say for sure this is the paper he’s citing, because I haven’t asked him, but here’s a pre-print article (that is, one that hasn’t gone through the usual peer review process) published by the Centre for Complex Systems and the Marie Bashir Institute for Infectious Diseases and Biosecurity at Sydney University that shows that “Coronavirus will continue to spread virtually unchecked unless at least eight in 10 Australians stay home as much as possible.” It says of social distancing (SD):

For the SD compliance set at 80% and 90%, we observe a reduction in both incidence and prevalence, lasting for the duration of the strategy (91 days). The 80% SD compliance does not completely eradicate the disease, but reduces the new cases to less than 100, with prevalence below 1,000 (during the suppression period, before the resurgence). It is evident that this level of compliance would succeed if the strategy was implemented for longer period, e.g., another 5–6 weeks.

The 90% SD compliance practically controls the disease, bringing both incidence and prevalence to very low numbers of isolated cases. It is possible for the epidemic to spring back to significant levels even under this level of compliance, as the remaining sporadic cases indicate a potential for endemic conditions. We do not quantify these subsequent waves, as they develop beyond the immediately relevant time horizon.

Although the paper has not been peer-reviewed, the model has been used before to map the spread of influenza in Australia, and the same team published peer-reviewed papers with those results.

The study was led by Complex Systems academic and pandemic modeling expert, Professor Mikhail Prokopenko, who said that with 80% compliance, the social distancing measures would have to be in place “for four months.”

However, if ninety percent of the population complies, then the duration could be as short as thirteen to fourteen weeks—meaning if we began tomorrow we could expect a control of COVID-19 by July.

But Prokopenko’s study also notes:

Nevertheless, we do share the concerns expressed by the Imperial College COVID-19 Response Team: “The more successful a strategy is at temporary suppression, the larger the later epidemic is predicted to be in the absence of vaccination, due to lesser build-up of herd immunity”.

I’ve been following U of T epidemiologist David Fisman on Twitter (@DFisman) and he has suggested the Public Health measures will have to be reimposed periodically over the next 18 months to two years or until a vaccine is discovered. (You can hear a good interview with him here, on #onpoli with Steve Pakin and John Michael McGrath.) Fisman says during this period we must “protect LTCF and hospitals throughout. We relax social distancing as ICU capacity rises, and strengthen when it decreases.”

Also worth noting, the words of James McCaw, a professor of mathematical biology at the University of Melbourne, who told ABC news:

…while the modelling is based on plausible scenarios, the results cannot be considered predictions.

Professor McCaw said that, in common with all epidemic modelling to date on COVID-19, the scenarios were illustrative but should not be considered definitive.

 

Advanced Care Directives

On the subject of COVID-19 and long-term care facilities, Dr. Strang said it was important that anyone in such a facility have an advanced care directive in place, because in the absence of one, the healthcare system has no choice but to give the “highest” rather than the “most appropriate” level of care.

 

Enforcement

Asked what measures the province would take to ensure police enforcement of the public health directives (which involves hefty fines) will not disproportionately affect the already marginalized in society, the Premier responded, “The virus doesn’t discriminate.”

First of all, the virus may not discriminate, but our society does, putting some people much more at risk of contracting it than others. People forced to live in close quarters; low-wage workers forced to continue working in suddenly “essential” services like grocery stores and gas stations; people with underlying conditions like diabetes and high blood pressure, both of which are associated with low-income; are all more likely to be infected.

And second, the virus may not discriminate, but police officers have been known to, and it’s perfectly reasonable to pay attention to who, exactly, is being hit with these fines (which, it must be noted, are much more onerous for low-income than high-income people).

Tim Bousquet has covered this in much greater detail today.

 

Healthcare workers

Strang was asked about protections for healthcare workers in the wake of two testing positive and said that, as much as possible, the province is trying to ensure workers don’t travel between healthcare facilities.

Patients with COVID-19 in LTCFs or acute care facilities are to be “cohorted” and separated from other residents (or patients) and, if possible, tended to by dedicated staff.

The question of masks did not come up again in this context but it’s worth noting that the US Centers for Disease Control (CDC) is recommending that all Americans wear homemade face masks when they go outside.

Canada’s chief public health officer, Dr. Theresa Tam, said on Saturday that Canada was looking at the latest recommendations right now.

While not flat-out recommending the masks yet, she did say there were situations where a homemade mask might be of some use, like on public transit where maintaining two meters of social distancing was not possible.

The CDC website offers advice on making, wearing, removing and laundering homemade face masks.

 

Cross Country Check-Up

Writing in the National Post on Saturday, Brian Platt described Canada’s public data on COVID-19 as “mostly a mess.”

The problem is that much of it’s based on public data that’s limited, incomplete and often outdated, meaning it can lead to wrong conclusions about what’s really happening.

Platt’s advice was to focus less on case counts, which he says “substantially underestimate the real case count due to limited testing capacity” and more on deaths and hospitalizations:

Hospitalizations — particularly intensive care stats — are also crucial to track because COVID-19 becomes especially deadly when hospitals run out of capacity.

Nova Scotia, as noted above, publishes hospitalization stats but not ICU stats.

This is in contrast to Ontario, which now publishes not just hospitalization and ICU stats but ICU-on-a-ventilator stats.

Québec publishes hospitalization and ICU stats.

British Columbia publishes hospitalization and ICU stats.

Alberta publishes hospitalization and ICU stats.

Manitoba publishes hospitalization and ICU stats.

Saskatchewan publishes hospitalization and ICU stats.

Newfoundland and Labrador publishes hospitalization numbers but not ICU numbers.

New Brunswick publishes no hospitalization numbers but it does break testing down by Health Zone (which Nova Scotia does not).

Prince Edward Island doesn’t publish hospitalization numbers.

Northwest Territories don’t list hospitalizations (but has only confirmed four cases to date).

Yukon Territories don’t list hospitalizations (but has only confirmed six cases to date).

Nunavut has yet to confirm a COVID-19 case.

 

Tonight’s Distraction(s)

I’ll give you choice. You can watch Thomas Wesley Pentz, better known as Diplo, DJ his Corona World Tour on YouTube, Instagram and Twitch  7:00 p.m.

OR

You can watch “ACM Presents: Our Country,” on CBS at 8 p.m. (This will require cable TV, or CBS All Access membership.) As The Mercury News explains:

With the annual Academy of Country Music Awards show postponed due to the coronavirus outbreak, country music artists are still finding ways to connect with fans. This two-hour special promises at-home acoustic performances, along with some intimate conversation, by some of the genre’s biggest stars. The impressive talent list includes Kelsea Ballerini, Dierks Bentley, Kane Brown and John Legend, Brandi Carlile, Eric Church, Luke Combs, Sheryl Crow, Florida Georgia Line, Lady Antebellum, Miranda Lambert, Little Big Town, Tim McGraw, Old Dominion, Thomas Rhett, Blake Shelton and Gwen Stefani, Shania Twain, Carrie Underwood, and Keith Urban. Also on tap: A tribute to the late Kenny Rogers with performances by Luke Bryan, Brad Paisley and Darius Rucker. (8 p.m. Sunday, CBS).