Explainer: Social distancing to self isolation; what about seniors?; and how do we know there’s not community spread of COVID in Nova Scotia?

Nova Scotia’s chief medical officer, Dr. Robert Strang

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Social distancing? Self-isolating? What does it all mean? What should I be doing?

Here’s how the province’s chief medical officer, Dr. Robert Strang, has explained how we should be acting. I’ve transcribed Strang’s comments at a press conference Wednesday, only slightly editing for clarity.

“It’s this progressive layer of distancing, from all of us doing social or physical distancing all the way through a case who is strictly self-isolating within their home,” explained Strang.

Level 1: Everyone

All of us need to be social distancing. We call it social distancing, but really it’s physical distancing — we actually physically get away from each other, reducing the chance of the virus being transmitted.

That means things like, as much as possible, working from home. It’s why we’re closing down so many things, minimizing the chance of groups of people getting together and spreading the virus.

That’s something we all need to do, that physical distancing. But it’s also a time when we actually have to be more socially connected to each other. This is a difficult time. We should be using our devices, using the telephone to connect with each more, so we’re supporting each other.

But it’s important to recognize that social distancing doesn’t mean people can’t be out if necessary. We still need to go get groceries. People who can, who are not self-isolating, need to support others who do need to be self-isolating, whether they’re self-isolating because of travel, or maybe they’re a senior or someone who is immune compromised, those for whom it’s more important that they stay home.

So people can still be out and about doing those essential things.

Level 2: People who have travelled

The next layer is people who have travelled and are being asked to self-isolate. It doesn’t mean that they have to stay in their home. If you’re in self-isolation just because of travel and you’re feeling well and you don’t have any symptoms, you can still take your dog for a walk, go for a bike ride, take your kids to the park.

What’s really important is that people are separating from each other. You don’t have to stay 24 hours a day behind your door in your home.

Layer 3: Close contacts of a known case

The next layer is, once we have a case, we’re going to identify who they have been in close contact with. Close contacts of a known case are more likely to have been exposed and are going to get sick, so it’s even more important that they are more vigilant about separating from others, and need to stay more in their homes.

Layer 4: People who are infected

This is people who are symptomatic and they’ve gone to be tested, and they’re waiting for the test result, or they’ve gotten the test result back and they’re positive. Those people need strict home isolation, so they should not be out and about.

Even within their home, it’s very important that as much as possible, that they’re separated from other people within their home — in a bedroom, if possible, with their own bathroom. People who are coming into close contact with the person who is sick, if they’re able to get a mask, have a mask on. Really careful hand-washing and cleaning in the home.

What about seniors?

On Thursday, I asked Strang his advice about how to deal with seniors in our lives. On the one hand, seniors are staying home for fear of becoming infected, but on the other hand, many people are afraid to visit seniors, even to bring them supplies, for fear of transmitting the disease to the seniors. Strang responded:

Now is the time for people, especially seniors  – it’s unfortunate but it’s necessary for them to isolate themselves from others, as much as possible. So if you have an elderly relative, stay connected by phone, by Face Time, make sure you’re checking in with them, and support them by delivering groceries, make sure they have their medications. But if you come in to deliver the groceries, make sure you’re staying well outside of that six-foot distance.

Community spread

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.

I’m quite interested in the testing protocol, and have asked for an interview with someone who can walk me through the technical issues. I’m told I’ll be granted that interview next week, but obviously everyone is quite busy. Understood.

One question I have is: What is the constraining factor for more widespread testing? I don’t doubt that there is a constraining factor, and don’t argue that there shouldn’t be one, but what is it, exactly: money? time? lab personnel? availability of test kits? I hope to be able to provide an answer that question next week.

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