NS COVID-19 Update for 21 April 2020

Daily brief

Dr. Robert Strang on Tuesday announced Nova Scotia’s 10th COVID-19-related death — which was also the sixth at the Northwood long-term-care facility (LTCF) in Halifax, site of the province’s worst COVID-19 outbreak.

He also announced 16 new cases (one of these from Northwood), a low number likely due to reduced testing this weekend. The microbiology lab in Halifax completed only 516 tests on Monday. Strang says those would have been tests done on Sunday and there were probably fewer done than usual for a number of reasons, one being the amount of activity happening at Northwood where two more patients have been moved to an off-site recovery facility (in a hotel) and the Halifax Infirmary has set up a COVID treatment unit.

Additionally, Strang said we’re approaching the end of flu season, so fewer people are exhibiting symptoms similar to those of COVID-19.

And finally (and let’s face it, very convincingly) that the weekend’s mass shooting incident likely meant getting tested for the virus was “the last thing” on many people’s minds.

The virus has been detected in a 10th long-term-care facility (as per his policy, Dr. Strang did not name it).

 

Numbers

Total new cases: 16

Total cases: 737

Total hospitalized: 11

Total in ICU: 3

Total recovered: 286

Total deaths: 10

Total long-term-care facilities (LTCF) affected: 10

LTCF residents: 128

LTCF staff: 62

Total positive and negative tests:  22,927

Age range of patients: under 10 to over 90

 

Hijacked

Using a press conference to ask about something other than the ostensible subject of the press conference is a longstanding (and I would say highly necessary) journalistic practice, but it’s a little jarring when the press conference is being held provide the people of a province with information about an ongoing pandemic and the hijackers are out-of-province reporters asking about a weekend shooting.

In their defense, though, there was no one, other than the premier, to ask questions of on Tuesday because the Nova Scotia RCMP did not hold a press conference, opting instead to ask themselves a bunch of questions about their ongoing investigation and then answer them on Facebook.

And in fact, the questions asked about the shooting produced an interesting piece of information: asked when the government was informed about what was happening and whether EMO was involved, the premier said the government was notified of “structure fires in Portapique around midnight” and warned they could become a forest fire. “Later in the morning,” he didn’t specify the time, the province was asked for “air support” at which point, “our EMO was activated” and the staff who activate the alert system came in, but the RCMP had to ask for an alert to be sent — “Quite frankly,” said the premier, “we need the information from them.” He said they had staff “on hand,” prepared to send an alert, but it was not requested.

For the record, “Why didn’t you send an emergency alert?” was not one of the questions the RCMP asked itself and answered today.

In answer to a question about whether the military was assisting the RCMP in its investigation, the premier said this was true.

And finally, a reporter (I didn’t catch which one) asked if Nova Scotians could still be safe in their homes and if so “why?” and while the premier did dignify that with an answer, I’m not going to.

 

PPE

The CBC’s Paul Withers noted that Nova Scotia had recently received a shipment of personal protective equipment (PPE) including 1.7 million masks, gowns and face shields (I didn’t know this and can’t find a link to the story but it’s clearly true because the premier didn’t contradict him) and asked where it had come from.

The premier said it had come from a couple of sources, one of which was China. He then noted, as he’s noted before and I may have failed to mention, that they’ve tasked Halifax lawyer Fred Crooks (Jim Vibert says he “wears the somewhat deceptive title of Nova Scotia’s chief regulatory officer”) to track down PPE and other medical equipment. The premier has mentioned him by name more than once which makes me think he must be good at his job (actually, it makes me picture him as a sort of Nova Scotian Milo Minderbinder, which is probably wildly inaccurate.) McNeil said we’d also received a shipment from Stanfield’s, the local underwear maker that has begun making surgical gowns.

McNeil said the stock that has arrived will “take us into May” and before it runs out, they are “very confident that our supply line will be there.”

Withers asked if one of the two Canadian planes that returned empty of supplies from China on Monday had been chartered by the Province of Nova Scotia and McNeil said that it wasn’t “to his knowledge.”

John MacPhee of the Chronicle Herald asked Dr. Strang about the rationing of surgical masks for frontline healthcare workers, saying he’d been told they received two masks per day.

Strang said everyone in the country is rationing PPE but that were a worker’s surgical mask to become soiled or otherwise unusable, it would be replaced.

 

Burnside

Tim Bousquet of the Examiner asked about the confirmed case of COVID-19 at Burnside jail, saying he’d heard from other prisoners that they were worried because staff was moving back and forth between the medical unit — where the person with COVID-19 is housed — and the general population.

Strang said the province had a very “robust” plan in place for its correctional facilities, which started with, as much as possible, emptying them out — Strang said he believed 50% (possibly more) of the people in the province’s prisons had been released, making physical distancing easier within the facilities.

He said the fact the person in question was in the medical ward was due to their COVID-19 protocols.

 

Re-opening

Asked whether Nova Scotia would begin re-opening in May, the premier said that while a number of things — including parks and schools — were scheduled to open in May, but this would only happen on the advice of Public Health.

For his part, Strang said the question of when and how to loosen restrictions is the subject of conversations happening nationally right now. He reiterated that we “may very well see” multiple waves of the disease and must be prepared to re-introduce measures, which means we’ll be lifting restrictions “very carefully” and using “robust surveillance systems” to adjust as necessary.

 

Silence

Today’s briefing ended in a moment of silence for the victims of this weekend’s mass shooting.

 

 

Testing, testing

Strang has been saying our testing per 100,000 population rate is is now second only to Alberta’s and while strictly speaking we are behind both Alberta and the Northwest Territories, we seem to be performing well nationally:

 

Prone to recovery?

Rush University Medical Center in Chicago is undertaking a clinical trial to determine if placing COVID-19 patients facedown and giving them oxygen could help them breathe more easily “thereby reserving ventilators for more severe cases.”

The Chicago Tribune reports that patients will lie facedown for 16 hours at a time with “heated, humidified oxygen flowing in through tubes in their noses.”

Some COVID-19 patients have preexisting conditions such as asthma or lung disease, and almost 1 out of 3 COVID-19 patients may develop acute respiratory distress syndrome, study sponsors said. Fluid may leak into the lungs, causing hypoxemia, or low levels of oxygen in the blood, which can lead to shortness of breath. The condition can be fatal and may leave survivors with weakness, fatigue and a decreased quality of life.

A high-flow nasal cannula, or tube, has been proved to improve oxygenation and avoid intubation for some patients, Rush officials said. Previous studies suggest that placing patients in the prone position, but with the bed angled to keep the head slightly up, can improve breathing and reduce mortality.

Guidance to UK physicians treating COVID-19 patients on the use of “prone positioning” explains that the technique was originally found — by Chinese researchers — to be beneficial for patients on ventilators, leading to the hypothesis that it might also benefit patients “requiring basic respiratory support.” In fact, the authors of the UK guidance state:

The traditional supine position adopted by patients lying in hospital beds has long been known to be detrimental to their underlying pulmonary function.

The Tribune says patients who volunteer for the Rush study and will be “randomly assigned by a computer” to lie either prone or supine. A team of six medical workers (including a respiratory therapist and and a nurse) will turn patients as necessary — a task that will be made trickier in many cases by “multiple medical tubes.” The Chicago study will have patients lie prone for 16 hours before being turned on their backs for 4. The UK guidelines call for patients to be turned more frequently, and to move through a range of positions — fully prone, lying on right side, sitting up, lying on left side, lying prone — each of which is to be held for 30 minutes to 2 hours.

 

Contacts

We’ve been told in these daily briefings about the contact tracing that happens each time someone tests positive for COVID-19 in this province, but I was curious about the process and discovered a helpful description in this April 17 document on “Public Health Measures of cases and contacts.”

Nova Scotia’s measures are adapted from those recommended by the Public Health Agency of Canada.

The document includes a chart that categorizes contacts by “exposure risk level” — higher, moderate and lower/no risk — and explains what measures the individual should follow (depending on level of exposure) and what steps Public Health should take.

updated_Interim

 

Tonight’s Distraction

In a word: booze.

Learn to make a Negroni with Stanley Tucci or a Cosmopolitan with the Barefoot Contessa, Ina Garten: