NS COVID-19 Update 29 April 2020

Daily brief

Premier Stephen McNeil began by offering his condolences to the family of the Northwood long-term-care facility (LTCF) resident who died on Tuesday and assured families withloved ones in the facility that the government is “working very hard” to get Northwood back to something like normal.

Dr. Robert Strang announced the Northwood death, which is the 22nd within the care facility and the 28th in the province as a whole.  He then announced 20 new confirmed cases of the virus and said the microbiology lab in Halifax had completed 935 tests in the past 24 hours.

To my eyes, this was the most optimistic the chief medical officer has allowed himself to be since these briefings began. He said the majority of the new cases were related to Northwood but also said, in response to questions about the facility, that the situation there has been stabilized. Asked to elaborate on the meaning of “stabilized,” Strang broke it down into three factors: first, he said, the facility’s staffing challenges, caused by the high number of infected staffers, have been addressed thanks to what sounds like a small army of volunteers (and non-volunteers) including healthcare workers from elsewhere in the system, students and community members — including restaurants who have provided meals. Strang also noted that the outbreak has been going on long enough that some staff who were infected have recovered and been able to return to work.

Second, he said enhanced testing means they know the status of everyone in the facility. He said they’ve tested all residents and staff and will re-test residents who have tested negative knowing they may soon test positive.

Third, he referred to the ability to provide “higher levels of care” at the facility thanks to the decision to move the COVID-19 Unit from the Halifax Infirmary to Northwood.

In addition, he said that 10 more residents have recovered and been moved to an off-site facility (a hotel) and he understands that many more will be ready to move soon, freeing up additional space at Northwood.

He also pointed out that while the death toll at Northwood, at 22, is serious, 211 residents tested positive and many of these have recovered, or are on their way to recovery. (As it happens, I was listening to an interview with an epidemiologist today — about which more later — who noted the overall death rate among people with COVID in Canada’s LTCFs is 25%. Northwood’s, today, is 10%.)

Strang also stated that in the nine other LTCFs in the province that have had at least one case of COVID-19, there have been no new cases in staff or residents and the facilities are considered stabilized, although Public Health can’t declare an outbreak is over until two full incubation periods have passed. In the case of COVID-19, that period is 14 days, so the all-clear sign can only be given after 28 days.

Strang saluted the good planning and foresight of these facilities, as wall as “good collaboration” from the rest of the system.

Asked if there were lessons to be learned from what happened in Northwood (the largest LTCF east of Montreal), Strang said that once the worst has past, his department will produce a “Lessons Learned” document capturing what they’ve learned about the virus and the impact of the response, which will be used in the case of a second wave of infection.

Interestingly, especially for someone who was writing about asymptomatic transmission and the implications for LTCFs and mask-wearing earlier this week, the premier stepped in at this point to say that they have also been learning as they go, pointing out that when they started seven weeks ago, they “believed asymptomatic people couldn’t pass the virus” and now they know “that’s how it got into long-term-care facilities.”

Strang said the same was true of masks, which they instructed all frontline healthcare workers to wear once the evidence pointed to their being effective. He said they now have evidence it is “making a big difference.” Asked if the province would consider making non-medical grade masks mandatory for everybody once the restrictions begin to be lifted, Strang didn’t rule it out but noted they were already recommending them for people going into public situations where they couldn’t adhere to social distancing rules.

Perhaps the biggest sign that Nova Scotia may have turned a corner? These briefings are no longer going to be daily, but only on Tuesdays, Wednesdays and Fridays.

Strang ended by saying (all together now): that the best way to protect Nova Scotians in group care settings of any description is to minimize community spread of the virus and the best way to do that is by following the public health rules.

 

Numbers

Total new cases: 20

Total cases: 935

Total hospitalized: 11

Total in ICU: 3

Total recovered: 529

Total deaths: 28

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

LTCF residents: 227

LTCF staff: 97

Total positive and negative tests to date: 28,421

Age range of patients: under 10 to over 90

 

Icebergs

Keith Doucette of Canadian Press (CP) noted that Newfoundland and Labrador will be announcing plans tomorrow for reopening the province, but that it would be tightening border controls in the wake of an influx of iceberg-chasing tourists. He also noted that New Brunswick plans to prevent further entry of temporary foreign workers and asked if Nova Scotia planned similar moves.

The premier said controls at our borders will remain in place and anyone arriving from outside the province will have to self-isolate for 14 days, but he said there were no plans to restrict the workers, who were an important part of the agricultural and fishing industries. Foreign workers will be permitted to enter but are expected to follow the protocols in place, which will see them self-isolating at a designated location for 14 days upon arrival.

McNeil said he and Strang will continue to watch other provinces, especially the ones further West whose epidemics began earlier than ours, but that decisions would be made on the basis of Nova Scotian epidemiology.

 

Surplus Police Equipment

Asked if, given the killer in Nova Scotia’s recent mass shooting had been able to purchase a great deal of surplus police equipment, he would consider tightening the Motor Vehicle Act regulations governing the resale of such equipment, the premier said they would be looking at “those details as the investigation unfolds.”

He noted the same discussion is going on nationally regarding both police and military surplus equipment.

 

Rescheduled surgeries?

A reporter noted that the province’s hospitals have not seen the surge in occupation anticipated and wondered if surgeries and treatments that had been postponed to free up capacity would be rescheduled?

Dr. Strang said it is part of the discussions about reopening everything, but that the “last thing” they want to do is “fill up the hospitals” and then discover a second wave of infection.

 

Feed Nova Scotia

Asked if the province was considering another round of funding to people on income support and Feed Nova Scotia, the premier said they are continuing to monitor the situation but no decision has been made yet.

 

Testing, 1,2,3

Asked if the province was considering expanding testing beyond the homeless to other groups, Dr. Strang said they are moving to testing the homeless in other parts of the province — in fact, they’d had a meeting this morning to “see what this may look like.”

They’ve made no decisions as to what other groups may be tested, although healthcare workers are a possibility. Strang said his colleagues in the microbiology lab have warned him there are challenges around testing “a large number of asymptomatic people” (I don’t know what these are but I am intrigued) but he said the lab can do up to 1,500 tests per day and that capacity will be put to some use.

 

Digs

A RadCan reporter told the premier he’d been hearing from workers coming from outside the HRM to work at Northwood that they were having trouble finding short-term accommodations and asked if the province would be prepared to help.

The premier said he hadn’t heard of this but that the province would be ready to assist and that they could put people in hotels if necessary.

 

Apple Polishing

The Post‘s Sharon Montgomery-Dupe asked the premier a very long question that involved a recitation of a list of the products bearing the premier’s “incredibly emotional” catch phrase “Stay the Blazes Home,” and the countries where they’ve been produced. I think the final question was how the premier felt about this, and as you can imagine, he felt pretty darn good about it and told Sharon he looked forward to her questions every day.

Montgomery followed up by asking if the case numbers provided for each Health Zone daily could include the number of cases resolved and Dr. Strang thanked her for the suggestion and said he’d look into it.

Then a reporter whose name I did not catch announced his question had already been asked so he’d use the opportunity instead to thank the premier for building a new hospital (I believe in Colchester). This also went over well.

 

Postal Codes

Tim Bousquet said he had a copy of a document identifying COVID-19 clusters by postal codes which he said some residents of the designated communities claimed were being used to deny them doctor’s appointments.

Strang said the document was internal information intended to alert staff in hospitals, especially in Dartmouth communities, that a patient had an elevated risk of being infected so they would use the necessary PPE.

Strang then said that this was “one of the things” they’ve always been concerned about when releasing the “local level information” reporters like Bousquet are always pushing for. I feel the need to point out that Sharon Montgomery, who could do no wrong with her questions today, regularly pushes for more local level information from Cape Breton.

Bousquet then noted that Strang has spoken frequently about healthcare workers bringing COVID-19 into Northwood but wondered if he was concerned about the infection traveling the other way, back into the community.

Strang said that strict infection control measures and PPE in acute and LTC facilities “greatly minimize” the chance of a healthcare worker being infected. (The numbers released by the province only include staff members at LTC homes who’ve tested positive, so I have no idea how widespread the illness has been among healthcare workers.)

 

Internet & Festivals

Kyle Shaw of the Coast asked first how many Nova Scotians had been connected to the internet thanks to the $15 million the province announced it would spend on March 20 to expand rural broadband. The premier said he’d have to get back to him with the numbers.

Shaw then asked if any summer festivals would take place this year and the answer was that it would depend on what Public Health said and how well people continued to follow the protocols.

 

Dr. Tam

Dr. Theresa Tam, Canada’s chief medical officer of health, presented update modeling of COVID-19 in Canada on Tuesday. (Dr. Strang, asked whether NS would also be updating its models, said his department was more focused on refining their epidemiology to understand the situation on the ground, although they were doing some modeling to determine what amounts of PPE would be needed.)

Tam’s models showed Canada has not yet brought the reproduction number of the virus below one (although it’s getting there) and predicted between 53,196 and 66,835 cases with 3,277 to 3,883 deaths by May 5.

Tam noted that Canada has “several regional epidemics,” with cases in Alberta, Quebec and Ontario driving recent national growth. She also said that outbreaks in long-term care and seniors’ homes are responsible for 79% of deaths country-wide and are currently driving the epidemics in Quebec, Ontario and here in Nova Scotia.

 

Eject button

Dr. David Fisman, the U of T epidemiologist, appeared on Quebec AM this morning to discuss the coronavirus outbreak and much of what he said will be of interest to Nova Scotians.

He said Canada, as a whole, seems to be past the peak of this first wave of the epidemic, which is on track to die down nationally by mid-May. But he added that this was happening not because it was a “pre-ordained state of affairs” but because of what we’ve done to make it die down.

Fisman said the reproduction number — the number of new cases made by an old case of COVID-19 — has slipped below 1 for the first time in Canada over the last couple of days, which is evidence of decline.

That said, he echoed what we’ve all been hearing from Dr. Strang, which is that a rapid return to normal is not going to be possible, because bringing the virus to heel has left much of the population susceptible to a second wave and if we’re not smart about reopening we could easily find ourselves back to where we were in March.

He also used a line I think Strang should borrow, “It’s the virus that calls the shots, not us.”

Fisman noted that the effects of the virus run literally the entire gamut of human illness, from people who are infected but asymptomatic to people who are infected and die from what he called a “sepsis syndrome” that causes the lungs — and even other organs, like the liver and kidneys — to fail.

As for how we reopen, he says everyone is trying to walk a tightrope between economic damage and disease control and “some will lean too far one way, some the other,” but he thinks we’ll learn from our mistakes. In fact, he said Quebec and Ontario now seem to be inadvertently establishing a control experiment, with Ontario remaining shut while Quebec opens up outside of the Montreal area.

He said in both provinces, the disease is past its peak outside of the major urban centers, so an argument could be made for either approach. In passing, I think you could argue Nova Scotia’s outbreak also fits this pattern, given the preponderance of cases in the HRM — here’s today’s case map:

That said, Fisman said he fully understood why Quebec parents might be nervous about sending their kids back to school, particularly since the epidemiology of this disease in children is not well understood, other than that they overwhelmingly don’t seem to develop severe symptoms. (He said so little is understood about the disease in kids, you can’t even have an informed debate about it.)

Fisman said the key to reopening will be surveillance and by this he meant testing, but testing where we don’t expect to find the disease — in grocery stores, for instance — rather than, say, testing someone in ICU with COVID-like symptoms. (This seems to jibe with what Dr. Strang has been saying about using the province’s lab capacity to learn more about the epidemic.)

He said social distancing is our “eject button,” we know it works and so, when we need to, we can use it. But surveillance, he said, is how we’ll know when we have to hit the button.

I’m going to stop recapping here, because you should really just listen to the interview, it’s very informative.

 

Michelin masks

The NSHA announced on Wednesday that Michelin has donated 75,000 surgical masks to the province with an additional 50,000 to follow “in the coming weeks.”

The company has apparently also been providing the province with scrubs sewn by workers at its plant in Waterville, NS, who:

…put their skills with sewing machines to a new use, besides sewing components as part of the tire-making process. Instead, they starting stitching hospital scrubs for Valley Regional Hospital and other hospitals in the Annapolis Valley, South Shore and South West Nova Scotia.

Some of the masks are designated for staff at LTCFs. The donation is part of a donation of 700,000 masks the company is donating to facilities across North America.