NS COVID-19 Update for 15 May 2020

Daily briefing

Premier Stephen McNeil has extended Nova Scotia’s State of Emergency for another two weeks, it is now scheduled to end on May 31 unless further extended.

Dr. Robert Strang announced four additional deaths at the Northwood long-term-care facility (LTCF), bringing deaths at the Halifax facility to 49 and total deaths provincially to 55. Both Strang and McNeil began the briefing by offering condolences to the families of the individuals who have died.

Dr. Robert Strang, NS COVID-19 Update 15 May 2020

Dr. Robert Strang, NS COVID-19 Update 15 May 2020

Strang announced eight new cases of COVID-19, six of which he said were connected to Northwood. On the bright side, as he pointed out, this indicates we have little community spread. On the not-so-bright side, it indicates the disease is still spreading within Northwood.

Strang wasn’t asked about the significance of this ongoing transmission within the facility, although he was asked if it had been established that shared rooms were part of the problem at Northwood and if so, how this would be addressed going forward.

Strang said that while he hasn’t gone into each case at Northwood in detail, there has been conversation between public health officers nationally about shared rooms leading to an increased likelihood of infections. This is why, he said, the standard today for LTCFs is single rooms. He said it is a question of transitioning, over time, to this new standard — I presume he meant in older buildings like Northwood, built in the 1960s. (I was thinking of single rooms as being a no-brainer, but something I read recently made me realize that although they are likely necessary from a public health point of view, they will be a hardship for couples in LTCFs, or even close friends.)

 

Numbers

Total new cases: 8

Total cases: 1,034

Total hospitalized: 9

Total in ICU: 5

Total recovered: 918

Total deaths: 55

Total long-term-care facilities (LTCF) affected: 3

LTCF residents: 25 (Northwood) 1 (other LTCFs)

LTCF staff: 15(Northwood) 1 (other LTCFs)

Total positive and negative tests to date: 36,409

Age range of patients: under 10 to over 90

 

Family bubbles

Nova Scotia is introducing what it’s calling “the immediate family bubble” allowing:

…two immediate family households to come together without physical distancing. The families must be mutually exclusive to each other to minimize risk of COVID-19 spread. This change takes effect immediately.

Families are still not permitted to have large family gatherings like birthday celebrations or reunions. The government press released stated that:

…when selecting which other family household they’ll connect with, families should…consider three factors – age, occupation and health condition of all household members.

I wanted to be sure I understood that the two households had to be actual family (like, related), so I clarified it with a provincial spokesperson, who told me:

This means two immediate family households can come together without physical distancing. This could mean parents, siblings, grandparents. These households will have to promise to be mutually exclusive. We know this is not a one-size-fits-all approach.

Strang said people will be allowed to decide who they bubble up with. (I mean, did the government actually consider ASSIGNING bubble partners? That would have had the makings of multiple great reality TV series.) That said, he advised giving the decision careful thought. For instance, think twice before pairing up with an elderly relative with respiratory problems or a younger relative with underlying conditions or a healthcare worker with higher potential exposure to the virus.

Bubble families don’t have to follow the five-person limit on gatherings, although Strang said people should think carefully about how many people gather at once, and noted, in passing, that getting together outdoors would be better than indoors.

Other restrictions being loosened include:

  • archery, equestrianism, golf, paddling, sailing/boating and tennis can resume at outdoor facilities as of Saturday, May 16 at 8 a.m. provided social distancing, environmental cleaning and participant hygiene can be maintained; organized coaching or training, competitions, tournaments, regattas or similar events are not permitted
  • public beaches can also reopen as of May 16 at 8 a.m.; people must stay two metres apart and not gather in groups of more than five
  • the province-wide ban on open fires — those within 305 metres (1,000 feet) of woods anywhere in the province including domestic brush burning and beach fires — has been extended to Monday, June 1 at 11:59 p.m. Use of backyard appliances like chimineas and fire pits will be temporarily permitted for households. The ban does not apply to private campgrounds.

Strang noted they are all outdoor activities, and while change rooms and washrooms are permitted to open where applicable, they can only do so while enforcing social distancing rules and strict cleaning protocols.

Strang said each lifted restriction has stemmed from discussions with the relevant representative organization, which has presented a plan for reopening that has been approved by public health.

(Also worth noting, it’s been two weeks since restrictions on parks and trails were lifted and we haven’t seen a spike in community spread of the virus.)

Asked if we could expect to see restrictions lifted on an every-two-weeks basis, the premier said they intended to go ahead as they’d said they would, in consultation with public health and the province’s various associations and organizations.

This includes campgrounds — in response to another question, Strang said he’d had a “very good discussion” with the private campgrounds association which needs “another couple of weeks” to complete its reopening plan and added that public campgrounds have also been working on their plans.

The premier said a number of times during today’s briefing that Nova Scotia, in consulting with all these various representative groups, is taking a different approach to opening up than other provinces have, his argument being that some provinces have lifted restrictions without properly advising businesses how to meet them. (His example was New Brunswick and daycares).

 

Daycare

Asked whether anything he’s seeing elsewhere in the country has made him revisit the plan to re-open daycares in early June, Strang said there was “growing comfort” in the belief that young children don’t transmit the virus easily. He said they have been talking to licensed daycare centers, and are waiting for them to present their re-opening plans, which public health will “carefully review,” balancing appropriate safety with the ability to operate.

Strang acknowledged that childcare would be “critical” to people getting back to work. He said there has been one outbreak in a daycare in Quebec, (which saw 12 of 27 children and four employees contract the disease) and that province will do a “thorough analysis” which will be brought back to the “national discussion.”

 

Homecare

A reporter told Strang she’d heard reports of people receiving home care services who feared their nurse was also working in Northwood.

Strang said any healthcare worker who spends time at Northwood must self-isolate for 14 days before going to another facility or to home care.

 

Public inquiry

Asked about a letter sent by 33 Dalhousie law school professors to the premier calling for a public inquiry into the Portapique mass shooting, McNeil said calling such an inquiry was not within the constitutional authority of the province, as both the RCMP and the country’s gun laws are federal responsibilities.

On the other hand, as the lawyers state:

Nova Scotia is responsible for law enforcement and the administration of justice in our province.

I don’t have time to write more about this but I trust much more will be written over the coming days.

 

Other parties?

Asked by a RadCan reporter if he was looking into ways to allow all-party legislative committees like health and public accounts to meet virtually, given other provinces and the feds have managed to arrange such meetings, McNeil said this was not a priority — for him or, apparently, for Nova Scotians. (Were you asked? I wasn’t asked — I would have voted for allowing committees and even the legislature to meet virtually if I had been.)

The logic behind this is patently absurd: we’re in a thoroughly unprecedented situation requiring the premier to take thoroughly unprecedented measures to protect the health of Nova Scotians but the legislature isn’t expected to meet until the fall and the committees are generally done by June, so those precedents should be respected.

I’m going to hand the baton to CBU Professor Tom Urbaniak who wrote a column on this very subject in the Post this week:

During this pandemic, Nova Scotia stands apart from most of the democratic world. Other than Premier Stephen McNeil, provincial politicians have not been seen playing a public role in policy, accountability or oversight.

Add to all this the shock and grief we all share over the horrific recent mass murder spree in our province. In the aftermath of that overwhelming tragedy, some legitimate policy and operational questions have been raised. Here is another important reason for our elected officials to hold some sort of initial, albeit cautious, public deliberations.

On the pandemic, there has been no opportunity for House of Assembly’s committees to call experts, make recommendations or dig into what measures are being taken, or not taken. No committee is functioning…

Elected officials, not just the premier, also have a constitutional duty to provide oversight of the public purse. MLAs have a constitutional duty to inspect the public accounts and monitor spending, and to ask questions to make sure investments have their intended effect.

 

Testing, revisited

This interview between the CBC’s Rosie Barton and U of T epidemiologist Dr. David Fisman is helpful in understanding what the next few months are going to look like and why we need a “really, really strong testing game.”

Also helpful, though, is this STAT article that gets into what Dr. Strang has been saying about why testing a lot of asymptomatic people for COVID-19 is not effective:

Diagnostic tests are developed with both sensitivity and specificity in mind. The greater the sensitivity, the less likely it will miss real cases. The greater the specificity, the more likely uninfected individuals will be correctly deemed negative.

The problem is that tests almost never have 100% sensitivity and 100% specificity. The test and the truth together create four possibilities: true positives, true negatives, false positives and false negatives. There’s a trade-off involved because an increasingly liberal test (more sensitive) will include more and more individuals in the population who do not actually have the disease (less specific). This trade-off has important implications for interpreting Covid-19 population trends based on testing to date and going forward…

COVID-19 testing sensitivity vs. specificity

 

When applied to a broad swath of the population, a test’s performance can be surprisingly counterintuitive. It can perform worse than expected, producing a potentially large proportion of false positives in populations less likely to have the disease. Consider a scenario with Covid-19 testing in an asymptomatic or mild population with 1 in 51 people infected…Assume the test is always positive in individuals with the disease but falsely positive 10% of the time (which would be superior to many medical tests in use). As shown in the figure, the chance that someone with a positive test result is actually infected is under 20% (1 in 6).

As systematic testing is performed in the general population, patients less likely to have the disease — including asymptomatic individuals without known exposures — will be tested. A large number of false positive results would lead to an overestimate of the number of asymptomatic cases in many regions.

A large number of false positives could also overestimate the contribution of asymptomatic spread to the dynamics of the pandemic. False positives could also decimate the health care workforce if workers were inadvertently and unnecessarily quarantined and kept from seeing patients. The magnitude of the false positive and false negative problem remains unclear. Policymakers are aware of this potential issue, but early data on the sensitivity and specificity of tests in Wuhan, China, have been retracted.

And on that note — enjoy your long weekend!