1. Daily COVID-19 update (sans briefing)
There hasn’t been a provincial COVID-19 briefing since Friday, but the province has continued to release numbers daily.
Here are yesterday’s numbers, from Campbell:
Total new cases: 27
Total cases: 900
Total hospitalized: 12
Total in ICU: 3
Total recovered: 509
Total deaths: 24
Total long-term-care facilities (LTCF) affected: 10
LTCF residents: 198
LTCF staff: 95
Total positive and negative tests to date: 27,131
Age range of patients: under 10 to over 90
Only one of the new cases, she notes, is at a long-term care facility.
Earlier this morning, Nova Scotia’s chief medical officer of health, Dr. Robert Strang, was interviewed on CBC Radio’s Information Morning. He talked about enhanced testing in areas that have community clusters, and where we are in terms of the curve. He said:
When we look at our epidemiologic curve, we’re actually past the peak and we’re down the downward slope… In HRM… we are certainly on the decline, but we have this concern of these little community clusters we have to follow… We’re not out of the woods yet, and it would be premature for us to think about lifting restrictions in any substantive way… There’s no firm number…. It’s really looking at your epidemiologic curve and have you reached the bottom… and are only seeing sporadic cases. And we’re certainly not there yet.
Portia Clark asked Strang if he thought restrictions might be lifted locally. If, for instance, there are no cases in one part of Nova Scotia, does it need to stay on the same lockdown as, say, the Halifax area? Strang said yes, because the danger is that people will travel to regions where, say, shops and parks are open, increasing the risk of transporting the virus.
There are stories out there of people from Halifax going to hang out in other parts of the province where there are few if any cases of COVID-19 reported, so this concern seems justified.
Strang said it will make sense to also add that when it does come time to ease restrictions, it’s likely the province will do it gradually, but that Nova Scotians need to remember that even as the rules loosen, that won’t mean going back to the way things were:
Perhaps ease restrictions on what people can do outdoors and then business sectors… but I think people need to understand the requirements for social distancing and careful handwashing — those crucial steps are going to have to be sustained for a long time… Social distancing and minimal numbers of people getting together are going to be sustained for a long period of time.
In her Cape Breton Spectator update, Campbell includes an informative explanation of asymptomatic transmission — the process through which people with no symptoms at all can infect those around them without knowing it — and what it means in terms of testing policy. SARS-CoV-2, the virus which causes COVID-19, is extremely infectious, and the fact that it can spread from seemingly healthy people is one of the reasons it has spread so dramatically.
I’ll turn it over to Campbell for the rest of this post:
When the virus enters your system, it attaches itself to a cell and uses that cell’s own machinery to replicate itself — one cell can produce thousands of new viruses that are released from the infected cell and can go on to infect other cells or end up in droplets that go on to infect other people. The process by which infected cells release new copies of the virus is called “viral shedding.”
Basically, with SARS-CoV-2, it seems there is more shedding of “live virus” from the nasal cavity in the upper respiratory tract and it can happen before an infected person exhibits symptoms. I think it’s worth comparing this to influenza, because the response to COVID-19 in long-term-care facilities, for example, is based on public health’s influenza protocols. According to Gandhi, Yokoe and Havlir:
“With influenza, persons with asymptomatic disease generally have lower quantitative viral loads in secretions from the upper respiratory tract than from the lower respiratory tract and a shorter duration of viral shedding than persons with symptoms,4 which decreases the risk of transmission from paucisymptomatic persons (i.e., those with few symptoms).”
The editorial [from the New England Journal of Medicine] concerns itself specifically with what this means for controlling the virus in nursing homes and it focuses on a study, published that same day in the NEJM, called, “Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility
The study was conducted in a healthcare facility in Washington State where a symptomatic healthcare worker tested positive for the virus prompting testing of all residents and staff. Arons et al, the authors of the study, divided the 76 (of a total of 89) residents who agreed to be tested into four categories: residents with typical symptoms (fever, cough, shortness of breath), those with atypical symptoms, those who were presymptomatic, and those who remained asymptomatic
The authors found that fully half the residents who tested positive exhibited no symptoms at the time of testing. They also discovered that samples collected from patients in all four categories, including asymptomatic and presymptomatic, had “similarly high” viral loads. This led them to conclude that:
“Current interventions for preventing SARS-CoV-2 transmission in health care settings rely primarily on the presence of signs and symptoms to identify and isolate residents and staff who might have Covid-19. The data presented here suggest that sole reliance on symptom-based strategies may not be effective to prevent introduction of SARS-CoV-2 and further transmission in skilled nursing facilities. Impaired immune responses associated with aging and the high prevalence of underlying conditions, such as cognitive impairment and chronic cough, make it difficult to recognize early signs and symptoms of respiratory viral infections in this population.16 Studies have shown that in the elderly, including those living in skilled nursing facilities, influenza often manifests with few or atypical symptoms, delaying diagnosis and contributing to transmission.17,18 Furthermore, symptom-based cohorting strategies could inadvertently increase the risk of SARS-CoV-2 exposure for uninfected residents, given that typical symptoms were common in those who tested negative.”
The measures laid out in Nova Scotia’s infection prevention and control guidance for LTCFs, most recently revised on April 24, are largely reliant on screening residents and staff for symptoms, but the document does state:
“Note: Symptoms in elderly residents may be subtle or atypical, and screening staff should be sensitive to detection of changes from resident baseline. The goal of active screening is to have a low threshold for detection of COVID-19 cases. Testing may be appropriate in some circumstances based on clinical knowledge and judgment, taking into consideration the resident’s baseline health status.”
I should also add that testing is stepped up in a facility once a case is found, but I’m not sure what protocols guide this, the relevant document states:
“Upon one positive COVID-19 result, determination of additional testing will be in consultation with local Public Health.”
The NEJM editorial argues that the rapid spread of the disease, the clear evidence of asymptomatic spread and “the eventual need to relax current social distancing practices” all “argue for broadened SARS-CoV-2 testing to include asymptomatic persons in prioritized setting.”
Moreover, they say the same factors also “support the case for the general public to use face masks10 when in crowded outdoor or indoor spaces.”
Nova Scotia’s response has been evolving as the science of COVID-19 has evolved and we’ve broadened testing considerably from the early days of the epidemic when we concentrated quite intensely on travelers, but we are still very much focused on testing people who exhibit symptoms. It will be interesting to see how findings about asymptomatic spread will shape Nova Scotia’s response as we start to talk about lifting some restrictions.
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2. We love our healthcare heroes, but we don’t want to pay them more
Jennifer Henderson reports on the “pandemic premium” Ontario and Quebec will pay some frontline workers and asks whether or not we’ll see the same thing in Nova Scotia.
Over the weekend, Ontario Premier Doug Ford announced that Ontario will pay “a pandemic premium” of $4 an hour to continuing care assistants (CCAs), licensed practical nurses (LPNs), as well as dietary and cleaning staff who work in long-term care homes, group homes, home-care, and homeless shelters. The premium will be added to their hourly wage. It also applies to some people working in residential care facilities and jails.
In environments where COVID-19 is rampant, the top-up to these lower- and lowest-paid workers is a sign their work is valued during a particularly stressful time. But there can be little doubt that it’s at least equally designed to keep them from quitting.
Right now, Henderson says, there are no signs of any pandemic premium coming for long-term care workers in this province though.
In an email response to a question from the Halifax Examiner posed yesterday, provincial spokesperson Marla MacInnis wrote, “We are continually monitoring the impacts of COVID-19 on our citizens and our publicly funded health sector workforce. We are not contemplating providing ‘pandemic pay premiums’ at this time.”
It’s safe to take that as “no.”
3. COVID-19 is not a great equalizer
We may all be in this together, but we are not all affected equally by COVID-19. For CBC, Shaina Luck explores how the effects of the pandemic are worse for vulnerable and marginalized populations:
“Any inequities and problems that existed in our society before have not disappeared now. And in some cases, are often being made worse by some of the policies that have been put in place,” said Dr. Monika Dutt, who works as a family physician and in public health, and at the Ally Centre clinic in Sydney, N.S….
On Thursday, a resident of a Halifax pop-up shelter tested positive for the virus. The province has responded by moving everyone from the shelter into a hotel to self-isolate.
“As a family physician I work at a centre that does work predominantly with people who do lack access to housing, who do have issues around drug use and so are already facing a lot of barriers. And now you add this on top of that, it just makes it even more difficult when you already have little to no income,” Dutt said.
“Now you’re even more isolated than you were before. That makes it more challenging.”
Luck also talks to people who advocate for people who are undocumented or here temporarily (such as migrant workers) and ISANS CEO Jennifer Watts, who says newcomers may face challenges like language barriers or isolation with large families.
Watts said ISANS has been able to keep working with about 75 to 80 per cent of its language clients, although some are too overwhelmed to continue lessons at this point.
Some ISANS clients are trying to cope with the pandemic without the support of any extended family in Canada, and sometimes with the additional worry about family members in countries without a strong medical system.
4. Halifax Transit seeks funding from feds
Halifax Transit’s ridership has dropped, but its fixed costs remain the same (about $10 million a month) at a time when there are no fares being collected.
At the same time, municipal revenues are down and residential property taxes have been deferred.
To fill the gap, Francis Campbell reports in the Chronicle Herald, Halifax Transit is joining other transit agencies to ask the federal government for help.
As council’s representative on the Canadian Urban Transit Association (CUTA), [councillor Lorelei] Nicoll will bring to Tuesday’s virtual regional council meeting a request from CUTA to the federal government for “emergency funding of $400 million a month in revenue relief to keep services running as fare box and other revenue drops by up to 100 per cent.”
The request from CUTA, an advocacy group that brings collective municipal transit issues to Ottawa, will also include a $1.2 billion ask to bridge as many as 40 per cent of the country’s transit systems over the coming months to help keep buses and trains running.
The CUTA request also asks for support to cover the costs of disinfectants and protective equipment for transit employees because the association says more than 70 per cent of transit providers have reported difficulty securing cleaning supplies and protective gear.
“This is a collective approach by all of the transit (providers) across Canada,” Nicoll said. “The prime minister has alluded to it when he speaks that help will be coming but nothing’s coming yet. This is a way of saying make it a priority for the municipalities to help them with their transit.”
In Nova Scotia, the provincial government doesn’t provide any funding for municipal transit services.
5. Decision on schools will have to come soon
We’re just a few days away from May 1, the date until which Nova Scotia schools are closed, and there’s been no word yet on what happens after that.
“It’d be great to see no cases, have an extended period of no cases before I would probably feel comfortable sending my children at least back into a condensed environment where there are multiple children,” said parent of three Sarah Oakley.
But even if schools do reopen this year, it will take some adjustments.
“What school looks like if physical bodies go back to school isn’t going to be the same. We’re not just going to go back like we always have,” said [teachers’ union head Paul] Wozney.
I’m trying to wrap my head around social distancing in classrooms, on the school bus, in phys ed class, during labs. I don’t know how you would even start to get a bunch of elementary school kids, for instance to stay distant. When I do school writing workshops for younger elementary classes, almost inevitably at least one child will fling themselves at me and give me a hug at the end of the session. (I kind of stand there awkwardly when this happens.) I’m thinking also about a 20-year-old I know who said it was important to maintain restrictions on gatherings because otherwise “the teens are just going to start making out.”
I’m not saying it can’t be done. Of course it can. But re-opening schools in a way that ensures student and staff safety is going to take a lot of creative thinking and some major adjustments, I would imagine.
6. Museums reaching out online
I missed this Halifax Magazine story from a couple of weeks ago, but it’s an interesting one. Olivia Malley looks at how local museums are connecting with their audiences (I was going to write visitors there) while they are closed to the public.
The Army Museum at the Citadel is posting videos online, and the Nova Scotia Sport Hall of Fame is running trivia challenges. I was especially interested in seeing how the Art Gallery of Nova Scotia is responding, by digging into the permanent collection that’s not on display, and giving people a look at the curatorial process:
Due to storage limitations, many of those pieces live in storage. Staff decided to dig through the collection and post videos and images to their social media accounts.
Doing this would “bring art to people and allow people who wouldn’t traditionally visit an art gallery to experience art and even have conversations through social media platforms about art,” says [marketing and visitor experience director Colin] Stinson.
Another thing people normally don’t have access to is the curators, so in addition to sharing art, the gallery is having the curators explain some of the pieces on Facebook.
1. Social media etiquette and missing people
Yesterday afternoon, police used social media to ask people to be on the lookout for a three-year-old girl missing in the Musquodoboit Harbour area. The tweet I saw featured a very cute girl with an impish look, standing in the woods. (She was found later the same day.)
Police regularly take to social media when looking for missing people. I don’t know how effective this is (I am sure someone has done research) but it certainly does get the word out quickly.
That’s not to say the practice is not without its drawbacks though, especially when it comes to how others share the information.
For a while, I would see posts, on Facebook in particular, urging users to share information about someone missing long after they had been found. It would go on and on for days: Urgent alert! etc. No amount of saying “this person has been found” seemed to make a difference. I don’t know what’s changed, whether it’s algorithmic or user behaviour, but I seem to see a lot less of that these days.
Still, when someone is missing, their name and face get splashed all over social media in an effort to find them. They may be in danger, they may have left a psychiatric institution without authorization and there is concern for their safety, they may have just gone for a hike and forgotten to tell anyone. Now, thousands of people have seen their face.
Yesterday, lawyer David Fraser tweeted about best practices for sharing information about missing people. The main takeaway? Share the original police post. He wrote:
When a person goes missing and the police are asking for help through social media, please re-tweet or re-post the original from the police. When the person is found, the police will usually delete their original posting so their name is not all over the internet for all time.
Later, Fraser went into more detail about why this is important. Essentially, people who are reported as missing are people whose lives should not be defined by the time they were missing. Or by the fact that at one point they were missing:
Police may choose to make a social media appeal for information, hopefully considering many factors in their decision. Sometimes, people want to just get away or unplug or are fleeing for their own safety. In most cases (thankfully), people who are reported missing are found.
And their lives continue. Today’s missing person appeal was about a toddler, but they are often about young persons or adults. People can be “missing” for a number of reasons. Of course, we immediately think about abductions or kidnappings or other criminal circumstances…
Thousands of well-intentioned tweets may become their “digital legacy”. Imagine having a crappy week and deciding to hit the road with your phone on “do not disturb” for a few days, only to have that be your defining moment for anyone who searches social media for your name.
Fraser’s original tweet about sharing police posts now appears above a greyed-out “this tweet is unavailable” box, because the police deleted their original message. But if anyone else shared the little girl’s image in a tweet of their own, that will still be out there.
Smart can be stupid. Like, really stupid.
Last year, we bought a new range. It’s great, and a huge improvement over the cheaper one we had previously, and that we had repaired one too many times. This range is not only new, it’s smart! I installed an app, connected the range to our wireless network, and now I too was part of the smarthome revolution.
Last year, when we went to New York, my GE app would cheerfully inform me every time the oven came on, so I could see if my kids were putting a frozen pizza in the oven around midnight.
Eventually, after a power failure, the oven lost connection with the WiFi. I never bothered to reconnect it, despite the alerts I got warning me that something might be wrong because my oven had been offline for several days now.
I was thinking about all this recently when I saw something on the Internet of Shit Twitter account about the Petnet smart feeder. This is a smart feeder that “automatically feeds your pet the right amount every time!” It costs, uh, around $150.
You would never know it to look at the website or blog, but the Petnet feeders have been offline for weeks now. Finally, whoever is behind Internet of Shit (they actually own one of these things) posted a message from the company, saying they were turning the pet feeder into a subscription service:
Oh my god. Petnet finally admitted that it’s out of money, has no staff, and can’t afford to keep its services running. They’re asking if paying customers are willing to PAY $4 PER MONTH to keep their pet feeders going.
Here’s how we feed our dogs: we measure out the food and we give it to them. Sometimes we are out (pre-pandemic) and the dogs get fed late. They can wait. Same goes for the cat. If we are not going to be home, we ask a neighbour to feed them. Has always worked so far. No subscription fees.
I can imagine a few very limited situations in which a product like Petnet might be useful and helpful. But does that make the product smart? I think “smart” in this context is propaganda. We’ve bought into the idea that connected = good, and because it’s more complex and offers more controls, that makes it smart. A couple of years ago I interviewed an executive for a company that makes a bunch of these smart devices, and he told me he couldn’t figure out the appeal of the smart lights. “I can turn on a light by myself,” he said.
No public meetings.
In the harbour
05:00: NYK Delphinus, container ship, arrives at Fairview Cove from New York
06:00: Venture Sea, offshore supply ship, arrives at Dartmouth Cove from Port Hawkesbury
11:00: Bigroll Beaufort, deck cargo ship, arrives at Woodside from Esbjerg, Denmark
16:00: NYK Delphinus sails for Rotterdam
20:00: Maersk Maker, offshore supply ship, arrives at Pier 9 from Thialf, a crane ship anchored just outside the harbour
Today is the National Day of Mourning for people injured, killed, or made sick by their jobs. Normally, there would be some public observances, but obviously that’s not going to happen this year.
According to the Canadian Centre for Occupational Health and Safety:
The most recent statistics from the Association of Workers’ Compensation Boards of Canada (AWCBC) tell us that in 2018, 1027 workplace fatalities were recorded in Canada, an increase of 76 from the previous year. Among these deaths were 27 young workers aged 15-24.
Add to these fatalities the 264,438 accepted claims (an increase from 251,508 the previous year) for lost time due to a work-related injury or disease, including 33,058 from workers aged 15-24, and the fact that these statistics only include what is reported and accepted by the compensation boards, there is no doubt that the total number of workers impacted is even greater.
And it’s not just these numbers on which we need to reflect. With each worker tragedy there are loved ones, family members, friends and co-workers who are directly affected, left behind, and deeply impacted – their lives also forever changed.
Many of us are now working at home, which also carries its own risks. Perhaps not of death, but certainly of injury.