NS COVID-19 Update 28 April 2020

Daily briefing

Premier Stephen McNeil opened today’s briefing by sending his condolences to the families of the three Northwood residents who died of COVID-19 over the last 24 hours and those who died over the weekend. He also marked the National Day of Mourning for all workers who’ve died on the job before turning the briefing over to Dr. Robert Strang who announced the three new deaths at Northwood long-term-care facility (LTCF) in Halifax and 15 new cases of the virus. This brings total cases in the province to date to 915.

Of those new cases, Strang said four were connected to Northwood, the only LTCF with a large, ongoing COVID-19 outbreak. To date, 199 residents and around 78 staff there have tested positive. Nine other facilities have at least one case but “no active, ongoing transmission” of the disease.

Strang said for an outbreak to be considered over, a facility must go 28 days without another case and that it will “take some time” to get the outbreak at Northwood under control.. That said, he said staff hope to move as many as 50 patients to an off-site recovery facility by the end of the week, freeing up significant space within Northwood.

The microbiology lab at the QEII Health Sciences Centre in Halifax, which does all COVID-19 testing for the province, processed only 483 tests on Monday, well below its 1000/day capacity (although it should be acknowledged, well above its 150-200/day pre-pandemic capacity).

Strang said a number of factors may have contributed to the drop in testing, including the weekend and the end of flu season, which means fewer people are exhibiting symptoms that “might be” COVID-19.

Strang allowed himself a cautious bit of good news today, noting that 57% of overall cases have recovered.

 

Numbers

Total new cases: 15

Total cases: 915

Total hospitalized: 12

Total in ICU: 3

Total recovered: 522

Total deaths: 27

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

LTCF residents: 218

LTCF staff: 95

Total positive and negative tests to date: 27,817

Age range of patients: under 10 to over 90

 

Slow and cautious

Premier McNeil said schools and licensed daycares in this province will remain closed until the May long weekend at which point the government will “reassess.” He said a second workbook will be delivered to households to guide learning and he ended today’s briefing by telling Nova Scotian kids that he was sure they could hang in for another three weeks of home schooling.

Strang had previously tried to head off questions about when the province would reopen after noting that people were no doubt watching other provinces (Quebec announced today that elementary schools and daycares outside of the Montreal areas will reopen on May 11) and wondering when we would follow suit. But he said, as he has repeatedly during these briefings, that while we follow the national framework for reopening, our restrictions will be removed “safely and slowly” based on Nova Scotian epidemiology and other local data.

Strang said we “still have a considerable amount of disease” in the province and it would not be “appropriate” to lift restrictions at this time. Once again, he stated that his team was working on a plan and getting input from various groups, businesses and organizations.

But, he warned, even as restrictions are lifted, measures like social distancing, handwashing and limits on gathering size will remain in place for “months ahead of us.” Businesses can only open safely if people stick to these rules, he said, adding that our “normal” is “actually going to look quite different for a significant amount of time.”

(He gave some of the rationale for this, explaining, for instance, that as long as gatherings remain small, if there is exposure, it will affect a limited number of people and be easier to bring under control.)

Asked if, given concerns about people’s mental health in the wake of the April 18-19 shootings, he might consider reopening parks and beaches to allow people to spend more time out of doors, Strang said they were “actively” looking at “opening up perhaps people’s options to be outdoors more.”

 

Municipal loans

Several reporters asked the premier about today’s announcement the province would make $380 million available to municipalities in the form of loans with a three-year payback period. The loans are intended to make up for shortfalls resulting from deferred property taxes.

In particular, McNeil was asked why loans and not grants? To which he replied the taxes would eventually be paid, at which point, the municipalities could repay the loans. He said the province was borrowing the money at a rate better than the municipalities would receive were they to approach a commercial lending institution. (I guess the municipalities should be grateful they weren’t instructed to take out bank loans to cover deferred property taxes.)

He said municipalities will determine their own rent-deferral programs but the province was advising people, “If you can afford to pay, pay.”

McNeil said the three-year payback plan is “outside typical municipal borrowing” and would not impact the current or next fiscal year. He noted that the deal was worked out by Municipal Affairs Minister Chuck Porter in cooperation with the Federation of Nova Scotia Municipalities (FNSM).

 

Did we peak?

Asked if our epidemic is on track to peak in late April/early May as predicted, Strang said it is possible the province did hit the peak at “just about the time we said,” but he warned that a peak may not look like “one defined” moment but could be a jagged series of moments, and said they would watch their epidemiology very closely to determine exactly what was happening.

He said that while there seemed to be an overall decline in community transmission, there were still “sporadic community clusters” of disease around the province.

Asked about the chances that a second wave of the virus could be worse than the initial wave, Strang said they recognized that “how much we’re impacted” will depend on how many people were actually infected in the first wave, which is why he is involved in talks at the national level about conducting a “sero-survey” to look for people’s level of immunity — that is, testing to see if people have antibodies in their blood showing they’ve had COVID-19, perhaps with mild or no symptoms.

Strang said there were caveats attached to this because they don’t know how long the immunity might last. Interestingly, the World Health Organization addressed the issue this weekend in a situation report, stating:

Although some governments have suggested that the detection of antibodies to SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an “immunity passport” or “risk-free certificate”, there is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.

Which doesn’t mean people don’t have immunity, just that we don’t know yet. The WHO has published a scientific brief on the subject.

Strang tied this discussion to the possibility of using the increased capacity at the microbiology lab to do additional work, like antibody testing. He said they were also beginning conversations about possibly testing the province’s entire homeless population, starting in Halifax, where a shelter resident tested positive last week. Strang said they tested all residents and staff in the affected shelter and then expanded to testing residents and staff throughout shelters in HRM. So far, he said, there were no further positives, although they had a few more tests to perform.

He said homeless people needing to self-isolate until they were no longer infectious were put in hotels as were their contacts.  Strang acknowledged that following any of the public health rules — social distancing, gathering with no more than five people, even handwashing — can be impossible in a homeless shelter. He said they are having conversations around “how do we do a better job supporting the homeless community.”

On the subject of additional work that could be performed by the microbiology lab, Strang said antibody testing could tell them something about community spread which could give them “other pieces of evidence to help form our response plan.”

 

Inquiry

Asked again whether he would call an inquiry into the RCMP response to the April 18-19 mass shooting, the premier said that the incident remained under investigation.

 

Senegal

I’ve heard that the COVID-19 pandemic is better described — even within Canada — as a “series of epidemics” and listening these past few days to reports from a few other affected nations, I’ve realized how very true that is.

What it comes down to is that, although the disease is the same (I realize there may be slightly different strains but my understanding is that SARS-CoV-2 doesn’t actually mutate that quickly) the course of the disease is affected by many factors, including demographics and public health responses.

I’ve heard quite a bit about these responses (good, bad and the jury’s still out) in countries like South Korea, New Zealand, Italy, the US and Sweden, but until Monday, I had not heard anything about the responses in Senegal and Turkey and it turns out both are interesting (albeit for quite different reasons).

Senegal, which has drawn on its experience battling Ebola to try to contain the coronavirus, is particularly interesting, although there seem to be two competing narratives about what is happening in that country.

On the one hand are the positives, as outlined in this Al Jazeera report, featuring journalist Nicolas Haque in Dakar, who explains that as soon as the Senegalese government saw the virus becoming serious in Europe — and before there had been any deaths in Senegal, although the virus had been detected there — it shut the borders and closed the airport on March 20 in a bid to avoid further imported cases. It shut restaurants, schools and mosques, mandated the wearing of masks in public transport and shops, banned travel between cities, encouraged people to stay home as much as possible and, as of March 23, imposed an 8 PM curfew. The country has not imposed a complete lockdown because, says Haque, for many people, if they don’t work, they don’t eat.

Another challenge, according to Voice of America (VOA), is that roughly half of Senegal’s 16 million people are illiterate, so to communicate public health messages, the government turned (as it did during the Ebola crisis) to the Senegalese graffiti artist collective, RBS (Radikl Bomb Shot):

The group of about 30 artists has been creating murals around Dakar to illustrate proper hygiene practices and to encourage people to stay home and respect the curfew.

 

Haque says that wherever you go in Senegal, your temperature is checked and if you go to a health center for any reason, you are first tested for COVID-19. Reuters reported on Monday that the country is also working to get its homeless children — who number 40,000 in Dakar alone — off the streets.

Hacque says that the country had begun using contact tracing in 2015 with Ebola and was now using it with COVID-19.  When someone tests positive for the virus, the people who were in contact with that person are isolated in a hotel — “tens of thousands of people” are now being housed in the country’s hotels, of which there are many because tourism is an important sector of Senegal’s economy.

The United Nations Conference on Trade and Development (UNCTAD) noted last week that Senegal was fast-tracking the implementation of e-commerce policies and reforms to help brick-and-mortar businesses move online. Senegal’s trade ministry has created an e-commerce platform providing access to the websites of small- and medium-sized businesses selling essential goods. The website Internet Stats puts internet penetration in Senegal at 58%. (The country is also, since the closure of its schools, offering lessons online — but in addition it is using TV and radio, as is Kenya, which has a well-established radio and television educational broadcast system.)

Senegal has also been supplying emergency food aid to vulnerable households.

 

Testing kits

But there is more to Senegal’s response than public health measures. The country is home to a renowned biomedical research center, the Institut Pasteur de Dakar, led by Amadou Alpha Sall, a key person in containing West Africa’s Ebola outbreak. In early January, the institute was working with Mologic, a British biotech company founded by the inventor of a widely used pregnancy test, to develop an early detection kit for dengue fever. As news of COVID-19 spread, they switched their focus from dengue to coronavirus and according to Haque, they have developed a cheap testing kit:

It’s a $1 kit and it’s a mobile kit so, you take [a] swab of saliva or blood, you put it into this small machine that looks like a suitcase, and 10 minutes later, you have the results of whether or not you’re infected with the virus.

The idea, says Sall, is to allow quick testing to be done in remote places without the need of a super-equipped laboratory. He says they could manage 500 tests per day with the possibility of going up to 1,000. According to an earlier Al Jazeera report:

Their test can be done in two different ways – using saliva or blood. Those with an active infection would use a saliva swab to detect the new coronavirus, while those with a previously undetected case would use an at-home finger prick test to check for coronavirus antibodies.

The price of the kits will be kept low thanks to funding from the UK government and the Bill and Melinda Gates foundation. Technext, a Nigerian tech website, reported on Monday that the test kits “won’t be ready for distribution until June, after necessary testing must have been concluded.”

Mologic announced on April 17 that its “point-of-need” COVID-19 test, as the mobile test is called, had been independently assessed and was being prepared for launch “with CE mark” — a certification mark that indicates conformity with health, safety, and environmental protection standards for products sold within the European Economic Area. The company said further validation of the tests would be carried out with other “independent validation groups,” including the World Health Organization (WHO)

And while the British firm had initially stated the COVID-19 test would be manufactured at diaTROPIX, a facility in Senegal, on April 24, Mologic announced work was “well underway” on a diagnostic manufacturing facility near its own laboratory in Bedfordshire UK:

The facility has been incorporated as an independent, sustainable social enterprise under the name of Global Access Diagnostics, with a commitment to deliver diagnostics at a fair price to both national and international markets…

The first products to be manufactured in the facility will be rapid diagnostic tests for COVID-19, as part of Mologic’s commitment to support the global pandemic response.

The new facility will be operational within eight weeks, enabling the company to produce up to 40 million tests per year, scaling from the existing manufacturing capability…

The facility will also look to support the establishment of manufacturing partnerships within low-income countries dedicated to serving the specific diagnostic needs of their people and regions.

There is another innovative Senegalese response to the virus that has come from engineers who are using 3-D printers to make ventilators, but 3-D printing of medical devices has turned out (unsurprisingly) to be a complex issue that I am going to discuss in more detail another day.

 

Statistics

The flip side of Senegal’s COVID-19 story is that, as noted at the outset, the virus has reached the country — its first case, a French citizen, was detected on March 2. According to Al Jazeera:

Senegal’s initial cases were linked to travellers and community transmission remained low. That changed mid-March when a Senegalese, returning from Italy, infected 20 people in Touba, the second most populated city…

By March 23, the cases jumped to 79 and Senegal declared a state of emergency. That evening, President Macky Sall, while imposing a dusk-to-dawn curfew, addressed the nation and said: “The situation is serious. I say this tonight in all solemnity.”

According to the Africa CDC, as of Tuesday Senegal had 823 confirmed cases of COVID-19, nine deaths and 296 recoveries. The health ministry has warned that market traders are particularly at risk.

The country has extended its state-of-emergency and dusk-to-dawn curfew to May 4.

I can’t find stats on how many tests Senegal is now capable of conducting but media reports that the country is able to do “widespread testing” thanks to its inexpensive test kits seem premature. The head of Africa CDC, John Nkengasong, wrote a piece for Nature on Tuesday stating that Africa’s COVID-19 statistics — which currently stand at 30,000 cases and about 1,400 deaths — are likely an “underestimate” due to low testing. South Africa, one of the continent’s richest countries, has run only about 280 per 100,000 population. Wrote Nkengasong:

[W]e need to speed up the production of test kits within Africa. Plans for production are under way in Kenya, Morocco, Senegal and South Africa. In April, Africa CDC launched an initiative called Partnership to Accelerate COVID-19 Testing (PACT). The goal is to reach 10 million tests in the next four months, although this timescale falls far short of serving our very real immediate needs.

Honestly, I had intended simply to write a paragraph or two about Senegal’s quick, cheap COVID-19 testing kits and 3-D printed ventilators and I’ve produced an entire screed on the one subject and have yet to broach the other. Somehow, nothing is ever as straightforward as some media reports make it seem.

 

Turkey

This one, I promise, I will keep short.

It seems Turkey’s hand-sanitizer of choice is cologne — or more precisely, kolonya. According to the BBC:

…kolonya has been a treasured symbol of Turkish hospitality and health since the Ottoman Empire, and it’s often described as Turkey’s national scent. Traditionally, this sweet-scented aroma made with fig blossoms, jasmine, rose or citrus ingredients is sprinkled on guests’ hands as they enter homes, hotels and hospitals; when they finish meals at restaurants; or as they gather for religious services. But unlike other natural scents, this ethanol-based concoction’s high alcohol content can kill more than 80% of germs and act as an effective hand disinfectant.

So, when Turkey’s Minister of Health championed kolonya’s capacity to fight the coronavirus on 11 March, it not only inspired a wave of national media attention touting the cologne’s anti-Covid-19 powers, but also caused queues stretching nearly 100m to quickly form at chemists and stores across Turkey. In fact, since Turkey’s first confirmed coronavirus case in mid-March, some of the nation’s main kolonya producers have said that their sales have increased by at least fivefold.

To meet the suddenly increasing demand for kolonya, Turkey stopped requiring that ethanol — a key ingredient in the fragrance — be used in gasoline to free up supply.

I liked this story — who wouldn’t? — but of course, there’s more to it. I have a friend in Istanbul who told me:

It is part of Turkish tradition so in the early weeks of this, they were being all self-congratulatory about already having the habit of sterilizing their hands. But it’s not the same as washing with soap/detergent, although you wouldn’t know it from the huge bowls and stacks of ‘kolonya’ at the entryway of all the markets. Now it’s become some kind of national health anthem.

Because of course, cologne — like hand-sanitizer — is good if you have nothing else, but not as good as soap and water when it comes to combating coronavirus.

Sorry, that was longer than I meant it to be. But I recommend the BBC story which is even longer and tells you all about Turkey’s cologne tradition.

 

Tonight’s Distraction

Mozart’s Don Giovanni, directed by Jean-François Sivadier with conductor Jérémie Rhorer. The production was recorded during the Festival International d’Art Lyrique d’Aix-en-Provence and is presented by France TV. (It’s one of a number of available productions if Mozart isn’t your jam.)