In the interests of public health, Dr. Strang should call for the legislature to convene

News

1. The politics of coronavirus

The good news on the coronavirus front: As of Sunday, Nova Scotia has gone 12 straight days with no new cases of COVID-19, and there is only one known active case in the province, someone in hospital. A second person is in hospital suffering from the effects of the disease but no longer has the virus, which underscores that some people who have “recovered” may suffer severe health consequences into the future, maybe even for the rest of their lives.

Even with the relatively rosy statistical profile of Nova Scotia at the moment, we should keep in mind that the virus may still be present in the community and there could be presymptomatic or asymptomatic cases of COVID-19. Or, as New Brunswick has experienced, the virus could be newly introduced from outside the province and spread again quickly. So we should continue with all the recommended cautions.

We can attribute Nova Scotia’s current disease picture to the success of three policies: border restrictions, the early shutdown, and a good testing and contact tracing regime.

But let’s not get too self-congratulatory. After all, as Stephen Kimber reminds us, 53 people died in Northwood. What happened at Northwood should be the subject of intense public scrutiny. Those deaths are the result of policy failures that stretch back over governments led by all three political parties, and the current government has repeatedly rejected pleas from Northwood for funding so it could place residents in single rooms, thereby reducing the risk of widespread virus infection.

Over the past few months, the once-daily, then three-times-a-week, now sporadic government briefings about the status of the pandemic have been led by Premier Stephen McNeil, just as other provinces’  and US states’ briefings are led by their respective premiers and governors. This is a profound shift in policy, and has worrying consequences.

As On The Media, the excellent WNYC radio show and podcast, explained:

Through polio in the 1950s, to H1N1 in 2009, to Ebola from 2014 to 2016, [public health officials’] experiences coalesced into a compendium of best practices for informing the public. A literal playbook published by the CDC’s Epidemic Intelligence Service. It’s dedicated to the Do’s and the please, please, please don’ts of pandemic communications.

That playbook is titled the Field Epidemiology Manual. It devotes an entire chapter to public communications during a pandemic.

Charles Duhigg wrote an article for the New Yorker about the playbook, and the consequences of either following it or not. On The Media host Bob Garfield interviewed Duhigg about it:

Charles Duhigg One of the very strong suggestions in that field book is that when it comes to health advice and scientific updates, put the scientists front and center. And Richard Besser, who used to be the acting director of the CDC, I think he put it best when he said, look, the problem is if you put a politician on the stage, there’s a very realistic chance that 50 percent of the audience is going to do the opposite of what he or she says, because they didn’t vote for that person. They don’t trust that person. They don’t like that person.

…

Bob Garfield A good example of this playbook in action you say happened during the Obama administration with the H1N1 epidemic. What happened there?

Charles Duhigg When the H1N1 pandemic was first detected in the United States and was a very serious outbreak, over 12,000 Americans died. Over 700 school districts were shut down. The reason we don’t particularly remember it is because the response from the Obama White House was almost a picture perfect adherence to the principles of communication that the CDC has put forth about how we ought to speak and behave during a pandemic. Obama actually said very little publicly about H1N1. Instead, he handed off communications to the director of the CDC, who at the time was Richard Besser and was replaced by a guy named Tom Frieden. And what would happen is that those scientists would stand up and give a briefing every single day at noon from the CDC. … And Obama stayed in the background. He only spoke about H1N1 a few times. And when he did, he always took great pains to compliment the Republicans.

[CLIP]

Barack Obama The Bush administration did a good job of creating the infrastructure so that… [END CLIP]

Charles Duhigg He was trying to signal to folks this is something that transcends party divisions. And we’re giving you advice based on science.

In short, the goal is to de-politicize the disease. Don’t make the politician the face of the response to a pandemic; instead, make it about the science, and have public health officials take the lead.

So why do we now have the politician in jurisdictions across North America being the face of pandemic response? Donald Trump, that’s why. Trump’s ego is so big he had to be front and centre; he first gave a COVID briefing on February 27, and that soon became daily; and he used that platform to spew lies and bad medical advice:

Charles Duhigg The problem is that this is all being done in the context of President Trump having a daily briefing. And so [New York Governor] Andrew Cuomo stepping forth and becoming the spokesperson for a data driven and scientific approach to dealing with the pandemic as opposed to a political or emotional approach. I don’t think that’s a terrible idea because I don’t know that a scientist would as easily become the foil, or the counterpoint to what the president is saying from the White House.

And so Canadian politicians followed suit. And we have Stephen McNeil acting as a sort of master of ceremonies when Nova Scotia’s chief medical officer of health, Dr. Robert Strang, gives his updates. It’s impossible not to be a political venue when the premier is on stage, and so everything about these briefings becomes politicized — every perceived success with the disease response is attributed to the greatness of the McNeil government; every perceived failure is demonstration of the McNeil government’s ineptness; and when I ask probing questions at the briefings, as is my job, it’s viewed as attacking McNeil politically.

It didn’t have to be this way. Strang could have given most of the briefings solo, or along with other public health professionals. Those rare times when politicians needed to be in on the stage — to announce new directives under the Emergency Measures Act, for example — it should have been the person with the relevant portfolio, Health Minister Randy Delorey, and not the premier.

“Stay the blazes home” was a failure in communications policy because it made it about McNeil authority as a politician ordering the citizenry around instead of being about the best policy as directed by health professionals with no electoral skin in the game.

But here we are. The disease has been politicized.

McNeil wants to claim there’s no politics involved. We’re in the midst of a health crisis and an economic crisis; McNeil tells us, however, that the legislature and its committees shouldn’t meet because his government and public health officials can’t waste time with committee meetings because they’re too busy “focusing on public health.”

This is absurd. When they aren’t being hijacked for political purposes, the entire point of the COVID briefings is to communicate with the public, to clearly give explanations of the latest public health recommendations. Reporters are present precisely to challenge those explanations, to see if they hold up. If the explanations do hold up, the response to challenging questions will demonstrate it. Alternatively, if the explanations are weak or unfocused, the public health officials can do more work to reframe or update their policies.

I’m not showing up at the briefing to piss on the premier. I’m there in hopes of getting a better public health response.

I’m reminded that at one of the first briefings, when they were held in person at the media room in One Government Place, Dr. Strang told the public we should all socially distance by keeping six feet apart from each other. But he gave that public health directive while sitting at a dais elbow-to-elbow with four other officials. I wasn’t just being a dick when I pointed that out; I was showing that there was a contradiction in the messaging.

At the next briefing, the officials were all properly distanced from each other. My question improved the public messaging. The day before, when the public heard the directive to stay six feet apart but saw the public health officer ignoring his own directive, a reasonable response would be “he doesn’t really mean it, so I can ignore it too.” But then when Strang was seen observing the directive himself, the take-away for the public became, “wow, look, he’s staying six feet apart from everyone, so he must really mean it and I should do that too.” It took a “rude” question from a pain-in-the-ass reporter to make that change.

(Likewise, if Strang really wants to encourage the use of masks, he should show up at the briefings wearing one.)

Look, the science is evolving on all things coronavirus, including the response to it. We’ve learned a lot, and we’ll continue to learn about it. In retrospect, the order to close the parks seems counterproductive, and I said so even at the time, but I at least understand where the order was coming from, and I’m not going to harp on it now. Likewise, I understand how the thinking about masks has evolved.

Some of what we’ve learned has been quite positive — it appears the chances of infection are relatively low for people outside wearing masks; at least, although it’s early days, there hasn’t yet been a noticeable uptick in infections from people who joined the uprisings for racial justice. On the other hand, other things we’re learning aren’t so positive — it now appears that children aren’t as immune as we thought they were, but rather express the disease differently.

Given a moving understanding of the disease and how to respond to it, we need a broad and public conversation. That’s how we get to better public health results. It’s not just scientists sitting in a lab reading the latest peer-reviewed articles on the epidemiology of the disease (although it’s that, too), but the give and take of probing questions from varying perspectives — and not just from reporters, but from politicians and the public generally.

Challenging public health officials is how we get to better public health. And they know this. They are scientists, who operate within a tradition of having their work critiqued and challenged, and then responding by either defending their original position or changing it. The ultimate goal of scientists is a better understanding of how the world works. This is how science operates.

It’s politicians who don’t like to be critiqued or challenged. It’s politicians who refuse to accept that they might be wrong, and who double down on their original position no matter what. The ultimate goal of politicians is not so much truth as it is electoral power. This is how politics operates.

So to address this public health crisis, we should have more, not fewer, avenues for critiquing and challenging the public health response to the pandemic. And that’s exactly why the legislature should be meeting. Especially the legislature’s Health Committee.

“There will be lots of time for [reporters] and the opposition to question Dr. Strang, and we’ll do that,” McNeil said Thursday. “But I’m not willing, quite frankly, to put at risk the health and well-being of Nova Scotians to satisfy a committee meeting.”

This is 180 degrees wrong. It could not be more wrong.

First of all, there are only nine people on the legislature’s Health Committee. Under current Public Health recommendations, they don’t even have to socially distance from each other.

More to the point, there are a lot of important decisions coming in the days and weeks ahead. Public health restrictions are being loosened. Are they being loosened in a responsible and defendable manner? We can’t know that if public health officials aren’t challenged and given the opportunity to defend and explain their decisions. Will there be public acceptance for the new policies? Not if Strang and other public officials can’t clearly explain themselves in the face of differing opinions.

Most worrisome for many people I’ve spoken with is the prospect that in mid- to late-July Nova Scotia is going to open its borders to people from all provinces in Canada. (Technically, the border has never been closed, but people coming into the province were directed to self-isolate for 14 days; whether they actually followed that directive is another matter.)

Is this wise? There were 175 new cases of COVID-19 announced in Ontario yesterday, and 92 in Quebec. Some Nova Scotians I’ve spoken with say they’ve sacrificed by following restrictions for three months, and we’ve achieved a low-risk situation in this province, but opening up like this threatens to undo all the good that came out of their sacrifice.

Others have an opposite view: the restrictions have had hugely negative economic impact, which is itself reflected in poor public health. We at the Examiner have been trying (with little success) to drill down into the health effects of the restrictions — how many more people have committed suicide or are victims of domestic violence? How much has substance abuse increased? How are delayed medical procedures reflected in public health; how many people died because they couldn’t get in for routine medical procedures?

So easing the border restrictions is a complex issue. There are varying views and concerns. The responses are public health decisions, but also political decisions. It’s not good enough for public health officials and politicians to make these decisions behind closed doors and then simply announce them as fait accompli.

If Strang wants public buy-in for the decisions that public health is making, then he should welcome challenge, critique, and questioning of those decisions.

In the interests of public health, Dr. Strang should himself call for the legislature to convene.

2. Prisoners and city elections

People who are imprisoned have the right to vote in federal and provincial elections, but not in municipal elections, points out El Jones:

The latest report published by Correctional Services in April 2019 shows an average of 470 people in provincial custody on any given day, with Central Nova Scotia Correctional Facility in Burnside being the largest institution…

The report also reveals that by the average daily count, 62% percent of people held in provincial custody are on remand, meaning they have not been convicted. Almost two-thirds of those in custody are legally innocent, yet are prevented from voting on issues that directly impact them.

The same report shows that “Indigenous persons and African Nova Scotians make up a greater proportion of people in correctional facilities than in the general population.” African Nova Scotians made up “2 percent of the Nova Scotian population, but represented 11 percent and 10 percent of admissions to remand and sentenced custody.” Indigenous women are particularly over-represented, as in “2017-18, Indigenous females represented 15% of female admissions to remand.”

Forty-two percent of federally incarcerated women are Indigenous, and Black incarceration is rapidly increasing. The Wortley report showed that Black people are six times more likely to be street checked than white people, and that one-third of Black men in Halifax have criminal charges. Disenfranchising incarcerated people suppresses the vote of communities who already face barriers to democratic participation. Even worse, the very people who are criminalized by racist policing regimes are denied the right to have their say about policing.

…

It is unconscionable in these times that incarcerated people, many of whom are the victims of the very systems thousands of people in Halifax are hitting the streets to protest, should be prevented from exercising the most basic right to vote. The city cannot continue to ban prisoners from voting while claiming that they are taking these issues seriously. Without action, taking the knee while injustice continues is purely performative.

Click here to read “If we’re serious about addressing systemic racism, then prisoners should have the right to vote in the upcoming municipal elections.”

3. Halifax’s climate change plan

“Halifax’s new climate change action plan aims for carbon neutral city operations in 10 years and carbon neutrality across the municipality by 2050, but the COVID-19 pandemic has put the ever-important short-term success of the plan in jeopardy,” reports Zane Woodford.

Click here to read “Halifax’s big climate change action plan is ready, but the COVID-19 budget crunch means it’s already ‘jeopardized.’”

Government

City

Monday

Special North West Community Council (Monday, 7pm) — teleconference; agenda here.

Tuesday

Special Halifax Regional Council (Tuesday, ) — virtual meeting; agenda here.

Province

No public meetings.

In the harbour

05:00: Atlantic Sky, ro-ro container ship, arrives at Fairview Cove from Liverpool, England
11:30: CSL Tacoma, bulker, sails from National Gypsum for sea
12:00: Atlantic Sky sails for New York

Footnotes

I keep trying to get Morning File published earlier, but it keeps getting later…