1. Community spread and vindictive behaviour
Yesterday, at the daily briefing on COVID-19, we learned that there is a possible case of community spread of the disease, probably related to a St. Patrick’s Day event. An hour or so after the briefing, the Nova Scotia Health Authority issued a release with details:
FOR IMMEDIATE RELEASE
Thursday, March 26, 2020
HALIFAX, N.S. – NSHA Public Health is advising of a potential public exposure to COVID-19 on March 14 at Lake Echo Community Centre (3168A Highway #7, Lake Echo).
The gathering was a public event related to St. Patrick’s Day with approximately 50 people in attendance. Public Health has been directly contacting attendees to advise on self-isolation protocols and next steps.
While most people have been contacted, there could be some attendees Public Health is not aware of or contact information may have changed for individuals.
It is anticipated anyone exposed to the virus at this March 14 event may develop symptoms up to, and including, March 28, 2020.
Moments after we published an article about the situation, social media lit up with condemnation of the attendees, so I updated the post:
Updated, 7pm, because of response to this article on social media:
People are afraid, I get it. But there’s a lot of vindictiveness bordering on vigilantism right now. Please, the premier and Dr. Strang have both urged people to be kind, to reach out and help people, rather than your first inclination to be to condemn.
There was a learning curve, including in our own government.
For example, the Lake Echo St. Patrick’s Day event was held on Saturday, March 14. At that time, the province had only suggested that public gatherings be limited to 150 people. The Lake Echo Event had about 50 people. The next day, Sunday, March 15, the premier made the 150-person limit an order, and he thanked downtown bars for voluntarily keeping to the 150-person limit in their establishments. So if the Lake Echo people were idiots or whatever your insult of choice is, so was the premier, the chief medical officer, and every level of government in Canada.
It was two weeks ago, which in this crisis was forever ago. We’ve all learned a lot since then. Please be kind. We can better win people over to better behaviour with kindness than by siccing the cops on them or making them the targets of social media attacks.
And we’re just at the beginning of this. I fear what will happen when people start dying. We’ve got to get control of our worst instincts.
To give an indication of how fast things were moving in those days, the day after the St. Patrick’s Day event, Sunday, March 15, there was a bingo scheduled at the very same community centre. This was projected to have about 125 attendees, and not to overly stereotype, but the bingo demographic skews older.
I’m not sure if the decision was made before or after Premier Stephen McNeil’s 3pm press briefing, in which he ordered gatherings limited to 150 people, but the bingo was cancelled.
I also asked the premier about rents. Here’s our exchange:
Bousquet: Rents will now be due six days from now, on April 1. Some time ago, on March 19, you ordered that no one be evicted as a result of COVID-19 — it was somewhat ambiguous, and I’ve been asking your staff and the provincial staff for a copy of that order, but it has not yet been published so far as I know. So I’m curious as to why it hasn’t been published. And also, yesterday, Manitoba premier Brian Pallister declared a freeze in rent, and as I understand it, that include longtime notices, the four-month notice for rent increases. Will you consider that?
McNeil: Well, first of all, we made the order early on that no one would be evicted as it related to COVID-19. We did not say there would no evictions, that there would be other evictions that had been in place for other reasons. But if it was directly related to COVID-19, we would be involved. As you know, all those would have to go to a hearing, and that’s where the role we can play without putting a blanket order on evictions across our province. We’ll continue to work with landlords and I know some of our landlords have actually expressed to their tenants to come to them if there’s issues related to COVID-19 and they will work with them to find their way through this.
I commented (not to McNeil, but in the article):
This was an unsatisfying answer, for several reasons.
First, without a published order outlining who can and who cannot be evicted, we’re left with an awful lot of room for interpretation. Must someone actually have COVID-19 to receive protection of the order, or is losing your job because your job site has shut down enough? And who’s going to check?
In either case, it seems like an enormous invasion of tenants’ privacy. A landlord has no right to know a tenant’s health condition or, for that matter, if they’ve lost their job because of COVID-19. So this leaves a very murky legal ground.
Still more to the point: if someone is evicted during this COVID-19 crisis, where are they supposed to go?
One area of recurring concern from readers is about testing protocols, and why we aren’t “testing everyone.” I asked Strang about this last week:
I also asked Strang about his claim that there is not yet any community spread of COVID-19.
This is extremely confusing to people, because they are reading that the contagion is being spread elsewhere by people who are asymptomatic. But in Nova Scotia, people are not being tested if they are asymptomatic.
In fact, the province’s 811 self-screening site excludes from testing anyone who has not travelled outside the province or who has come into contact with someone who is either infected or who has travelled outside the province. So how can Strang categorically claim there is not community spread of COVID-19 in Nova Scotia? His response:
Well, that’s always a possibility. But based on what we knew as we built our approach, the virus wasn’t here, so we are aggressively testing people who are coming into the province.
We’re also looking at other indicators of potential community spread. So we’re monitoring rates of people going into emergency rooms with influenza-like illness, which is part of our standard influenza surveillance. And we’re getting daily reporting on that from all of our hospitals; if we see a spike in flu-like illness in any community, we’re certainly prepared to go in and do some testing, but we haven’t had to do that.
If we get an outbreak in a school before they close or in a long-term care facility, along with our regular viruses, we’ll now be testing for COVID.
We are now testing anyone who has to be admitted to hospital with respiratory illness for COVID.
So even though we’re not testing people with just fever or cough, we’re looking for community spread in a number of other ways. And we’re actively looking at how do we do that more community-based testing in certain locations. There’s nobody around the world that is testing everybody with a fever or cough, that’s just not realistic or feasible. So we have to focus the resources we have in the most appropriate places.
Since then, testing has been broadened to include all close contacts with positive COVID-19 cases.
And on Tuesday, I had an half-hour long, in-depth conversation with Jason LeBlanc, the director of Virology, Immunology and Molecular Microbiology at the Nova Scotia Health Authority, in which among other things, we discussed testing protocols. You can listen to it here:
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The relevant portion:
Bousquet: How does someone get tested?
LeBlanc: It’s either by a contact if they have travelled and have symptoms, they can call 811 and they will get directed to an assessment site. If they are feeling unwell and make it to the hospital, they’ll get tested there as well. We do community based surveillance approach to see if there’s virus out there that’s not being captured by these routes. By looking at anybody that would have an influenza-like illness that would be in a long term care facility — which would be some of the individuals at greatest risk — people presenting to the emergency departments will automatically get it as well. In-patients will get it as well. So there’s a lot being done other than what the assessment sites that they’ve been rolled out.
LeBlanc: Right now, it’s anybody that has travelled outside of Nova Scotia is the key people that we’re focusing on, but anybody with symptoms that have been hospitalized or it is in a long term care or ends up in a emergency room gets tested.
Bousquet: So when you say anyone who has travelled outisde Nova Scotia, that includes people who are not showing symptoms?
LeBlanc: To tell you the truth, the testing of people that don’t have symptoms can be very misleading. And I wouldn’t advocate for that. I’ll give you an example. If someone has been exposed and they are not showing symptoms, we may not be able to identify it from a lab perspective that they are a positive case. Viruses, they take time before we can actually detect them, from the time of clinical presentation. So if we release a negative result, they’re going to think, even if later on they develop COVID, they’re going to think they’re negative for COVID. So that would be a false negative result. So that’s the reason that we can’t just go out and test everybody right now for COVID.
Bousquet: Okay, that’s helpful, because there’s a narrative out there in the world, you know, these are not microbiologists, but it’s out in newspapers. There’s a wide understanding that testing is the solution to isolating this.
LeBlanc: And it is actually not. Testing is not going to stop this. The key point is the self-isolation and the social distancing. That is really what is going to stop the spread of this virus. You can test all you want. It will not stop the spread if people are out there circulating and mingling. So it’s really the social distancing and the self isolation that’s key here.
Bousquet: I guess this one small town [in Italy], 3,000 people. The narrative is that they somehow are testing everyone. I don’t know if it’s once a week or whatever, but as a result of that, they’ve been able to eliminate it from any new cases.
LeBlanc: I mean, from if you’re in a setting where you have a very small population, it goes back to the testing of people that don’t have symptoms yet. If they are going to be negative, negative, negative. If you keep testing them every day until they just start showing symptoms and then they’ll become positive if they were exposed. So from that perspective, you would have to test everybody every day, and from a Nova Scotia perspective, that’s not possible.
Bousquet: There’s this view out there that, oh, they’re only testing for people who come in from out of the province, they screen out any potential community spread. So how do we know it’s not out there in the community?
LeBlanc: Well, we we don’t because we’re not testing everybody. There’s some people that even with symptoms, may not show up or may not want to get tested. So I think it’s fair to say that you should assume that there is community spread and you treat it as such. So that, again, self-isolation, social distancing, washing your hands, all the key messages from public health are very important. Assume it’s in the community.
We can talk around this issue forever. But I think Leblanc’s and Strang’s approach is defensible, if somewhat unsatisfying. There is a limit to how many people can be tested, and while that number is being increased (Wednesday, 470+ people were tested), there still has to be a prioritization. In the meanwhile, act as if you and everyone else has it.
4. Homelessness and coronavirus
“Amid a public health emergency that relies on people keeping six feet apart to halt the spread of COVID-19, a team is putting on a full court press to deal with one group of citizens,” writes Jennifer Henderson:
Housing Nova Scotia, the Halifax Regional Municipality, the YMCA, and agencies such as the Salvation Army and Shelter Nova Scotia are trying to reduce by 50% the number of homeless men and women crowding into emergency shelters.
“Those who are in a shelter or without shelter cannot self-isolate,” wrote Meghan Laing, Chair of Shelter Nova Scotia in a letter published on the website yesterday. “With large numbers in small spaces that is impossible. We are scrambling to find temporary alternatives to overcrowded conditions.”
Related to the above, at least in my opinion,
With travel restrictions in place, several hotels in Nova Scotia have closed and others have laid off the majority of their staff — but demand for rooms may be growing from health-care workers.
Business is down 90 per cent or more, according to a survey of members done this week by the Hotel Association of Nova Scotia, said president David Clark, who is also the general manager of the Atlantica Hotel Halifax.
“It’s devastating for our industry, we’ve lost between 80 and 92 per cent of our staff right across the board,” he said.
The vacancy rates are reflected in current pricing, with many hotels that usually charge more offering rooms for less than $100. The Prince George Hotel in downtown Halifax is not taking reservations until June.
Clark said at least seven hotels in Halifax have shut down temporarily. He wouldn’t specify which ones, but said some are part of chains with multiple locations that have amalgamated staffing resources for the time being.
I have a particular interest in the Sutton Place Hotel promised for the Nova Centre, and so I signed up for job notifications. On March 5, the automated email notified me of potential jobs in Halifax for Guest Services Supervisor, Accounting Manager, Housekeeping Supervisor, Guest Services Manager, and Chef Concierge, all of them closing on March 23.
But on March 19, the automated email said, “Hi Tim, I hope you are having a great week!” just as I was hunkering into my encampment with a year’s supply of dried beans, enough frozen orange juice to ward off a shipload of scurvy, and 50 rolls of toilet paper to see me through the apocalypse. The email listed just one job — the Guest Services Manager — again with a closing date of March 23. This morning, the hotel’s website show zero jobs in Halifax.
I don’t know if this means all the jobs have been filled or if the project is on hold. I suspect the latter, but either way, there are a bunch of brand new hotel rooms up there looking for an opportunity.
And I know of an opportunity.
Several jurisdictions are closing homeless shelters and placing clients in hotels, for fear that the shelters will become vector points in the spreading pandemic. In Richmond, Virginia, a large tent city called Camp Cathy is being closed, with all residents moved to permanent housing, mostly rooming houses. I’m told similar efforts are being made in the Yukon.
The old way of thinking about the homeless was that they needed to go through lifestyle changes to improve their lot, each change rewarded with some benefit. In general, the idea was that you’re living in the shelter (or for the most problematic cases who are barred from shelters, out on the street) until you kick your addiction or look for a job or whatever, and then we’ll reward you with a housing subsidy.
But in recent years, that script has been flipped. “Housing First” works to, as the name implies, first give homeless people a place to live, and once they have that stability, work to help them address their other life problems.
The results have been dramatic.
For example, a Canadian study published in December 2015 ran an experiment in five cities — Vancouver, Winnipeg, Toronto, Montreal, and Moncton — by randomly placing people in a Housing First program and comparing them to people who were receiving traditional programs. The study found that Housing First participants had a much better (especially immediately) quality of life improvement. As for costs to society:
On average, Housing First with ACT services cost $22,257 (Canadian dollars) per participant annually. Taking into account use of health, social, and justice services, Housing First produced an average net cost offset of $21,367 Canadian per participant per year, or 96% of the cost of the intervention. The most important cost offsets were office visits, hospitalizations for general medical conditions, emergency shelter visits, home visits, and incarceration.
In short, it’s a bit cheaper overall to place people in Housing First programs. And it concluded:
The findings of our trial extend previous research into a Canadian context and demonstrate that Housing First with ACT yielded significant benefits to individuals with high levels of need, notably helping them to exit homelessness as well as experience rapid gains in community functioning and quality of life. In comparison, individuals receiving treatment as usual experienced poorer housing outcomes but similar nonhousing outcomes. From a policy perspective, the choice becomes to either implement Housing First and significantly reduce homelessness while having a modest effect on mental health and addiction or to provide treatment first, then housing, with similar clinical outcomes but inferior housing outcomes. The Canadian federal government has used the study findings to prioritize the development of Housing First programs in its national homelessness initiative.
Other studies have duplicated those outcomes. To his credit, Mayor Mike Savage has been banging the Housing First drum since his election.
I attended one of several housing symposiums in 2014, in which an ambitious plan to “end homelessness in Halifax in five years” was laid out. Phase 1 of the program started in the fall of 2015, with some funding from all levels of government, but here we are five years later and we still have hundreds of homeless people in Halifax.
There are lots of reasons for the failure to “end homelessness” — the drift of political attention away from the problem, the superhot housing market, and the province’s broken financing model for new subsidized units, among others.
To make Housing First a permanent part of our approach to homelessness will require a lot of policy changes. We need lots more commercial rooming houses (last I checked, there were just three registered rooming houses in all of HRM, and one of those was attempting to evict its residents to go more upscale). We need a huge infusion of public money into non-market housing. And we need better support for the agencies that work on the ground to help homeless people. Remember, all of this will save us money in the long run.
But the pandemic gives us an opportunity. There are hundreds of vacant hotel rooms, with entire hotels closed. And there are hundreds of homeless, who not only need housing, but should be housed lest the virus spread like wildfire among them.
Why can’t we match the two, and place homeless people in unused hotels, at least for the duration of the current crisis?
A city press release from yesterday:
The Halifax Regional Municipality continues to monitor and respond to the rapidly evolving effects of COVID-19.
Based on current staff availability, Halifax Transit anticipates that conventional bus service will be significantly impacted at the start of service tomorrow, March 27.
Riders should expect route delays and/or cancellations and are asked to make alternate plans if possible.
All ferry service will continue as scheduled.
Unimpacted routes, as well as ferry service will continue to operate on a reduced schedule.
The lack of “staff availability” relates to a man working in the Burnside transit garage testing positive for COVID-19. Reports CTV:
The Halifax Regional Municipality says Halifax Transit was notified about the case Wednesday evening.
HRM says staff working the evening shift were told to go home and the morning crew were told not to report for their shift.
The Burnside maintenance department workspace was disinfected, with a particular focus on high-touch surfaces such as doorknobs, work surfaces, and tools.
At the daily briefing yesterday, Dr. Robert Strang stressed that the single COVID-19 case was not a result of anyone riding on a bus; the man who tested positive had either himself travelled outside of the province or contracted it from someone who had travelled outside of the province.
1. Charlotte’s Web
“In my ‘stay at home’ considerations about being connected, part of a herd, part of a community, I have been obsessed all day by Charlotte’s Web,” writes Halifax lawyer Barbara Darby:
Charlotte transforms scraps of garbage and the barn community’s suggestions into art. Wilbur is TERRIFIC. With her endorsement, his value to others increases. He’s more important because he’s been noticed. And we get some rare insight into the artist’s process, as she swings from the secure points, choosing her threads and her fonts. She’s not just weaving, or spelling words. She’s designing and writing to persuade.
Darby walks us through the tale, to Charlotte’s demise:
Their last talk is a sad one. Wilbur wants to know why…how did he deserve this? And it is because of the simplest of things:
“Why did you do all this for me?” he asked. “I don’t deserve it. I’ve never done anything for you.”
“You have been my friend,” replied Charlotte. “That in itself is a tremendous thing. I wove my webs for you because I liked you. After all, what’s a life, anyway? We’re born, we live a little while, we die. A spider’s life can’t help being something of a mess, with all this trapping and eating flies. By helping you, perhaps I was trying to lift up my life a trifle. Heaven knows anyone’s life can stand a little of that.”
Read the whole post. All the way through to the end:
Take care of each other.
All meetings are cancelled.
All events are cancelled.
In the harbour
08:00: Baie St. Paul, bulker, moves from Pier 33 to National Gypsum
11:00: RHL Agilitas, container ship, sails from Pier 42 for Kingston, Jamaica
11:00: YM Express, container ship, sails from Fairview Cove for Rotterdam
14:00: Pictor J, container ship, arrives at Pier 42 from Argentia, Newfoundland
16:00: ZIM Yokohama, container ship, arrives at Pier 42 from Valencia, Spain
18:00: Nolhanava, ro-ro cargo, sails from Fairview Cove for Saint-Pierre
18:00: AlgoTerra, oil tanker, arrives at Imperial Oil from Quebec City
19:00: Oceanex Sanderling, ro-ro container, sails from Pier 41 for St. John’s
23:45: Pictor J sails for Portland
The Examiner has a bunch of projects lined up, and we’ll be publishing more articles through the day. Check back.
As well, I’ll be “attending” (via phone) the daily briefing from the premier and Dr. Strang today. I’m deluged with messages from readers (you can reach me by email, firstname.lastname@example.org; or by Facebook messenger; or my open Twitter DMs, @Tim_Bousquet), so many that I can’t respond directly to more than a small percentage. But I do try to read them all, and they inform my questioning of the premier. I appreciate your input.