For the first time since the outbreak started, Nova Scotia announces no new known cases of COVID-19

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The first three known cases of COVID-19 in Nova Scotia were announced on March 15, for testing conducted the previous day. Every day since then, there have been announcements of more cases, with a one-day high of 55 new known cases on April 22. The daily new case numbers have been in the single digits since May 4, and, finally, today, for the first time since the outbreak began in Nova Scotia, it was announced that yesterday there were zero new cases discovered.

But, as I began compiling the data for this article, I noticed a discrepancy in the official numbers released by the Department of Health. Two new cases were announced on May 26 (that is, for the day previous) but the cumulative total increased by just one. I wasn’t at the briefing that day, so I missed it, but Dr. Robert Strang, the province’s chief medical officer of health, said that on May 25 the sole case reported (for the previous day, May 24) had turned out to be a false positive.

Hey, stuff happens. No big deal. Except this means there has in fact been one previous day with zero new known cases of COVID-19 — May 24, last Sunday. It was just never announced.

So here’s what the new case curve looks like:

Throughout the first wave of the disease in Nova Scotia, 1,055 people have tested positive. Nine-hundred and seventy-eight of those people have recovered, and 59 of them died. That leaves just 28 active cases of the disease in the province, and half of those are connected to Northwood (10 residents and four staff). Eight more people are in hospital, three of whom are in ICU.

Restrictions eased further

At today’s daily COVID-19 briefing, Premier Stephen McNeil announced an increase in the gathering limit, from five people to 10 people. A press release explains that:

Physical distancing of two metres or six feet is still required, except among members of the same household or family household bubble.

The limit is the same indoors and outdoors, with an exception for outdoor weddings and funeral services which can have 15 people.

The gathering limit applies to things like social gatherings, arts and culture activities like theatre performances and dance recitals, faith gatherings, and sports and physical activity. It also applies to businesses whose main function is gatherings, such as theatres, concerts, festivals and sporting activities, and to businesses that are too small to ensure physical distancing.

Additionally, the province announced the easing of other restrictions:

— starting June 5, private campgrounds can open for all types of campers. They can only operate at 50 per cent capacity and must ensure public health protocols are followed including adequate distance between campsites
— provincial campgrounds will open to Nova Scotians on June 15, with the reservation line opening June 8. They will operate at a reduced capacity to ensure a minimum of 20 feet between individual campsites
— pools can start maintenance work to prepare for reopening, likely in time for summer
— sleepover camps are not permitted this year

Testing

During the briefing, I asked Dr. Robert Strang, the province’s chief medical officer of health, about the testing strategies. Here is our exchange:

Bousquet: I wonder if you could talk to me about testing. A couple of weeks ago, you had made the statement that because the number of people exhibiting symptoms was lowering, you were thinking about doing some randomized population studies for testing. But then after that, the number of tests had declined to a couple of hundred a day; now we’re back up to over a thousand. So are you doing a randomized sampling of asymptomatic people, or is something else at play? If you’re not doing that, why aren’t you? And if you’re about to, how will you go about that?

Strang: Well, actually, the numbers have come up as we expected when we announced this a few days ago, Tim. We broadened quite substantively the number of symptoms that we would look to if someone were to have these new or worsening chronic symptoms, and they fit a category of possibly having COVID. And that was based on our growing understanding of how COVID presents in more diverse ways. And as we broadened that, we actually knew we would get more people calling 811, more people being directed to testing, and that’s exactly what’s happened. The good news is, as we were hoping to see as we broadened that testing, we’d still see very low numbers of COVID-19. The first step in our ongoing surveillance was actually broadening this symptom list.

We were planning this, we just had to see what was happening in other provinces that were a bit ahead of this. We were also building to make sure we had the right capacity at 811, the assessment centres, and our lab.

We’re still looking at the options of how we might do [testing of] selected populations of asymptomatic people in a very focused and targeted way. We need to do this thoughtfully, working with our lab and our clinical colleagues, because there’s a lot of — because as I said earlier, if you just broadly test a lot of asymptomatic people, you’re going to get a lot of false results out of that, so we have to be thoughtful about we do that. But the first step in our plan was always to broaden this symptom list, based on the clinical evidence of how COVID presents, and that’s what we’ve done and we’re seeing the impact of a significant increase in testing, and we need to continue. Because anyone with a suspicion that they could have COVID, we gotta make sure they’re tested early, and we need to sustain this. The list of symptoms may change over time, but our whole testing strategy has been based on testing people as early as possible who have symptoms that could be COVID.

I suppose that makes sense, especially given that, relative to other provinces, Nova Scotia has a high per capita rate of testing, even though the number of tests conducted dipped significantly the last few weeks. And since the the symptom list is so extensive that it includes symptoms connected to hay fever, and it’s now spring, those tested might actually be pretty close to what a randomized sample would look like.

At issue is: How many people are carrying the virus but are asymptomatic? Until we can answer that question with at least a ballpark measure of understanding, I don’t see how we can comfortably “reopen” much of our society without risking second and third waves of the disease.

This isn’t criticism of Nova Scotia’s testing, which appears to be fairly extensive compared to other provinces. Just, we’ll need to increase the level of testing much more.

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