NS COVID-19 Update for 13 April 2020

Daily briefing

Dr. Robert Strang announced a third death and 29 new cases of COVID-19 in Nova Scotia for a total of 474. The third COVID-19 victim was a man in his ’80s in Halifax Regional Municipality, no further details were offered on privacy grounds. (I would like to see these privacy rules spelled out.)

 

Numbers

Total new cases: 29

Total cases: 474

Total hospitalized: 9

Total in ICU: 4

Total recovered: 101

Total deaths: 3

Total positive and negative tests: 16,054

Age range of patients: under 10 to over 90

 

Masks

The Premier led off today’s briefing with the announcement that we now have 300,000 masks — surgical, N95 and shields. The official government statement says:

Front-line workers in every public and private long-term care home, residential care facility and home-care agency across the province will now be expected to wear masks to help reduce the spread of COVID-19. Distribution to workers began over the weekend.

Effective Tuesday, April 14, masks will be distributed to all front-line workers in residential care and continuing care facilities and to home-care employees.

McNeil said they couldn’t begin to distribute equipment until they were sure they had “enough” PPE, having watched other jurisdictions use their supplies and then run short as their outbreak reached its peak.

(It is beyond the scope of today’s article to explore whether jurisdictions that were more generous with PPE in the early days might also have reduced the severity of their outbreaks, but that seems like a reasonable question to ask.)

McNeil said they sourced masks from the private sector (companies not currently operating gave theirs up), the federal procurement program and McNeil’s own “friends in China.” This comes as the CBC is reporting Canada is building its own “PPE network” in China, led by McKinsey-managing-director-turned-ambassador-to-China Dominic Barton, a man some nameless federal official tells us we are “lucky to have.”

We will need “millions” of masks and McNeil said he was both confident those still on order will arrive and hopeful about the possibility of a Nova Scotia company beginning to manufacture them.

 

Northwood

Northwood Manor, a long-term-care facility in Halifax, now has 16 cases of COVID-19 among its 485 residents. Symptoms range from “very mild to moderate” and all who have tested positive have been segregated on a single treatment floor. (Jennifer Henderson wrote about Northwood’s COVID-19 plans for the Halifax Examiner on March 31, before the facility had discovered any cases.)

Ten staff members have also tested positive.

Dr. Strang said he was always concerned when the disease entered a facility filled with vulnerable residents, but expressed his faith in Northwood’s executive director of long-term care (whom he didn’t mention by name, but who is Josie Ryan), with whom he said he’d worked for 20 years.

CTV, however, reported:

Angela Downey, a continuing care assistant and the business agent for the Unifor local at Northwood, says the spread of the virus through nursing homes in the province is likely to expose underlying weaknesses in staffing levels.

She says she fears there could be shortages of workers as the illness spreads and continuing care assistants cannot report for their shifts…

Downey said that it’s not uncommon for a unit with over 30 residents to have three continuing care assistants to look after their daily needs, and if they fall ill, it becomes increasingly difficult to provide the necessary care.

Members of the Northwood executive did not provide CTV a comment.

Northwood is Atlantic Canada’s largest not-for-profit LTCF.

 

Thanks, but no negotiations

The premier thanked all front-line medical workers and, indeed, all those workers risking illness to keep our world turning — bus drivers, cashiers, delivery people, etc — but when asked by a reporter (who cited Unifor’s concerns) if he would be prepared, once the worst of the outbreak was over, to address chronic staffing shortages in LTCFs, the premier bridled and said this was not the time for contract negotiations, this was the time to “come together” as Nova Scotians.

I’m guessing this is not the time to talk about a living wage for those heroes we’re thanking so profusely either.

Except, of course, this is precisely the time to be talking about these things — before life goes back to something-like-normal and we all forget whose work really mattered when the chips were down.

And although the premier didn’t want to discuss it, LTCF staffing IS an issue, which Dr. Strang acknowledged in response to a question about the safety of allowing workers who have been exposed to COVID-19 but test negative to return to work before their 14-day isolation period is up.

Strang said they don’t have the “luxury” of enforcing the 14-day quarantine because “staffing is an issue.”

Healthcare workers who return to work in these circumstances follow “work isolation” protocols that involve monitoring their temperature and wearing PPE. Strang said he felt the alternative — bringing staff in from other facilities — carried too high a risk of transmitting the virus between facilities.

 

 

North Preston

Asked about the situation in North Preston, a community considered a COVID-19 hotspot and in which the province has established a temporary assessment facility, Dr. Strang said the government is providing “social supports” in the community where COVID-19 is having a “substantive impact.”

Strang said they’re “engaging” with the community to deal with what he admitted were “longstanding challenges” in the North Preston area — financial challenges, housing challenges, transportation challenges.

(I wonder is this a good time to talk about finding “longstanding solutions” to these challenges rather than temporary measures to facilitate COVID-19 suppression?)

Asked about shortcomings raised by Unifor about the assessment facility itself, Strang said it was a matter for the local union to raise with the provincial government.

 

Projections

Nova Scotia is in the “final process” of getting its COVID-19 projections “in the right format,” said Strang, adding they are worried about communicating their meaning to Nova Scotians in a way that is “understandable” and not “confusing.”

Presumably, Nova Scotians who were able to understand the national numbers presented by Dr. Theresa Tam last week will be able to grasp the significance of the Nova Scotia numbers, but perhaps Dr. Strang knows something about us I don’t. (Actually, I’m sure Dr. Strang knows a lot about us I don’t.)

 

Law & Orders

I spoke earlier today with David Fraser, a Halifax-based privacy lawyer with McInnes Cooper, who says there needs to be more clarity in the COVID-19 orders and directives issued by the provincial government — including Dr. Robert Strang’s Heath Protection Act order and Justice Minister Mark Furey’s Police Act directive.

We spoke about two particular concerns, the first stemming from clause 6 of the Health Protection Act order, which states:

All persons present and residing in Nova Scotia must maintain social distancing of two metres or six feet and keep social gatherings to 5 persons or less

As Fraser notes, as written, the law (because this order, although temporary, is law while in effect) makes no exception for people residing in the same home. In theory, police could fine a parent for a changing a baby’s diaper or a couple for going for a walk and failing to maintain a six-foot distance between them. Of course, people are behaving as though this exemption exists, but that’s not the way the law is supposed to work. Exemptions need to be spelled out. It’s not that difficult, here’s what the social distancing by-law passed by the City of Brampton, Ontario says:

Every Person shall maintain at least a 2.0 metre distance from every other Person when on Public Property, except Persons who reside together in the same premises.

Fraser’s second major concern was sparked by a weekend tweet from the Halifax Police Department:

1/2 We are hearing rumours again, claiming our officers are stopping all vehicles with 2+ riders to check for recreational travel. While inspecting vehicles can at times be part of our #COVID-19 enforcement efforts if necessary, NOT ALL vehicles are being stopped… pic.twitter.com/GGDJcubort

— Halifax_Police (@HfxRegPolice) April 12, 2020

Other than at the Nova Scotia/New Brunswick border where incoming vehicles are apparently stopped and drivers questioned about their purpose in entering Nova Scotia, Fraser says there is nothing in the Health Protection Act or the Emergency Orders authorizing police to pull over vehicles without reasonable grounds to believe there is a violation of the law in progress and yet, that tweet from the Halifax police suggests they are pulling people over.

Which raises the question: pulling people over for what? For recreational driving? While this is actively discouraged by Premier McNeil and Dr. Strang, it is not actually against the law. Fraser says if the province thinks it should be, then it needs to add it to the list of offenses police are authorized to enforce.

On the other hand, if they’re enforcing the social distancing rule, it means they’re stopping cars on “suspicion” that the driver and passenger/s do not live in the same residence, a fact I think would be rather difficult to ascertain by eye-balling a passing vehicle. Nor should they be determining it by asking for IDs from everyone in the car because, other than the driver, who must produce a driver’s license, registration and proof of insurance when stopped by police, no one else is required to present ID.

Fraser is concerned the directive from Justice Minister Mark Furey leaves too much up to the discretion of police officers who “have a “real history and track record in Nova Scotia” of carrying out policing in “a discriminatory way” against marginalized people.

I should point out that Fraser is very clear the government has every right to make these rules in the name of protecting public health. His point is simply that such rules — which curtail people’s freedom to travel and socialize and even earn a living — must be clear and unambiguous, both for the citizens expected to follow them and the police expected to enforce them.

It strikes me, too, that given these measures a) may have to be in force for weeks yet and b) may have to be re-introduced periodically after the initial outbreak is tamed, the clearer and more reasonable they are, the more likely the government will be to get buy-in from citizens.

And yes, I know some citizens will never buy in — I have had considerable experience with the human race. I say that not by way of boast.

 

Spartan cube

Dr. Strang was asked about today’s announcement that Health Canada had approved a rapid COVID-19 test (and testing device) made by Ottawa-based Spartan Bioscience.

I am fascinated by the notion of technological “leapfrogging” — like what happens when areas that have no landline telephones skip the technology altogether in favor of cell phones– and what I’ve been reading about the “Spartan Cube,” as the testing device is called, seems like an example of the phenomenon.

As you no doubt know, all COVID-19 testing in Nova Scotia is done at the QEII Health Sciences Microbiology Lab in Halifax, which is the only lab with the necessary equipment to process DNA tests. I had asked if the lab at the Cape Breton Regional Hospital (CBRH) could process the tests and was told the equipment was too expensive and required too much training to be deployed outside the microbiology lab in Halifax.

But the “Spartan Cube” technology approved today leapfrogs the lab entirely. As the web copy explains:

Spartan’s test consists of a portable DNA analyzer called the Spartan Cube, which is the size of a coffee cup. The Cube performs the test with Spartan’s COVID-19 test cartridges and proprietary swabs, manufactured in Ottawa. The automated test can be operated by non-laboratory personnel in settings such as airports, border crossings, doctors’ offices, pharmacies, clinics, and remote communities.

Elsewhere the company includes “cruise ships” and “military bases” in its non-lab settings.

The basic test is the same as the one now being performed in Halifax:

The Spartan Cube is the world’s smallest DNA analyzer. Samples are collected with a non-invasive swab and inserted into a single-use DNA test cartridge. Inside the analyzer, the cartridge extracts the DNA and makes millions of DNA copies based on Nobel Prize-winning chemistry called Polymerase Chain Reaction (PCR). An optical system detects the increased fluorescence and algorithms automatically generate a test result.

But Spartan says its device produces results in “under an hour,” compared to about four hours for the tests now performed in Nova Scotia.

Alberta recently signed a $9.5 million contract with Spartan Bioscience for 250 devices and 100,000 test kits. (Unfortunately, that’s all the detail offered, so I’m not sure how much a device or a test kit costs or how it compares to the cost of the “mainframe” machines, as Bioscience CEO Paul Lem calls them, found in microbiology labs).

I presume the Spartan Cubes are not suitable for the volume of testing the lab in Halifax is undertaking, but you can certainly see how they could be used in the province’s COVID-19 assessment centers, hospitals or long-term care facilities.

I can’t imagine anyone actually caring about the aesthetics of the device (“Get me the most beautiful DNA analyzer you can find, STAT!” said no microbiologist ever) but if looks matter to you, rest assured that:

If Apple made a personal DNA testing product, it might look something like the Spartan Cube: A minimalist, anodized aluminum box, about the size of a large coffee mug, and roughly as heavy as a small laptop.

That reference to a “personal DNA testing product” doesn’t seem to be a mistake — apparently the product is (or was) being pitched to people who wanted to test their own DNA for reasons I have no interest in exploring. In fact, Lem, in a video about the Spartan Cube, says it will give you “the power to be your own doctor with instant diagnoses in the palm of your hand,” which is, frankly, kind of disturbing. Fortunately, the plan in Alberta is to distribute the devices to “healthcare facilities outside Calgary and Edmonton,” not to individual households. The first shipments are expected to arrive “next month.”

The success of this will depend upon the company’s ability to meet demand (Lem has said that although they’ve attracted interest from other countries, the firm will focus on Canadian orders first) and the devices functioning as advertised, but Spartan Bioscience says its “molecular diagnostic test” is based on 13 years of R&D and “decades of scientific research and its web site includes links to papers in learned medical journals referencing use of the device.

Spartan’s test was developed with funding from the National Research Council of Canada Industrial Research Assistance Program (NRC IRAP).

Strang said he’s spoken with Dr. Todd Hatchette of the QEII Health Sciences Microbiology Lab and they will look into the device.

In passing, I’m also interested in the development of a serology (blood) test to determine whether people have antibodies associated with an immune response to COVID-19 in their blood. This will be important in determining how many people actually had the virus because it will capture even those who were asymptomatic. It could also identify people who have survived the virus and have immunity (which, in the case of healthcare workers, for example, could allow them to return to work with more confidence.) Scientists worldwide are working to develop such a test which, because it requires just a small blood sample, will be “relatively inexpensive” and will “produce results in about 15 minutes.”

 

Tonight’s Distraction

Metallica’s “#MetallicaMondays”

When: Monday, April 13th at 9:00 pm ADT.

Where: YouTube

#MetallicaMondays is Metallica’s new weekly concert series. The series sees the band posting archived sets of live performances from over the years. The first broadcast premiered on March 23rd and featured their June 2019 performance at Ireland’s Slane Castle. The latest one captures the band’s 2017 headlining performance at Outside Lands Music Festival in San Francisco.