Clear as mud: the status of the backlog of positive COVID cases not entered into the province’s database is anyone’s guess

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Overview
Backlog
Demographics
Testing
Vaccination
Schools
Potential exposure advisories

One-hundred-and-twenty-one new cases of COVID-19 are newly announced today (Monday, May 10). As was the case Sunday and Saturday, there’s still not much clarity on the state of the backlog of unrecorded positive cases, but today Chief Medical Officer of Health Dr. Robert Strang tried to explain it, and so I’ve devoted the next section to the issue.

Of today’s newly announced cases, 94 are in Nova Scotia Health’s Central Zone, 16 are in the Eastern Zone, five are in the Northern Zone, and six are in the Western Zone.

Because the numbers are so large, Public Health is no longer able to provide the cause of cases (i.e., travel related, close contacts, etc.) by the time the release comes out.

There are now 1,655 known active cases in the province. Fifty-eight people are in hospital with the disease, and nine of those are in ICU.

Here are the daily new case numbers and the seven-day rolling averages (today at 169) for the current outbreak, dating from March 28, the last day Nova Scotia had zero new daily cases:

And here’s the graph of daily new cases and the seven-day rolling average since the start of the second wave (Oct. 1):

Here’s the graph of daily new case numbers from the start of the pandemic in March 2020:

Here is the active caseload for the current outbreak:

Here is the active caseload since the start of the second wave on Oct. 1:

And here is the active caseload from the start of the pandemic in March 2020, showing the primary associations of each of the major outbreaks:

Backlog

So where do we stand with the 200 or so positive cases that were known about but weren’t yet entered into the system on Friday?

Here’s what Strang had to say about it today:

We have been making steady progress and addressing the case backlog in public health, and we’re close to being caught up. Many of the backlog cases were reported in our numbers over the last few days, and some may continue to show up for a day or two. But by midweek, I suspect the backlog will be cleared and we will be back to our usual process.

CTV reporter Natasha Pace asked the obvious question:

Pace: Could you explain exactly what the backlog is at this point? From my understanding, talking to Dr. Hatchet, the lab is now all caught up in processing just within 24 to 48 hours. But we are still hearing of people who five, six days after getting their first covid test have still not heard from public health. So where exactly is the backlog?

Strang: So the backlog in Public Health is almost resolved. As I explained on Friday, the process goes: somebody goes for a test, their test — their swab — then goes to the lab. The lab processes it. We had thousands and thousands of those which created a backlog, and were resolved through the lab. Of the thousands of tests, there were hundreds of positives, which then went over to Public Health. Each positive that comes in, Public health assigns that to a case investigator who starts the followup. They enter all the information into our information system, Panorama. And from that, the epidemiologists extract the case information and create, you know, our epi report every day. That’s the process. So that bulge that went through the lab and then the smaller but still big bulge that went over to Public Health, it’s taken us a number of days. We only have so much capacity, so many cases per day that Public Health can start new investigations on. But we’re almost through that. So again, in the next day or two, we’ll be back to regular processes where it flows through at a much more timely manner from into the lab, out of the lab, over to Public Health and Public Health initiating a quick beginning of an investigation.

That of course didn’t answer Pace’s first question, which was “Could you explain exactly what the backlog is at this point?” So another reporter, Nebal Snan with the Chronicle Herald, tried again:

Snan: Premier Rankin said that we’re close to clearing up to the data entry backlog that we have. I was wondering if you, or Dr. Strang, can give us an estimate into how many cases are left in that backlog.

Strang: Well, that’s very fluid. It’s certainly come down significantly over the last few days. But, you know, I’ve used the analogy of a bucket. So we had a big bucket of cases that Public Health has every day pulled from the bottom — the first in, first out. And the level of water in the bucket is coming down. But there’s always new cases coming in, bringing the level back up. But we’re pulling a lot more out than new ones coming in. So the level, the overall at the end of each day, it’s lower than it was the day before. And I expect within the next day that we will no longer have that bucket — cases in will be assigned and they go up for investigation with no delay.

Sigh.

By this time I was banging my head on my desk, but reporter Lyndsay Armstrong with allnovascotia gave it another try:

Armstrong: I’d like to follow up on my colleague’s question about that backlog. Dr. Strang, I’m hoping you can clarify the numbers, given that this backlog is expected to be cleared up in the next few days. I’m wondering how this backlog affects the actual new case numbers that are reported — are the numbers that we’re getting from the province the actual positive cases that have been identified that day? I’d like to know that the specific 200 additional cases you mentioned Friday were those reported over the weekend.

Strang: So now the 200 — we talked about 200 plus on Friday. We talked about that was the backlog. We’re down to a point now that we’re well below 100 with our backlog. The number of positive cases we’re reporting are the ones through that backlog — and you’ve got to remember that backlog built up over time — that there were ones that, we come back to the bucket. As we pull them out of the bucket, they get assigned and they’re entered into Panorama. And as they’re investigated, each of those cases gets confirmed. And then that’s the number, at 6:30 every morning is our cutoff — we pull how many positive cases were investigated and entered into Panorama over the last 24 hours. And that’s the number of reportable cases we give every day. Once we clear up the backlog, then we know that the cases coming in or the cases that we report are the cases that came in in the last 24 to 48 hours.

Well below 100, eh? Is that 60? 20?

Everyone wanted some hard figures — something close to exact figures, even — because an exact figure would help us understand the state of the current outbreak. Armstrong tried yet again:

Armstrong: Given this lag and the process that’s involved in getting these cases to the point where they’re reported publicly, I’m wondering how confident you can say that our numbers are actually trending downwards. Do you have a clear sense that our cases are actually going down, given that the numbers may be a bit higher just with this backlog.

Strang: Yeah, we’re seeing some — we look at a number of things, you know, positives coming through the lab. We’re also seeing the average number of contacts per case is coming down substantively, which means that for every case, that’s a good indicator that actually people are following the restrictions and having far fewer contacts when they might have been infectious. And that’s a very important indicator that says how many new cases may result from one case. But all the early indicators are that things are trending in the right direction. But we have to get through this backlog and then start to see the real time case number. We fully expect that by the middle of the week we’ll start to get that number and then I suspect we will start to see that slowly trend down over the next number of days.

So once again: the real daily numbers might be coming down. Or they might be going up. Who knows? Apparently no one, because no one can answer the simple question: How big is that backlog now?

Demographics

Here is how the new cases break down by age cohort*:
• 23 aged 19 or younger (12 girls or women, 11 boys or men)
• 44 aged 20-39 (19 women, 25 men)
• 41 aged 40-59 (25 women, 16 men)
• 10 aged 60-79 (3 women, 7 men)
• 1 aged 80 or over (a man)

* the total is only 119 because the provincial data have been amended without explanation. I don’t fully understand it, but my suspicion is that two of the weekend cases were reassigned to another province, but Public Health hasn’t told us which two. This means that the breakdown above is off by two, which is unfortunate, but it won’t make a noticeable difference in the graph below.

This graph shows the percentage of daily positive cases by age cohort, since April 17:

The active cases are distributed as follows:

• 466 in the Halifax Peninsula/Chebucto Community Health Network in the Central Zone
• 559 in the Dartmouth/Southeastern Community Health Network in the Central Zone
• 151 in the Bedford/Sackville Community Health Network in the Central Zone
• 46 in the Eastern Shore/Musquodoboit Community Health Network in the Central Zone
• 7 is in the West Hants Community Health Network in the Central Zone
• 112 in the Cape Breton Community Health Network in the Eastern Zone
• 21 in the Inverness, Victoria & Richmond Community Health Network in the Eastern Zone
• 4 in the Antigonish & Guysborough Community Health Network in the Eastern Zone
• 29 in the Colchester/East Hants Community Health Network in the Northern Zone
• 7 in the Pictou Community Health Network in the Northern Zone
• 11 in the Cumberland Community Health Network in the Northern Zone
• 29 in the Annapolis and Kings Community Health Network in the Western Zone
• 20 in the Lunenburg & Queens Community Health Network in the Western Zone
• 7 in the Yarmouth, Shelburne & Digby Community Health Network in the Western Zone

One-hundred-and-eighty-six cases are not assigned to a Community Health Network, but they are in the Central Zone.

Testing

Nova Scotia Health labs completed 5,021 PCR tests yesterday. This figure does not include the antigen tests taken at the various pop-up testing sites, or the antigen tests collected at some of the PCR testing centres (see below).

You do not need a health card to get tested.

Pop-up testing (antigen testing) is for asymptomatic people over 16 who have not been to the potential COVID exposure sites (see map below); results usually within 20 minutes. Pop-up testing has been scheduled for the following sites:

Monday
Canada Games Centre, Library, noon-7pm
John Martin School (Dartmouth), noon-7pm
Bridgewater Cineplex, 2-7pm
Centre 200 (Sydney), 3-7pm

Tuesday
Halifax Central Library, noon-7pm
Halifax Convention Centre, noon-7pm
Canada Games Centre, noon-7pm
Central Spryfield Elementary School, 2-7pm
Alderney Gate Public Library, noon-7pm
John Martin School (Dartmouth), noon-7pm
Bridgewater Cineplex, 2-7pm
Centre 200 (Sydney), 3-7pm

Wednesday
Halifax Central Library, noon-7pm
Halifax Convention Centre, noon-7pm
Canada Games Centre, noon-7pm
Central Spryfield Elementary School, noon-7pm
Alderney Gate Public Library, noon-7pm
John Martin School (Dartmouth), noon-7pm
Bridgewater Cineplex, 2-7pm
Centre 200 (Sydney), 3-7pm

Thursday
Halifax Central Library, noon-7pm
Halifax Convention Centre, noon-7pm
Canada Games Centre, noon-7pm
Central Spryfield Elementary School, noon-7pm
Alderney Gate Public Library, noon-7pm
John Martin School (Dartmouth), noon-7pm
Bridgewater Cineplex, 2-7pm
Centre 200 (Sydney), 3-7pm

Friday
Canada Games Centre, noon-7pm
Central Spryfield Elementary School, noon-7pm
John Martin School (Dartmouth), noon-7pm
Bridgewater Cineplex, 2-7pm
Centre 200 (Sydney), 3-7pm

You can volunteer to work at the pop-up testing sites here. No medical experience is necessary.

Public Health Mobile Units are available only for pre-booked appointments for PCR tests for people of all ages (results within three days). There are currently no mobile units scheduled.

You can also get PCR testing at the Nova Scotia Health labs by going here. Appointments can be made for the IWK, or for various locations listed below in each of the health zones (appointments may not be available at each site).

Also, asymptomatic testing has been restored at at least some of the PCR testing centres listed below, but as I understand it, some of those locations may be giving asymptomatic people the antigen tests and not the PCR tests.

Central Zone
Bayers Lake (41 Washmill Lake Drive)
Burnside/Dartmouth Crossing (77 Finnian Row)
Canada Games Centre
Dartmouth General Hospital Drive-Thru (No Taxis)
Eastern Shore Memorial Hospital
Mayflower Curling Club
Musquodoboit Valley Memorial Hospital
Saint Mary’s University (Homburg Centre)
Twin Oaks Memorial Hospital (Musquodoboit Harbour)
Zatzman Sportsplex

Northern Zone
Colchester Legion Stadium (14 Lorne Street, Truro)
Truro (625 Abenaki Road, with drive-thru at 600 Abenaki Road)
Truro Farmers Market Drive-Thru testing
Amherst (34 Prince Arthur Street)
Pictou County Assessment Center (678 East River Rd, New Glasgow)

Eastern Zone
Antigonish Market Square
Buchanan Memorial Community Health Centre (Neils Harbour)
Eastern Memorial Hospital (Canso)
Grand Lake Road Fire Hall (Sydney)
Inverness Consolidated Memorial Hospital
Membertou Entertainment Centre
Northside General Hospital (North Sydney)
Sacred Heart Community Health Centre (Cheticamp)
Strait Richmond Hospital (Evanston)
Victoria County Memorial Hosptial (Baddeck)

Western Zone
Acadia Festival Theatre
Acadia University Club
Berwick Firehall
Digby Station (7 Birch Street)
Liverpool PAC (157 School Street)
Roseway Hospital (Shelburne)
South Shore Assessment Centre (215 Dominion Road, Bridgewater)
Yarmouth Mariners Centre
Yarmouth Visitor Information Centre (228 Main Street)

Vaccination

As of end of day Sunday, 366,089 doses of vaccine have been administered. That’s an increase of just 9,111 over the three days since Thursday.

People ask me about a lot of things, but overwhelmingly, the two questions most asked of me are the two I asked Strang about today; here’s our exchange:

Bousquet: Dr. Strang, recognizing that there’s been privacy issues and you couldn’t give these sort of details before, but unfortunately the numbers have been much larger, so I think those issues are not so much at play, can you — of the people who are in ICU, the people in hospital, the people who have died, can you give us an indication of what the vaccination status has been with those people?

Strang: So I don’t have a breakdown of all the cases. What I do know is that we’ve had certainly some cases — and I don’t know whether any of them are in a hospital or not. We do know we’ve had some cases of people who were vaccinated — virtually all of them were people who became ill within a short period of time after getting vaccinated, which means they were exposed either before they got vaccinated or shortly after getting vaccinated. You have to be able to remember it takes two weeks in healthy people to get a full immune response. And especially if people are elderly or have underlying health conditions, it may take up to three weeks to get the maximum immune response. So if you’re exposed to COVID shortly after getting vaccinated, it’s not surprising at all that some people still get sick. We also know the vaccines aren’t 100%. So there may even be people who have had two doses of vaccine who are still getting COVID infection. But what we do know is that for them, their disease is in all likelihood going to be mild and that they’re going to be much less infectious and much less able to pass the virus on to other people.

Bousquet: On the vaccination issue, the province is making progress and getting more doses out there. It’s difficult, however, to look at the daily figures, you know, over the last three days with an average just about 3,000 each day. And we’re seeing wide open appointment times on the website. And pharmacists are saying, putting out Facebook messages saying, “sign up for these because they’re open.” Doesn’t that all just lead to the conclusion that since older people have been vaccinated, it should just be opened up for more age ranges, maybe every age group now?

Strang: No, because we only have a certain amount of vaccine. We have two-week blocks, we know how much vaccine is coming out in the next two weeks, and we book exactly the number of appointments, open up the number of appointments for that amount of vaccine. We don’t want to overpromise. And twice a day, actually, people are looking at where we’re at in terms of our appointments and we’re adjusting things. And so Friday, we opened up to the 45- to 49-year-olds expecting that we were going to get to the next group of 40- to 44-year-olds, maybe in the next week to two weeks. [But] when we’ve looked at the number of appointments already filled up in the 45- to 49-year olds, we’re probably in the next few days going to be able to open up to that 40- to 44-year-old [group]. So when we have availability, we will open up, but we always do it in a very staged manner to make sure that we can deliver on the appointments — that when people book appointments, and when they go to their appointment, we can guarantee that they’re going to have vaccine available to them.

People 45 and over can make appointments for the Pfizer and Moderna vaccines. People who are from 40 to 54 can book an appointment for the AstraZeneca. You can book an appointment here.

Schools

The current status of schools:

All schools in the province are closed through May 31.

Potential exposure advisories

Last night, Public Health issued a list of potential COVID exposure advisories, which were mostly new bus routes and flights (the release also contained a couple of corrections from previous releases; I’ve updated the potential exposure map to reflect those corrections).

I’ve collected all the active advisories for potential COVID exposures on bus routes and flights here.

The updated potential COVID exposure advisory map is below; you can click on the icons to get information about each site. Note: in HRM, potential exposure sites that are considered low-risk for transmission are no longer subject to advisories; that’s because everyone in HRM is encouraged to get tested, whether they were at a potential exposure site or not.

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