NS COVID-19 Update 9 April 2020

Daily briefing

Dr. Robert Strang announced a second COVID-19-related death in Nova Scotia, that of a woman in her ’90s with underlying medical conditions at the Cape Breton Regional Hospital. In response to a reporter’s question, Strang said there was no known connection between this death and an earlier COVID-19 death at the hospital — he said the women were both admitted on the same day but came from different parts of the community.

Both Dr. Strang and Premier Stephen McNeil sent their condolences to the family.

 

 

Both also used today’s briefing to urge Nova Scotians to celebrate their various religious holidays — Easter, Passover, Ramadan — by staying home this long weekend and I presume the advice applies to chocolate-eating heathens as well, although this demographic did not merit special mention.

Strang ended with:

We will get through this and maybe we will be better — we will be different, but maybe we will be better.

Premier McNeil said that applications for a fund for small businesses and one for workers will be available tomorrow at 8:00 a.m. and the province will be operating a toll-free number to assist applicants from 8:00 a.m. to 8:00 p.m. daily. (Information can be found on the province’s dedicated COVID-19 website.)

He also announced stricter measures at the province’s borders where those not coming in for work purposes will be encouraged to go home and only healthy workers in certain essential industries will be exempt from the need to self-isolate. As of today, this group will NOT include fishers and temporary foreign workers who will be required to self-isolate for 14 days. (Fishers may self-isolate on their boats and will be permitted to dock to receive grocery deliveries.)

He said provincial parks and campgrounds are closed, as are private campgrounds.

 

Numbers

Total new cases: 31

Total cases: 373

Total hospitalized: 10

Total in ICU: 4

Total recovered: 82

Total deaths: 2

Total positive and negative tests: 12,550

Age range of patients: under ten to over 90

(Further data visualizations)

 

Dr. Tam

Dr. Theresa Tam, Canada’s chief public health officer, released data and modeling today suggesting that even with strict public health measures in place, Canada could have between 22,580 and 31,850 COVID-19 cases and 500 to 700 deaths by April 16 (as of today we have 19,774 cases and 461 deaths — you can view the figures on the Canadian COVID-19 Situational Awareness Dashboard).

She said their ambition was “early and rapid epidemic control” which would mean responses to outbreaks “will likely to continue to be required over time.”

She said this means measures like physical distancing and handwashing and sleeve-coughing and travel restrictions and case detection and quarantining will have to be re-imposed — or as Dr. Strang put it, loosened and then tightened again periodically. This is because if the epidemic is brought under control rapidly, there will be no “underlying immunity” in the community which will be susceptible to another, albeit likely less serious, outbreak.

Asked what this meant for summer activities here in Nova Scotia, Dr. Strang said it remained to be seen but the stricter we are about observing the Public Health rules now, the sooner we’ll be able to begin lifting them. That said, the measures are not likely to be lifted until at least June.

Dr. Strang was asked again when Nova Scotia intended to present its own modeling but he said (again) that it is sophisticated, technical work; that it takes time; that Nova Scotia doesn’t have the resources of larger provinces; that they’ve been more focused on ramping up testing capacity; and that the projections will one day be made public (presumably before our second or third pandemic wave). The same goes with more granular information about COVID-19 cases in the province, health officials “are looking at” breaking the cases down by something other than health zones.

 

Democracy later?

Asked if he had any plans to get the band — meaning the Nova Scotia legislature or some abbreviated version of it — back together anytime soon, the premier didn’t seem to be in any rush. He said he speaks with the other party leaders each morning and the house has already passed a budget, so…

Apparently the Alberta legislature is sitting while New Brunswick and British Columbia have struck special committees to carry out government business during these trying times.

McNeil said his government will be “held accountable” by Nova Scotians, so pay attention, Nova Scotia!

 

PPE

Asked about supplies of personal protective equipment (PPE) and nurses’ concerns about having to wear a single mask for a full shift, Premier McNeil said, again, that we have enough supplies to last until the end of April and if the equipment on order come through on time, we will then have enough to last to the end of May or even early June. He also said there were Nova Scotia companies looking at producing supplies like surgical masks and clear shields.

Both the Premier and Strang said they were looking at the possibility of using the masks more broadly among front-line workers.

I heard the president of the Nova Scotia Nurses Union, Janet Hazelton on CBC Information Morning Cape Breton this morning voicing concerns over the lack of personal protective equipment (PPE) available to the province’s nurses.  Hazelton made it clear her union is as in the dark as the general public is as to how much PPE the province actually has. (Her concerns seem to have been addressed later in the day.)

I think this is another situation where being straightforward and telling us how much equipment we have would be a better strategy than trying to comfort everyone with the idea that we’re good for a month — which they can only know if they knew precisely how this epidemic is going to unfold over the next four weeks.

There is a worldwide shortage of protective medical equipment as anyone who follows the news even recreationally knows, to the point where yesterday the World Health Organization released guidelines on rationing its use. Nova Scotia is no more immune to this shortage than it is to the virus.

 

Testing, testing

I have an update on my story about COVID-19 testing.

While increasing shifts and adding staff to handle paperwork has been, no doubt, effective in increasing the capacity of the QEII Health Sciences Microbiology Lab’s COVID-19 testing ability, it seemed to me that it couldn’t be ramped up fivefold without additional equipment — and I was right.

NSHA spokesperson Brendon Elliot confirmed for me today that the lab has acquired a new thermocyler, the pricey machine used to process the tests.

I had asked earlier if it might be possible to do COVID-19 tests in the lab at the CBRH and was told the equipment was too expensive and required specialized training. Price, though, is apparently not really an object.

I wonder if, post-pandemic (or post-first-wave of this pandemic) that new machine might be sent to Sydney and staff trained in preparation for the next wave?

On a related subject, I had also been told that the CBRH and other hospitals across the province would be supplied with kits allowing them to do rapid — but low volume — COVID-19 tests for “urgent clinical decisions.”

I asked Elliott what the status of these kits was and he told me (promptly, I need to say this, he has answered all my questions promptly):

There are a very limited number of kits available for the province to do STAT tests (90 kits in total at this point). They will be distributed to labs in the province once the lot of tests pass the validation testing.

Cape Breton Regional is high on the provincial priority list given its distance from Halifax and the fact it is one of the few labs in Nova Scotia already equipped with the specific instrument this new test requires.

The Infectious Diseases physician at CBRH and the Microbiology team are a key part of provincial planning.

The “specific instrument” is the Cepheid GeneXpert, in case you are into these things.

 

Etc.

There are a few things I’ve meant to include in past reports but didn’t, due to time constraints, so I’m going to add them now:

1. Premier McNeil has a “designated survivor” strategy of sorts. He said during a briefing earlier this week that Health Minister Randy Delorey and Deputy Premier Karen Casey would be prepared to step up were he to get sick.
2. In what sounds like a moment from a Trailer Park Boys episode, Dr. Strang actually had to call out people for lying to 911 about having COVID-19 symptoms to get them to respond faster. (I say that’s pure Ricky.)
3. During CBRM’s virtual council meeting I heard — for the first time — the disease referred to as “the COVID,” which means it has definitively penetrated the Cape Breton consciousness.

 

Location tracking

The American Civil Liberties Union (ACLU) has published an interesting paper on the uses (and limitations) of cell phone data in tracing the contacts of people diagnosed with COVID-19.

The authors first lay-out the various ways in which data on peoples’ movements and locations is collected — cell tower location data, GPS, Wi-Fi, Bluetooth and other radio location and finally, in China anyway, QR codes (the Chinese government requires citizens to download an app on their phones and use it to scan QR codes in taxis, at the entrances to buildings, on buses and in subway stations).

Then they explain that none of these is accurate enough to determine whether two people have been within 2 meters of each other for a “prolonged period of time” — the circumstances under which, according to the US Centers for Disease Control, the virus can spread from one person to another.

This has already proved problematic in Israel, which has been using location data to track the possible spread of COVID-19 and where a woman was issued a quarantine order because she waved at her infected boyfriend from outside his apartment building:

Using an inaccurate technology to determine who might have been exposed to COVID-19 can lead to “expensive mistakes such as two week isolation from work, friends and family for someone — perhaps even a health care worker or first responder — who was actually not exposed.”

Another problem is that there is “no single, centralized party” holding all the location data we generate.

Most location data with any level of precision is generated by an essentially corrupt ecosystem of shady, privacy-invading companies that engage in mass location tracking without individuals’ meaningful awareness or consent, typically by paying the developers of smartphone apps to hide tracking capabilities inside those apps. This location data is scattered among dozens of such companies most Americans have never heard of. And giants like Google and Facebook that collect location data have enormous reach within the population, but only have location data on a minority of their users. Any kind of automated contact tracing that hopes to find close contacts will need to access more than a slice of existing data pools if the tracking is to effectively find otherwise unknown infected people.

Location data works best, the report says, when used to “trigger a patient’s recollection of places traveled in the past.” In South Korea, for example (do you sometimes feel the whole world is playing Jan Brady to South Korea’s Marcia?) the legislature:

…passed a law giving the government authority to collect location data from those who test positive. But instead of trying to cross-reference the location histories of infected people against massive population-wide location datasets, South Korean officials simply “anonymize” and publish the patients’ location histories. Numerous web sites and apps make that information available, and citizens can check for possible collisions with infected people. Widespread and quick testing is available for anyone worried that they have been exposed. Such checks have become a part of daily life in South Korea.

But South Korea isn’t good at everything — it hasn’t always done an adequate job of anonymizing the data (ask the 43-year-old man who was identified by his district and located “at his work” attending “a sexual harassment class.”)

In fact, anonymizing data is “surprisingly difficult,” and this is particularly true of location data because “people reveal themselves by where they go.”

That said, information about the times and places where infected people were present could certainly be aggregated and anonymized far more effectively than South Korea has done. And there are ways to use location data that don’t involve publishing it —for example, it could simply be used in cooperation with those who are infected to jog their memories and help them retrace their movements.

The authors then consider the possible use of such data for enforcing quarantines and shelter-in-place orders — turning people’s phones into “ersatz ankle monitors.” They give the example of aggregate data being used to shut down a rogue bar in Los Angeles during a shelter-in-place regime and electronic tracker wristbands being given out in Hong Kong to people under compulsory home quarantine.

But they end with a warning:

Public health experts caution, however,that a law enforcement approach to combatting disease is less effective than relying on voluntary measures and compliance. That is because an enforcement approach often sparks counterproductive resistance and evasion and tends to sour the relationship between citizens and their government at a time when trust is of paramount importance. Good public health measures leverage people’s own incentives to report disease and help stop its spread.

 

Tonight’s Distraction

Serena Ryder performs via Facebook and Instagram as part of the NAC’s Canada Performs series. 7:00 p.m. ADT