NS COVID-19 Update for 5 May 2020

Daily briefing

Dr. Robert Strang announced three more deaths at the Northwood long-term-care facility (LTCF) in Halifax, bringing total deaths there to 35 and total COVID-19-related deaths across the province to 41. He also announced six new cases of COVID-19, four of which were detected in “various parts” of HRM, leading Strang to say that while community spread seems much reduced, it still exists.

The QEII Health Sciences microbiology lab processed only 454 tests on May 4, well below its capacity.

Strang focused on long-term-care facilities in general and on Northwood in particular today, beginning by stating that there are now 11 facilities with at least one case of COVID-19 but the majority of cases are in Northwood.

Of the 245 long-term-care residents across the province who have contracted the disease, 46 have recovered and 39 have died.

Of the 113 long-term-care staff members across the province who have contracted the disease, 61 have recovered and the others are still completing their (minimum 10-day) isolation periods. There have been no staff fatalities from COVID-19.

All the active cases of the virus in long-term-care residents — 160 — are in Northwood which also has 49 active cases among its staff.

Strang made the case that “Northwood aside” (if it is possible to put Northwood aside), the province has been able to manage the COVID-19 outbreaks and limit the spread of the disease in other long-term-care homes, which he said was testimony to the work that has happened in the LTC sector and reflects the success of the protocols and planning that other facilities had in place. (Which is not to say he faults Northwood for its protocols and planning, as you will see below.)

 

Numbers

Total new cases: 6

Total cases: 991

Total hospitalized: 6

Total in ICU: 2

Total recovered: 652

Total deaths: 41

Total long-term-care facilities (LTCF) affected: 11

LTCF residents: 245

LTCF staff: 113

Total positive and negative tests to date: 31,975

Age range of patients: under 10 to over 90

 

Timeline

Clearly responding to criticism of his handling of the crisis at Northwood, Strang offered a timeline for the response, to which I’ve added additional details:

March 12: Northwood activates its “pandemic plan” to respond to the virus

March 15: The province restricts visitors to long-term-care facilities. This is the same day NS announces its first three presumptive cases of COVID-19 (all travel related).

March 28: Employees at the R.K. MacDonald Nursing Home in Antigonish and Lewis Hall, a Shannex-owned retirement community in Dartmouth, test positive for COVID-19. (I believe these are the first cases of COVID-19 in provincial LTC facilities.)

March 29: A “non-resident” of the Magnolia long-term-care center in Enfield tests positive for COVID-19.

March 30: Nova Scotia detects community spread of the virus.

April 5: Northwood announces two staff members in home care and one staff person at Northwood have tested positive for COVID-19. (I’ve linked to the page with all the updates for April and you can watch the outbreak grow daily.) At this point, Nova Scotia has 293 confirmed cases, 9 people in hospital and 64 considered recovered.

April 6: The province turns what Strang terms a “comprehensive” set of guidelines for handling the COVID-19 outbreak (built on existing influenza protocols) into directives. Strang says Northwood began requiring frontline staff to wear surgical masks in all interactions with patients.

April 7: Northwood announces five residents and two staff have tested positive at Northwood, in addition to the two home care workers.

April 8: The Public Health Agency of Canada recommends masking for all staff providing or participating in resident care and any essential visitors in long-term-care homes:

The rationale for full-shift masking of LTCH staff and essential visitors is to reduce the risk of transmitting COVID-19 infection from staff or visitors to residents or other LTCH staff, at a time when no symptoms of illness are recognized, but the virus can be transmitted.

April 11: The province gives an official directive that frontline staff in long-term care homes, residential care facilities and home-care agencies in Nova Scotia are expected to wear a mask to help limit the spread of COVID-19. This CUPE memo dated April 11 explains the new protocol.

April 13: The premier apologizes to frontline workers for “any confusion surrounding surgical masks” and tells them “masks are on their way.”

April 17: Three Northwood residents die from complications of COVID-19.

April 19: CUPE issues a press release calling the situation at Northwood’s long-term-care facility “dire,” says the care home is facing a staffing crisis due to staff members having tested positive for COVID-19 and calls for staffers willing to help.

April 20: Northwood says it is activating “an emergency plan” in cooperation with the province to address the COVID-19 outbreak. CEO Janet Simm and Executive Director of Long Term Care Josie Ryan said additional resources would include:

• Staff from NSHA and Department of Health and Wellness onsite at Northwood to support our response
• Staff from many other partner organizations
• A COVID-19 Recovery Unit, which has been established at a local hotel to care for recovered residents—our first resident moved there yesterday
• Equipment we have received from Shannex for our recovery unit including electric beds, tables, and other supplies.

April 22: The NSGEU, which represents nurses from the Halifax Infirmary who were sent into Northwood to establish an on-site COVID unit, issues a press release calling the facility a “war zone.” The list of complaints includes a lack of proper infection control and a lack of sufficient personal protective equipment (PPE).

Dr. Strang denies this during that day’s press briefing, accusing the union of “fear-mongering” and “hyperbole.”

April 23: The province says that staff in a facility with an active outbreak cannot work in another LTCF without self-isolating for 14 days.

April 24: The NSEU issues a press release objecting to its members being mandated to go to work at Northwood and reporting “important improvements in infection control protocols and access to appropriate PPE at Northwood Manor.”

 

Nothing to be done?

Strang insisted that Northwood had followed all the necessary protocols, but that the “uniqueness” of the LTC facility — its size, for one thing, it is the largest such facility in the Atlantic provinces with 485 residents, and its age, which means it still houses some residents in double rooms — made it particularly challenging to fight the virus once it had found its way in.

Just as an aside, Northwood dates to 1962 and I found this in an essay about the history of nursing homes:

Most nursing homes in recent memory were built around the old military model of efficiency. Much like older hospitals, nursing homes had narrow hallways and small double rooms…the only people to have private bathrooms were those in private rooms. The rest shared hall bathrooms. Later, during the ’70s I believe, came private bathrooms, a huge step forward.

Strang has said repeatedly that Northwood was also unique in that there were “multiple introductions” of the virus from “unsuspecting staff” who were asymptomatic at the time they brought the disease into the facility. In answers to questions about the timing of the decision to make masks mandatory for frontline care workers, Strang said it was a combination of wanting to be “sure” about the science around asymptomatic transmission and having sufficient supplies of PPE in place.

He said the first COVID-19 infections detected in LTCFs were found in late March, meaning the individuals had become infected in mid-March, at which point he said, the science around asymptomatic transmission of the virus was not settled.

The press conference didn’t allow for a proper exploration of the subject, but an obvious question would be, why was the science convincing enough for Northwood to make masks mandatory on April 6?  And why, after the Public Health Agency of Canada recommended mask-wearing by all frontline healthcare workers on April 8, did it take five days before Nova Scotia issued its directive?

Asked by the CBC’s Shaina Luck if he was saying that nothing could have been done to prevent the 35 deaths at Northwood, Strang said he’s saying the appropriate things were done to minimize the introduction of the virus and reiterated that Nova Scotia was one of the first provinces to restrict visitors to long-term-care homes. But, he said, once the virus enters such a facility, it becomes harder to manage and the virus spread around Northwood “before we even recognized their was an outbreak going on.”

Asked by CTV’s Natasha Pace if it was “appropriate” to have residents who tested positive sharing rooms with those who’d tested negative, Strang said Northwood had done what it could to avoid such situations, and where this was not possible, had enforced strict infection control protocols. He also said that patients who tested negative in such situations had almost certainly been exposed to the virus and would test positive soon after.

Asked by Keith Doucette of Canadian Press if the configuration of Northwood should be rethought, Strang said Public Health was busy dealing with the outbreak now, but recognized the “physical structure” was something that would have to be looked at when the department reviewed its COVID-19 response.

Strang also noted that there is now a recovery unit within Northwood itself.

Asked if the province would consider calling a public inquiry into the outbreak at Northwood, the Premier said they were “working very hard” with Northwood and the unions across the province and they would “continue to focus on that.”

And finally, asked what he’d said to the Liberal MLA for Cole Harbour-Portland Valley, Tony Ince, whose mother, Thelma Eunice Coward-Ince, died at Northwood on April 17, McNeil said he had “adored her” and had expressed his condolences to Ince.

 

Authoritarian tendencies

I never fail to be amazed by how little value some reporters seem to place on civil liberties — during today’s briefing, one asked whether Public Health planned to use an app like Alberta’s to notify people if they may have come in contact with someone diagnosed with COVID-19.

Dr. Strang noted that Alberta has already run into hiccups with the app — ABTraceTogether — which apparently doesn’t work particularly well on Apple devices.

I wrote about location tracking back on April 9, based on concerns raised by the American Civil Liberties Union.

Another reporter asked if Nova Scotia was considering allowing peace officers the right to “detain” people for COVID-19-related reasons at the border. The premier said he was not.

 

Universities

A RadCan reporter (oh, give him a name, call him Olivier LeFebvre) asked the premier about an open letter signed by a coalition of unions representing students, staff and faculty at Nova Scotia’s universities. The signatories are asking for reduced tuition for the 2020/21 academic year, no lay-offs in the higher education sector and no cuts to programs and services.

The premier said things like “proud,” “drive” and “innovation” before stating he would let university administrators run the universities.

 

Manoir Stanstead

Back on April 9, the CBC reported on the Manoir Stanstead, a seniors’ residence in Stanstead, Quebec, where 13 staff members — and a chihuahua named Bobo — moved into the facility to care for the 53 elderly residents as an “added precaution to keep COVID-19 at bay.”

On Monday, after nearly a month living on-site, the workers went home.

The facility has not recorded any cases of COVID-19.

The dog was VERY popular.

 

Recall

Remember my excited reporting on the Spartan cube? The rapid COVID-19 test devised by an Ottawa biotech company and approved for use by the federal government on April 13?

Well, the company, Spartan Bioscience, voluntarily recalled the device on Sunday after Health Canada expressed concerns about its effectiveness.

As the Canadian Press reported:

Chief public health officer Dr. Theresa Tam said Sunday at a news conference that real-world trials of the test so far haven’t delivered necessary outcomes.

“While the Spartan system, or the device, performed very well in a laboratory setting, and along the specifications the manufacturer had provided, it was in the real-life setting, in the clinical setting, where it didn’t perform well.”

Tam said the recall won’t affect the national testing goal of 60,000 people a day, since that figure is based on systems already in use, but that it could affect the speed of further test increases and especially affect rural communities where local in-clinic tests would be especially useful.

The company responded in press release:

Spartan Bioscience said Sunday that the concerns centre around the proprietary swab used in the test, but that the Health Canada report out Friday did not raise concerns about the accuracy of the test reagents and portable analyzer device.

The company said it would recall the 5,500 test shipped nationally and work on additional clinical studies to assess the sampling method and swab.

“Spartan will be working as quickly as possible to address the concerns and bring its test to market,” the company said in a statement.

Health Canada has restricted the product to “research use only” until “adequate evidence of clinical performance can be provided.”