Nova Scotia is now treating COVID as just another respiratory disease. Here’s what the data say

Nova Scotia has lifted the Health Protection Act order as it relates to COVID.

The lifting of the order will make no difference in practice, Chief Medical Officer of Health Dr. Robert Strang told reporters on Tuesday.

“That order really just gave us the legal framework to take actions if we felt necessary, most of which have ended,” said Strang. “But it was kept in place in case there was a resurgence. Now the likelihood of that is extremely low, so it was felt we could just lift that order. And if something happens or there’s a new virus, then we need to go back to a new Public Health order. It doesn’t take away our ability to do that, but we no longer have need to have the existing order in place.”

Strang explained that when vaccines became available, he imposed a vaccine mandate for people working in hospitals and long-term care facilities, but those mandates have been lifted over the past year.

“The Public Health order has given the ability for organizations to create their vaccine mandates, but it hasn’t directed them what they should do,” said Strang. “The responsibility has always been with those individual organizations, and we have left it with them to make that decision. We have never given them direction that they should or should not, other than in the very initial phase.”

Nova Scotia Health this afternoon told the Halifax Examiner that there is no change in the existing policies related to COVID — hospital employees are required to have their primary series of vaccination, and mask mandates remain in place.

Each long-term care and congregate living facility (jails and adult residential centres operated by Department of Community Services) will decide for itself how to proceed.

Still, Strang said people should get vaccinated.

“I continue to ask Nova Scotians, as I’ve done throughout the pandemic, to understand that even though we not we may not consider ourselves vulnerable, there are people around us that we may not even know that are more vulnerable,” Strang said. “And all of us need to do what’s necessary to help keep each other safe, but also those who are at highest risk. One of the most important things that they can do is maintain the appropriate levels of vaccination.”

“Aren’t you contradicting yourself?” I asked Strang. “You just said that we should be conscious that there are those around us who may be vulnerable and we should do what we can to protect them. You said that in a press conference announcing that workers in nursing homes no longer have to get vaccinated.”

“We’re not saying they don’t have to have the vaccine,” responded Strang. “We’re saying it’s up to individual organizations about whether they maintain their required mandatory vaccine policy or not. They know their own individual setting and their risks the most. What we’re saying today, in general, is that, like the W.H.O., we no longer need to have a COVID emergency response plan.”

To that end, the province is winding down its COVID reporting process. This Thursday will be the last time the weekly COVID dashboard will be updated. The monthly COVID reports will continue through September, but in October COVID will be rolled into the Respiratory Watch reports, which come out monthly in the summer but weekly during the winter flu season.

“By no means does today’s update mean that the COVID 19 virus is gone,” said Strang, “but rather that it is now at a stage that we can respond to it and live with it like we do with all other respiratory viruses.”

But is COVID just another respiratory virus?

The graph above shows the number of all non-COVID respiratory deaths per flu season since 2013, as related in Public Health’s Respiratory Watch reports. As you can see, there was an increase in such deaths from 13 in the 2013-14 season to a high of 61 in 2017-18. But with the COVID restrictions in place starting in 2020, the death count for other respiratory diseases fell to 0, only to increase to a record high 69 this season.

COVID didn’t exist until 2020, but the death count has been considerably higher than the death count from all other respiratory deaths combined. Even in this record high flu death count season, more than five times as many people have died from COVID.

Here’s what happens when COVID death counts are added to the death counts from other respiratory diseases[*:

“Are we now expecting that there will be five or six times as many respiratory deaths every year?” I asked Strang.

“No,” replied Strang. “I think there’s a couple of things there. Pre-pandemic, I think we underappreciated the extent of how influenza and RSV contributed to death in people who were at the end of their lifespan anyway. Now we are testing everybody for COVID. Everybody goes into hospitals, they get tested. So, we’re recognizing COVID at a much greater rate as a contributor to people who are at the end of their life anyway.”

“And COVID may be a lot of the things that ultimately ends in their death. But we’ve never tested to the same extent of influenza and RSV. So you really can’t make the comparisons. The conclusion that we have to have is that all of these respiratory viruses can have a significant impact on the frail elderly. And we have to take appropriate steps while the rest of life generally goes on. But we have to take appropriate steps to help keep those those groups safer.”

* Seasonal COVID deaths were calculated as follows:
157 (March 1, 2020 – December 7, 2021)
330 (December 8, 2021 — June 28, 2022)
378 (July 1, 2022 — May 15, 2023)

With files from Jennifer Henderson.