Daily briefing
Premier Stephen McNeil and Dr. Robert Strang began by offering their condolences to the families of the Northwood resident who died on Saturday.
Strang announced one new case of COVID-19 today which, added to the seven new cases announced Sunday and three announced Saturday brings total cases in the province to 1,020.
Premier Stephen McNeil and Dr. Robert Strang, NS COVID-19 Update 12 May 2020
(Sunday’s figures also showed a new case in the Eastern Zone, which includes Cape Breton, the first new case in 15 days. The Cape Breton Post has confirmed there is a case of COVID-19 at the Cape Breton Regional Hospital and that eight medical staff are self-isolating as a consequence.)
Strang stressed that while the latest new cases numbers look encouraging, we shouldn’t read too much into a few days and we will need to go a full COVID-19 incubation period (14 days) and preferably two (28 days) before beginning to reopen the province.
Strang addressed discrepancies between the provincial active case numbers and those coming from the LTCFs, saying the provincial numbers are the “true” figures but that they are doing their best to bring more consistency to the two reporting systems. He also noted that over the last 24 hours, Public Health had worked “very hard” to move “a large number of cases” from active to resolved.
Strang addressed the question of students recovering belongings left in schools, which will not open again this academic year. He said as of May 25, one student or family member will be permitted to access their school by appointment. He said Public Health was advising the Department of Education around this process.
Strang ended with a warning about smoking and vaping, which he said the World Health Organization (WHO) has now recognized as contributing to more severe COVID-19 symptoms. I looked up the official WHO statement and it warns against tobacco smoking but doesn’t actual reference vaping:
Tobacco smoking is a known risk factor for many respiratory infections and increases the severity of respiratory diseases. A review of studies by public health experts convened by WHO on 29 April 2020 found that smokers are more likely to develop severe disease with COVID-19, compared to non-smokers.
COVID-19 is an infectious disease that primarily attacks the lungs. Smoking impairs lung function making it harder for the body to fight off coronaviruses and other diseases. Tobacco is also a major risk factor for noncommunicable diseases like cardiovascular disease, cancer, respiratory disease and diabetes which put people with these conditions at higher risk for developing severe illness when affected by COVID-19. Available research suggests that smokers are at higher risk of developing severe disease and death.
Strang advised smokers to do their best to quit and offered a number of resources including talking to your doctor, pharmacist or healthcare provider, calling 811 or visiting Tobacco Free Nova Scotia.
Asked if this would also apply to cannabis, Strang said he wasn’t aware of any applicable studies, but that it “makes sense to think” that smoking anything could make you more vulnerable to COVID-19 and the province has always recommended people consume cannabis by methods other than smoking.
Numbers
Total new cases: 1
Total cases: 1,020
Total hospitalized: 9
Total in ICU: 4
Total recovered: 864
Total deaths: 48
Total long-term-care facilities (LTCF) affected: 3
LTCF residents: 157 (Northwood) 1 (other LTCFs)
LTCF staff: 8 (Northwood) 1 (other LTCFs)
Total positive and negative tests to date: 35,224
Age range of patients: under 10 to over 90
LTCF
Asked if there were any light at the end of the tunnel in Northwood, the site of the province’s most serious COVID-19 outbreak, Strang said the good news was they’d finished testing all residents, although they would retest any who’d tested negative. He said the “significant reduction” in the number of positive residents was encouraging and that their examination of recent cases in which some staff tested positive has reassured them they have “appropriate infection control measures” in place.
In response to another Northwood-related question, Strang said they were considering the LTCF as a separate outbreak and decisions on reopening the province would be based on community epidemiology, meaning we do not have to wait until Northwood has gone 28 days without a new case before lifting restrictions once the province at large has achieved this milestone.
There was a startling exchange that began when a reporter told the premier she’d understood Dr. Strang to say during an interviewer earlier in the day that people with loved ones in LTCFs should consider the possibility they will never see them again.
Premier McNeil quickly corrected this to say that people with loved ones in LTCFs should consider that they won’t be seeing them anytime soon because these facilities will be among the very last places to reopen to the public. (I’m not going to lie, I breathed a sigh of relief at this.)
McNeil was then asked whether the experience at Northwood will inform the design of future LTCFs, like those to be built in New Waterford and North Sydney. The premier said the new facilities are being built based on the latest data from continuing care, and will be nothing like Northwood, a very large facility dating to the 1960s.
The premier said the new facilities generally consist of a common area with wings leading off it, each of which could, if necessary, be isolated.
Cluster-free?
CBC reporter Shaina Luck said she’d been told by the provincial health authority that there were no longer “clusters” of cases (defined as three active cases) in Fairview, Dartmouth North, and the Prestons and asked if Dr. Strang could confirm that information.
Strang did, saying there were no clusters, even within HRM, and “no indication of significant ongoing community transmission” in the province but “we need that trend to continue” for a minimum of two weeks to declare we have low-level COVID-19 activity.
Bubbles
I’m going to clump these two “opening up” questions together.
First, the premier was asked about the suggestion from New Brunswick and PEI that they may become “bubble provinces, allowing residents to travel back and forth, but excluding Nova Scotia. (I think this is called a “Mean Girl Bubble.”)
McNeil said the reality is Nova Scotia must focus on flattening its curve, working with its partners in the business and service sectors to draft a reopening plan that will let everyone know, on Day 1, what they must do.
Asked if he would consider opening other parts of the province up before HRM, McNeil said it depended on the circumstances but he was open to considering, for example, allowing a dentist with a local clientele to open. What they want to avoid, he said, is opening something like a mall, which would attract shoppers from elsewhere in the province.
Top-up
Asked if workers at privately-owned LTCFs like those operated by Shannex would qualify for the $2,000 pandemic bonus the province, with funding from the feds, has promised healthcare workers, McNeil says workers in facilities supported by public per diems would qualify, but those in other facilities would not.
The money, he said, would go to “partners,” like Shannex, who would distribute it to their employees.
Open spaces
Asked if he had plans to lift any additional restrictions on outdoor activities (beaches are still closed), Strang said they are looking at it and he will have more to say on the subject in the next few days.
Boat Harbour
McNeil was asked why the province is paying $10 million to clean up Boat Harbour and responded that the province always knew it would be responsible for cleaning up the effluent treatment facility, which it owns.
McNeil said the province is paying, among other things, to remove the leachate, ensuring it poses no future problems. He also said that the government’s share of the estimated $20 million clean-up costs is capped at $10 million — anything above will be covered by Northern Pulp.
He said he looked forward to the environment being restored and said the company “can make a decision about its future in this province.”
BVM
Disposable bag valve mask resuscitator
Strang was asked about reports that Nova Scotian paramedics are being asked to hold onto their used bag valve masks (BVMs).
Strang said he was aware of the advisory from the Emergency Health Services system and understood it had been prompted by fears of a possible mask shortage. He said his understanding is that the department is both looking for additional masks and exploring “options for safely sterilizing and reusing masks.”
Bag valve masks are used to assist patients who are not breathing or not breathing adequately and are usually disposable.
CERB
Kyle Shaw pointed out that the Canadian Emergency Response Benefit (CERB), at $2,000 a month, is more money than some workers actually make when they’re working and wondered if the premier had any thoughts on why the province (which sets the minimum wage) and the feds had such different ideas about what a basic income looked like. (I’m freestyling somewhat here, but I think that’s what Shaw was getting at.)
The premier, in case you’re wondering, did not say, “This is a crazy situation and people should obviously be paid more.”
He said the province has been focusing on keeping businesses operating so that, once public health restrictions are lifted, they will still be there to “hire our sons and daughters” and pay them less than $2,000 a month. (I added the last bit, but that’s clearly what he’s saying.)
Serology
Asked about the status of testing for antibodies to determine who has had COVID-19 (and might, therefore, have acquired immunity), Strang said the National Microbiology Lab in Winnipeg is in the process of validating such tests, called serology tests, to be sure they perform with appropriate accuracy.
There have been numerous media reports about such test failing to perform with appropriate accuracy.
The moderator of today’s briefing, who usually ends by saying, “That’s all the time we have for questions,” then said something I have never heard her say before:
“That’s all the reporters on the line for today.”
Risk assessment
If you read one article about COVID-19 today, I recommend this one by Erin Bromage called “The Risks — Know Them — Avoid Them.”
Bromage, a comparative immunologist and professor of biology (specializing in immunology) at the University of Massachusetts, Dartmouth, helps you understand the circumstances under which you are at most risk of catching the virus. In fact, he boils it all down to a formula for successful infection: exposure to virus x time.
He estimates (and warns that it is just that, an estimate, based on what we know about MERS and SARS) that “as few as 1,000” SARS-CoV-2 particles are needed for an infection to take hold:
Infection could occur, through 1000 viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.
The most efficient way to breathe in those 1,000 viral particles is to have someone with COVID-19 sneeze in your face. Sneezes release about 30,000 droplets containing as many as 200 million virus particles traveling at up to 200 miles per hour. (Coughing is bad too, releasing about 3,000 droplets at 50 miles per hour.)
This, he says, is why people with symptoms should stay home.
But an asymptomatic person also releases viral particles, just by breathing and speaking, and Bromage shares the example of how that led to an outbreak in a restaurant:
Restaurants: Some really great shoe-leather epidemiology demonstrated clearly the effect of a single asymptomatic carrier in a restaurant environment (see below). The infected person (A1) sat at a table and had dinner with 9 friends. Dinner took about 1 to 1.5 hours. During this meal, the asymptomatic carrier released low-levels of virus into the air from their breathing. Airflow (from the restaurant’s various airflow vents) was from right to left. Approximately 50% of the people at the infected person’s table became sick over the next 7 days. 75% of the people on the adjacent downwind table became infected. And even 2 of the 7 people on the upwind table were infected (believed to happen by turbulent airflow). No one at tables E or F became infected, they were out of the main airflow from the air conditioner on the right to the exhaust fan on the left of the room. (Ref)
When assessing the risk of infection (via respiration) at the grocery store or mall, you need to consider the volume of the air space (very large), the number of people (restricted), how long people are spending in the store (workers – all day; customers – an hour). Taken together, for a person shopping: the low density, high air volume of the store, along with the restricted time you spend in the store, means that the opportunity to receive an infectious dose is low. But, for the store worker, the extended time they spend in the store provides a greater opportunity to receive the infectious dose and therefore the job becomes more risky.
He is also encouraging on the unlikelihood of contracting the virus outdoors — say from a passing jogger:
Social distancing rules are really to protect you with brief exposures or outdoor exposures. In these situations there is not enough time to achieve the infectious viral load when you are standing 6 feet apart or where wind and the infinite outdoor space for viral dilution reduces viral load. The effects of sunlight, heat, and humidity on viral survival, all serve to minimize the risk to everyone when outside.
I highly recommend the post which has gone — no pun intended — viral in the past few days.
