NS COVID-19 Update for 1 May 2020

Update

Dr. Robert Strang announced the death of another resident of the Northwood long-term-care facility (LTCF) in Halifax, bringing total COVID-19-related deaths at the facility to 23 and total deaths in the province to 29. Strang also announced 12 new cases of COVID-19, bringing total cases in the province to 959, and active cases to 338.

Strang and Premier Stephen McNeil announced Nova Scotia would ease some of its public health restrictions, although those around social distancing and social gatherings remain in place — people (not in the same household) must keep two meters apart and gather in groups of no more than five.

But, here’s what’s loosening up:

• provincial and municipal parks (including skate parks) can reopen, but playground equipment will continue to be off limits (people are asked not to drive to parks, but if they must drive, they’re asked not to stop at the park of their choice if they notice a significant number of cars already there)
• trails are allowed to open
• people are allowed to use and visit community gardens (Strang noted their importance for food security.)
• garden centers, nurseries and similar businesses can open (Strang said people must use them safely, respecting physical distancing and numbers as in grocery stores; Strang also reminded people to limit shopping to once a week and try to send one person per household — he says he’s been noticing people beginning to forget these rules.)
• sportfishing is permitted from shore or boat, but fishing derbies are not allowed
• people can attend boating, yacht or sailing clubs for the purpose of preparing boats for use
• golf driving ranges can open, including those at golf clubs, but the course must remain closed; golf clubs can perform necessary maintenance and preparations for opening
• people can use their cottages. Use is restricted to one household unit at a time, travel must be directly to the cottage and back, and travelling back and forth frequently from cottage and primary residence is discouraged
• provincial and private campgrounds remain closed, but they can perform necessary maintenance and preparations for opening. An exception is recreational vehicles parked year-round at private campgrounds, which can be used but must follow the same rules as cottages
• drive-in religious services will be allowed, as long as people stay in their cars, they are parked two metres apart and there are no interactions between people in cars or between people in cars and others

These measures took effect as of 3:00 PM today.

Beaches and playgrounds remain closed, but Strang hopes they may be opened soon. Even as things begin to open up further, however, core public health measures — handwashing, social distancing and limited gatherings — will remain in place. Strang also said people may consider wearing non-surgical masks when out in public. He said how much more things can open up will depend upon “how well we do with these initial adjustments.” Public Health will monitor the epidemiology closely to measure the impact of the loosened restrictions.

“Ultimately,” Strang said, they were “asking people to do their best” to adhere to public health measures, whether they are legally required or strongly encouraged.

The premier reiterated it would be a “slow and steady opening” of the province adding that he was meeting with representatives of a number of service sector associations to talk about what the new “normal” will look like for businesses in sectors like food and beverage, cosmetology and recreation.

He also said that Health Minister Randy Delorey and Deputy Minister Kevin Orrell would be looking at how to allow short-term care clinics to open and day surgeries to proceed.

 

Numbers

Total new cases: 12

Total cases: 959

Total hospitalized: 10

Total in ICU: 3

Total recovered: 592

Total deaths: 29

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

LTCF residents: 237

LTCF staff: 105

Total positive and negative tests to date: 29,842

Age range of patients: under 10 to over 90

 

Mental health

There was a great deal of discussion around Nova Scotians’ mental health during this briefing which I am going to boil down to the premier stating it was “no exaggeration” to say he was very worried about the mental health of people in the province, between the stresses associated with COVID-19 and the April 18-19 mass shooting and the recent helicopter crash, and the decision to allow us a “little more freedom” (the key, he noted, being “a little”) was in large part based on recognition of people’s need to get out and breath fresh air.

He made special mention of the stresses faced by those who live alone, single parents with small kids, and people caring for elderly relatives by themselves.

 

Litmus test

Asked how the province would know whether restrictions could be lifted further or needed to be reimposed, Strang said there were a number of ways, beginning with the epidemiology — if, two weeks from now, we see a surge in COVID-19 cases, we’ll know it was caused by people not continuing to follow public health rules this weekend.

Strang said police will still be responsible for enforcing the restrictions that remain in place and will be one source of information as to how well Nova Scotians are continuing to adhere to the social distancing rules but the police “can’t be everywhere” (a positive thing, I would suggest) so really it will come down to trusting that people will use their “common sense.”

Strang also said that the epidemic curve is continuing its downward trend (outside of Northwood which he said is “frankly a separate issue”). He said that as we open up and continue testing the key will be whether a new case can be traced or not — cases that cannot be traced to a source of exposure will raise flags that the disease may be spreading in a given community.

 

Postal codes

Tim Bousquet of the Halifax Examiner asked a follow up from yesterday’s question about a list of “COVID Clusters” identifying outbreaks by three-digit postal codes that the Examiner has heard is being used to deny people healthcare. Bousquet wondered about the usefulness of using postal codes to identify “clusters,” given how few active cases there now are outside Northwood and how large an area these codes represent.

Strang’s answer was that the three-digit postal code designated a “medium” sized geographic area (more granular than a health zone, less so than a six-digit postal code). He said public health goes into areas designated as “clusters” and tests aggressively and sometimes determines there has been no significant community spread.

Strang said the list of clusters was given to the NSHA at their request and was to be used in helping healthcare workers decide what level of PPE to wear when seeing patients from an area designated as a cluster, the goal being to use the PPE efficiently.

Bousquet said the problem was the list was being used to deny people healthcare. Strang said he regretted the list being used in a way it wasn’t intended to be used.

 

This is the law

In response to a reporter’s question, Dr. Strang spelled out which laws were changed to ease public health restrictions:

Private campgrounds were reopened for seasonal campers via an amendment to the Health Protection Act order.

Municipal and provincial parks were reopened via an amendment to to the declaration of a state of emergency under the Emergency Management Act.

The sportsfishing season was opened via directive from the Department of Fisheries.

 

Daycare

A reporter asked the premier about a shortage of daycare services for essential workers and the premier said it was something they began looking into very early on, that they’ve seen family members, neighbors and community groups assisting with childcare for essential workers and that they monitored the example of other provinces where daycares remained open and didn’t see huge uptake by essential workers.

McNeil said as more and more people return to work, the government and public health will “have to find a childcare model that works for us.”

 

Rentals

Asked whether it would be permissible to go to a rented cottage as well as a personal cottage, the premier said no, and explained the rationale was to avoid having somebody new coming into a rental space each weekend and potentially bringing in the virus. The same reasoning was applied to campgrounds, where seasonal campers are permitted to return but not weekend campers.

McNeil said that they’d be looking at how and when to change this, but that campgrounds in Nova Scotia didn’t usually open until the last week in May anyway.

 

Canada’s missing data

This is a subject I’ve seen tackled by both the Globe & Mail and the National Post of late — the lacunae in Canada’s COVID-19 data.

Latest to beat the drum is Postmedia columnist Colby Cosh who uses a recent Lancet editorial to take Canada — or more precisely, the provinces, which are in charge of collecting and publishing “vital statistics” — to task for their lack of “[t]imely reporting of all-cause mortality.”

The point of reporting all deaths in a given period is that it allows you to compare those numbers to the numbers from the same period in a non-pandemic year and generate a figure for “excess deaths.” The medical journal says this might be a more accurate measure of COVID-19-related deaths than actual death stats, as different jurisdictions use different criteria for labeling a death “COVID-19-related.”

Weekly excess deaths could provide the most objective and comparable way of assessing the scale of the pandemic and formulating lessons to be learned. This measure can be constructed by comparing the observed weekly deaths throughout 2020 to values expected from the experience of previous non-pandemic years. This approach allows for the assessment of the total mortality effects of the pandemic in different places. Crucially, the counts would be of deaths by all causes combined, thus side-stepping issues of what is or is not a death attributable to COVID-19. Unfortunately, most countries do not publish such statistics, and those countries that do typically do, do so with considerable delay.

But this is not the only gap in Canada’s data collection. In fact, the Globe and Mail published an “in-depth” investigation of Canada’s “data deficit” in 2019 — well before the first cases of COVID-19 surfaced in Wuhan, China. Reporters Eric Andrew-Gee and Tavia Grant began with an account of a public health scholar at U of T who was stymied trying to replicate a US study that found white, middle-aged Americans without college degrees “were dying at a rising rate.”

The researcher, Arjumand Siddiqi, found that in Canada, death records “do not tell you the person’s race and education level.”

Fast forward a little over a year, and consider the research now being done in the United States, which is showing the disproportionate toll coronavirus is taking on black and Latino Americans.

Here in Canada, such research would not be possible. Andrew-Gee and Tavia Grant report that:

Nationally, the ethnicity of those who have been infected or have died is unknown. Because of data gaps, the death toll likely is being underestimated.

They spoke again to Dr. Siddiqi, who called this “one of the most pressing gaps” in Canada’s data collection:

No Canadian province makes this data available, in keeping with a long-standing national aversion to publishing statistics about racial disparities in health. (Toronto’s Medical Officer of Health, Eileen de Villa, has announced that the city is exploring ways to collect race-based coronavirus data on its own.)

But there is reason to suspect race may be a factor in determining who is being infected and dying from the virus, Dr. Siddiqi said, both because of the prevalence of various underlying health conditions in some racialized communities, and their over-representation in low-wage jobs such as nursing, delivery and retail, which make them highly prone to exposure to the virus

The Health Association of African Canadians was advocating for “the implementation of health system data with race, ethnicity, language and other diversity identifiers” before the COVID-19 outbreak, I have asked them to comment on the importance of such data in the context of COVID-19 and hope to be able to share their response soon.

 

Vaccine dreams

This excellent New York Times article begins by throwing a big bucket of cold water over expectations that a SARS-CoV-2 vaccine will be discovered within the next 12-18 months. Writes Stuart A. Thompson:

The grim truth behind this rosy forecast is that a vaccine probably won’t arrive any time soon. Clinical trials almost never succeed. We’ve never released a coronavirus vaccine for humans before. Our record for developing an entirely new vaccine is at least four years — more time than the public or the economy can tolerate social-distancing orders.

But having stepped on our rose-colored glasses, Thompson then looks at how such a miracle might be achieved.

The piece is as informative as it is sobering and left me with a much better sense of what finding a vaccine in “12 to 18 months” would actually represent. It also offered a ray of hope based on the search for an HIV vaccine, not because nearly 40 years of work has produced such a vaccine (it hasn’t) but because in searching for one, researchers developed:

…a litany of antiviral drugs that lowered the death rate and improved health outcomes for people living with AIDS…

Therapeutic drugs, rather than vaccines, might likewise change the fight against Covid-19.

That’s the articles conclusion. How Thompson reaches it is a great read.

 

Active Transport

Listening to CBU Prof. Tom Urbaniak’s “People’s School on Local Government” on CBC Mainstreet Cape Breton has got me to thinking about what the CBRM could be doing to help people cope with the ongoing public health restrictions.

While it’s true the municipality hasn’t the authority or the resources to do the heavy lifting, which has fallen to the federal and provincial governments, it does have the means to make some changes that would make life better for all of us — if not immediately, then certainly as the province begins its gradual reopening.

One of the best things other cities are doing is closing streets to cars, widening pedestrian walkways and introducing bike lanes to make it easier for people to maintain social distance while still getting around.

Here’s what Milan is doing, for example:

The city of the future is for people.
I am very proud that Milan took position announcing the #stradeaperte #openstreets plan for low-cost temporary cycle lanes, widened pavements, pedestrian and cyclist priority streets.
All cities should do the same. pic.twitter.com/ySeI93PzQv

— Demetrio Scopelliti (@demescope) April 22, 2020

And Milan is not alone, as Forbes has noted:

Cities as diverse as Berlin and Bogotá are using so-called “tactical urbanism” to take road space from cars overnight and give it to people on foot and on bicycles to keep key workers moving—safely—during lockdown. Now New Zealand has become the first country to provide funding to make tactical urbanism into official government policy during the coronavirus pandemic.

You can add Paris to that list, too.

We’ve been toying with the idea of closing Charlotte Street in Sydney to traffic for years — what better time to give it a try? (And not to be Sydney-centric, why not try it on the other municipal main streets?)

Closer to home, the CBC reports that as New Brunswick begins reopening, the City of Fredericton ” wants to expand its use of sidewalk cafés to help restaurants kick-start business while ensuring they have adequate space for physical distancing.”

Ken Forrest, the city’s director of planning and development, said it was part of an overall plan to help restaurants recover from the devastating financial effects of the global COVID-19 pandemic.

He said the city is waiving fees for sidewalk patios and being generous with permits in terms of the space allocated.

“The city is demonstrating a fair bit of flexibility this year so that restaurants can take physical distancing into account and try to maximize seating,” he said.

He said the city is also looking at providing picnic table seating in public spaces like Officers’ Square, Carleton Street and Barracks Square to give customers options for taking food out or having it delivered to those locations.

St. John City Councilor Donna Reardon is open to closing some streets to traffic to “give uptown businesses more options for keeping people apart — and for pedestrians to be able to physical distance while out and about.”

(She raised that old canard about businesses needing to receive deliveries, but cities that have closed streets to traffic have solved this problem — it’s not rocket science, it’s as simple as designating a certain time of day for deliveries.)

In a recent open letter to Halifax CAO Jacques Dubé and director of public transportation and works Brad Anguish, Martyn Williams made a strong cases for providing “additional street space” to pedestrians (and possibly cyclists), setting up — and knocking down — each of the Halifax CAO’s previously published objections.

Now is the time to be thinking of creative ways to reopen while respecting those public health measures that will have to remain in place, I hope the municipalities active transport advocates are on it (I bet they are).

 

Tonight’s Distraction

So, this happened:

Is there an individual/group/organization that deserves a day in May proclaimed their honour for the good they have done during the COVID19 NS State of Emergency? Please submit recommendations, with some bg & details of their kindness to mayor@cbrm.ns.ca Subject line #CBRMProud pic.twitter.com/XU3RHHFNpB

— Cecil Clarke (@MayorCBRM) April 29, 2020

I’m not sure what’s worse, the grammatical errors or the hashtag #CBRMProud with all its unfortunate “Proud Boys” connotations, but taken together, it looks a little rushed.

That said, the actual proclamation — declaring May 1 (which has kind of already been taken on behalf of the workers of the world) “Primary Assessment Centre Employees Day” — WAS distracting. Watch it here.