Daily briefing
Premier Stephen McNeil opened today’s briefing with a shout out to Richard Martell and Debbie Johnson Powell, the sign-language interpreters who translate the COVID-19 updates. McNeil noted that today is National Interpreter Day as he thanked them for their work.
Premier Stephen McNeil, sign language-interpreter Robert Powell (insert)RobR
Dr. Robert Strang then announced no new COVID-19-related deaths in Nova Scotia and only seven new cases of the virus across the province.
Northwood continues to be the epicenter of the outbreak, with 160 residents and 51 staff affected.
Strang has begun reporting active cases in long-term-care facilities instead of cumulative cases and it’s helpful in understanding where we are with the pandemic — as of today there are three affected LTCFs, Northwood, as noted above, and two unnamed facilities each of which has one sick staff member.
Strang did note, however, that two Northwood staffers have tested positive in the last few days, and they’ve launched an “intense review” to discover the source of the infection and are taking a “deep dive” into their cleaning and infection-control protocols.
While the “bulk of” disease activity remains in the Central Zone (which includes HRM), Strang reiterated that there was still “significant potential” for the disease to appear in other communities, so people should continue to obey the Public Health regulations and guidelines.
Numbers
Total new cases: 7
Total cases: 998
Total hospitalized: 5
Total in ICU: 2
Total recovered: 661
Total deaths: 41
Total long-term-care facilities (LTCF) affected: 3
LTCF residents: 160 (Northwood)
LTCF staff: 51 (Northwood) 2 (other LTC facilities)
Total positive and negative tests to date: 32,539
Age range of patients: under 10 to over 90
Masks
Strang was asked by a reporter about comments by Samir Sinha, chief researcher at the National Institute on Ageing, who told the Chronicle Herald that Nova Scotia had “lagged” in adopting two specific federal COVID-19 guidelines for long-term-care homes, namely, instructing workers to wear surgical masks and testing asymptomatic residents at outbreak sites.
Strang said the federal guidelines are “guidance” and each jurisdiction must take into consideration their “applicability” and consider how best to adopt them. He denied there was a “substantive” time lag between the federal government advising that frontline healthcare workers should wear masks and the province adopting the measure (as noted yesterday, the federal government made the recommendation on April 8 and the province introduced it on April 13). Strang also noted that Northwood ordered frontline healthcare workers to begin wearing masks on April 6.
Asked why masks weren’t used as a “precautionary” measure, Strang said they needed to be sure of supplies. He also said that wearing “even basic surgical masks” requires “some level of training” and that not all workers would have experience wearing one.
I had actually run across this 12 March 2020 memo to Northwood staff that mentioned address the subject:
It is essential that PPE are put on and taken off correctly. An education session is available on the Hub and all staff are expected to complete the module. Reviewing proper hand hygiene technique is important for all staff as well. If you have any questions, please contact the Staff Educators.
Northwood
Strang was asked again about reports of Northwood residents who had tested positive for COVID-19 continuing to share rooms with patients who had tested negative, until eventually testing positive themselves.
He answered as he has before that in these situations Northwood staff had learned that the negative patient had often already been exposed and would test negative in a couple of days, the implication being that the two patients were already infected when the first tested positive. He added that there were floors at Northwood free from COVID-19 and staff worried about moving patients who might have been exposed to the virus onto floors where “it didn’t exist.”
Randomized testing
The CBC’s Shaina Luck asked a question I’ve been wondering about, namely whether, with so much testing capacity going unused and given what we know about asymptomatic transmission, the province was considering randomized testing for COVID-19.
Strang’s answer was interesting: he says the COVID-19 tests are more effective when you’re testing people who are likely to test positive. He said the science around asymptomatic testing shows it’s not effective because it produces too many false positives.
He said they test all contacts of an infected person, whether they are showing symptoms or not, because they have a higher likelihood of testing positive.
He said it’s a subject he had his chief medical officers have discussed at the national level and they are “all in agreement.”
Underfunding
Asked if the province bore some responsibility for what has happened at Northwood due to its underfunding of the LTC sector, the premier said that “nowhere in the world” did people fully understand asymptomatic spread of the coronavirus at the time it entered Northwood.
He also cited the additional 120 LTC beds the province plans to add in the CBRM, plus a new facility in Eskasoni and additional beds in Mahone Bay and stated the wait list for LTC beds has been halved on his watch.
But he did say there are “lots of questions around the size of Northwood and whether we should have smaller facilities” and that his would be something they would review when the first wave of the pandemic has died down.
Asked if he was prepared to call an inquiry (which the NSGEU is calling for) or have the health committee look into what had happened at Northwood (as opposition leader Tim Houston has requested), the premier said only that he was focused on dealing with the crisis and that it would be “inappropriate” to do anything other than focus on the crisis right now.
Fisheries
The premier was asked what he hoped to see in the federal aid package for the fisheries expected to be announced in the coming days and said that Fisheries Minister Keith Colwell was dealing with it and that he himself had yet to be briefed.
That said, he added that they need to know what the the season will look like if they have a lot of supply they can’t move and they need a flexible federal policy because “depending where you are in this province, it’s a very different season.”
McNeil noted that the federal fisheries minister, Bernadette Jordan, the MP for South Shore-St. Margarets should understand the situation as she’s from Nova Scotia and her riding is home to one of the province’s most lucrative lobster fisheries.
New Normal
Strang was asked again for a timeline for when we will return to “normal” and said there was no timeline — it’s all being driven by the epidemiology — and we won’t be returning to “normal,” although he suggested that some aspects of the “new normal (he cited virtual medical care and working from home ) might be “positive” developments.
Drive-thru testing
Strang was asked about a drive-thru assessment center in Dartmouth and said there is no drive-thru assessment center in Dartmouth or anywhere else in the province.
Instead, there’s a “large container” (this is the term he used) on the grounds at Dartmouth General Hospital where people can go to be tested without entering the hospital proper. He also mentioned that the VON can do testing in rural parts of the province and EHS can do mobile testing.
Inflammatory syndrome
Asked about an inflammatory syndrome associated with COVID-19 in children, Strang said his colleagues at the IWK were “well aware” of it and any child affected with it would likely end up at the IWK.
He added that the Halifax hospital is part of a network of pediatric hospitals watching for this “newly recognized symptom,” but he added that no child in Nova Scotia had been hospitalized for COVID-19.
Mutant virus
Asked about reports that COVID-19 has mutated into a more contagious strain, Strang said he was not aware of this, but that he would rely on the Public Health Agency of Canada to bring any relevant information to the provinces about it.
According to the BBC:
Researchers in the US and UK have identified hundreds of mutations to the virus which causes the disease Covid-19.
But none has yet established what this will mean for virus spread in the population and for how effective a vaccine might be.
Viruses mutate – it’s what they do.
The question is: which of these mutations actually do anything to change the severity or infectiousness of the disease?
Preliminary research from the US has suggested one particular mutation – D614G – is becoming dominant and could make the disease more infectious.
It hasn’t yet been reviewed by other scientists and formally published.
And here’s what the Atlantic had to say on the subject today.
Reopening hospitals
Asked when hospitals would be reopened to people in need of non-urgent care, Strang said it was under discussion right now and while there was no exact timeline, they were moving “very quickly” on it.
Serology
Thanks to Jennifer Henderson (whose coverage of long-term-care homes in this province predates the COVID-19 outbreak by years — every research road I go down seems to end up at one of her articles) for this STAT feature on “serosurveys,” the hunt for SARS-CoV-2 antibodies epidemiologists say will be key to re-opening our economies.
Dr. Strang has addressed the subject in previous press briefings, saying it is one of the issues he is discussing with his fellow public health officers — and the Public Health Agency of Canada — on their regular conference calls.
A “serological” survey involves testing the blood of people who have not tested positive for COVID-19 to see if they have antibodies in their blood showing they actually were infected and had an immune response to the virus.
The article warns about two things: the first is over-optimism that serosurveys will show a significant portion of a given population has already had the virus, the hope being that people with antibodies will have immunity (a theory yet to therefore, have immunity — although the jury is still out on whether having COVID-19 gives you immunity, and the article notes there is some evidence that it is possible to have such a mild case of COVID-19 you produce no antibodies) and faulty tests.
On the first subject, author Andrew Joseph notes that some high-profile announcements about double-digit findings — from the Boston suburb of Chelsea, where some 30% of residents had been exposed, to a German town where 14% of the residents had antibodies — are the exception, not the rule:
Most of the results to date have shown just a tiny fraction of people have been exposed to the virus, including one survey released this week that found 5.5% of 760 participants in Geneva were infected. Others have found 2% to 3% of people test positive.
On the second subject, Joseph writes that both serology tests and serology studies are going public without the sort of vetting both would normally be subject to. In the case of the tests, he says the US Food and Drug Administration (FDA) has “taken the extraordinary step” of allowing serology test manufacturers to do their own validation and the World Health Organization (WHO) maintains a list of nearly 275 serology tests it is working with labs to try and validate.
As for the studies:
Experts say it is imperative in these early days to review the methodologies of these studies and assess the performance of the antibody tests being used. It’s also important to recognize that many have not yet gone through the rigorous peer review process before results are made public. Some are publicized in press releases, others on preprint servers, which post drafts of scientific papers before publication in journals so that they can be shared rapidly.
The article goes into much more detail and is worth a read if you haven’t quite had your fill of COVID-19 information for the day.
Featured image: I cheated and used an old photo because today’s hadn’t been released by the time I was publishing, which is why the premier is wearing a different outfit than he is in the screen capture, which is from today’s briefing.
