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Atlantic Canada’s chief medical officers are in no rush to pop the bubble.
That was one of the key messages to come out of a virtual panel discussion last night, hosted by Dalhousie University’s MacEachen Institute for Public Policy and Governance.
Dr. Jennifer Russell, Chief Medical Officer of Health for New Brunswick, opened her segment by holding up a chocolate bar whose wrapper was emblazoned with the words, “Stay in your own bubble and don’t burst anyone else’s.”
“In the summer it was looking better in terms of relaxing some of those border measures,” Russell said. But now, with infection numbers rising in the rest of the country, “we are not really in a hurry to have that conversation.”
She added, “Certainly our risk tolerance is very low as an Atlantic bubble for good reason… I feel like over the next six to nine months the challenge is going to be to get through the school year, get through Christmas, see how things go… I think we are going to have to continue to amp up our messaging of things that are already in place and incrementally work at being creative about where else can we tweak things.”
Even before the Atlantic Bubble was announced, premier Stephen McNeil talked about opening to the rest of Canada by mid-July, saying “We have to learn to live with COVID. We need to figure out how we’re going to be able to move about inside of this country.”
But there was none of that talk on last night’s panel. Nova Scotia’s Chief Medical Officer of Health, Dr. Robert Strang, showed no inclination to open the bubble any time soon. And he rejected the idea that public health measures and the economy are at odds with each other.
“Now is not the time to relax. If you look around us, we certainly have to be very vigilant,” Strang said. “There’s a lot of people saying, well, from the economic perspective, why can’t we be more relaxed? I think we have to take a longer-term view to this… Good public health is good economics… If we stay very tightly restrictive and get through the next six to nine months, we’re in a position to actually be in an economic recovery much sooner than many other jurisdictions who have been overwhelmed by large spikes of waves of COVID.”
While he said he thought the spring lockdown restrictions were “necessary,” Strang recognized that the “broad and very tight shutdown” also came with “unintended impacts.” If Atlantic Canada does get hit by a second wave (and the participants in the panel noted that this is not an inevitability) he said he would adopt a “much more evidence-based and nuanced response.”
He added, “When we do have to strengthen our public health measures, again, our goal is to do that based on the local epidemiology, to avoid, if at all possible, a broad shutdown. So how do we focus our restrictive measures on a certain geography, a certain community or a subset of the community, a certain set of population, or even certain specific settings where the highest risk of transmission is?”
Responding to a question about why there is inconsistency even within the bubble when it comes to public health rules on, for example, gatherings, Russell said the answer has to do with each province’s health-care system’s capacity to respond to an outbreak.
“We do have to consider all of those things when we’re making a decision about what the group size or mass gathering size can be in your province. It’s not just simply about, OK, because we have no cases, the average gathering size can be X number. We have to look at our capacity to respond if we had a large gathering that had an outbreak.”
All four panel participants spoke about unintended consequences of lockdowns on people’s mental health, and about how the pandemic has made it impossible to ignore harsh social inequities and their effects on health.
Dr. Janice Fitzgerald, Newfoundland and Labrador’s acting Chief Medical Officer of Health (she was appointed in September 2019), said, “COVID-19 has really laid bare the inequities that exist in our society and in our populations. We need to really work hard to ensure, number one that our measures that we’ve put in place don’t exacerbate those inequities and that we really work to reduce them moving forward. So we do need to look at some of those unintended consequences and really carefully consider vulnerable populations.”
Russell said, “Vulnerable populations were vulnerable before COVID-19. And if we don’t take this opportunity now to set right what should have been set right, even prior to COVID-19, I don’t think there’s a way for us to successfully navigate through the pandemic. And I don’t think we would feel good about ourselves as a province or as a country if we don’t really put our money where our mouth is and put those policies into action that we know from an evidence-based perspective can work.”
Strang said he wants public health to look at the role it can play in promoting policies that will reduce inequities. “How do we create different models of housing for people who are homeless? A focus on affordable housing. Knowing that many of the people who were most economically affected are our frontline service providers, whether it’s child care or in the entertainment sector — and so how do we talk about actually making them less vulnerable for the next pandemic, or the impacts of climate change by things like a guaranteed income?” he said. “And then how do we look at things in the health care system like virtual care and other advances that are actually providing better access to care?… We need to find a better balance, a focus on health and all the determinants of health and not just focussing on do I have access to a family doctor or a hospital?”
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