Daily COVID-19 update: Death and chaos at Northwood

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Two more residents of the Northwood long-term care facility have died from COVID-19 related illness. The two newest deaths brings a total of five residents of Northwood who have died with the disease, and nine people who have died overall in Nov Scotia.

The disease is spreading quickly in nursing homes. Today, the Department of Health announced that a total of 147 people at nursing homes (93 residents and 54 staff) have tested positive for COVID-19; that’s an increase of 32 from 115 yesterday (67 residents and 48 staff). (That increase of 32 exceeds the provincial total increase of 26 announced today, but that’s because the two numbers have different daily reporting timeframes — see below for more discussion of this problem.) Strang said, however, that the problem is mostly concentrated at Northwood.

Yesterday, 26 more people tested positive for COVID-19, bringing the provincial total to 675. Eleven people are currently in hospital with the disease, four (one fewer than yesterday) of whom are in ICU; 200 people have recovered completely.

Northwood

Today, Premier Stephen McNeil and Dr. Robert Strang, the province’s chief medical officer of health, announced an emergency plan for Northwood.

Residents who have recovered from COVID-19 are being moved to a hotel (I’m told it’s in Dartmouth, but I don’t know which hotel).

Those still with COVID-19 will be treated on site at Northwood. “Starting tonight,” said McNeil, “the Halifax Infirmary COVID Unit will be redeployed to Northwood to help support the more acute needs of the residents.”

During today’s briefing, Strang admitted that people who have tested negative for COVID-19 are still sharing the same room in Northwood as people who have tested positive. Strang’s explanation laid out a scenario that can perhaps best be described as chaotic:

Northwood, as part of their COVID plan, they established one, and then a second one, COVID units, where all of the people who tested positive were moved into those COVID units. But in the last few days, the numbers have grown significantly, and those COVID units have been full.

So they’ve had to keep people up on wards. They’ve isolated them as much as possible. They are making sure that residents’ movements are limited. They’re also making very clear that health care workers are taking the appropriate infection control steps, minimizing the chance of them transmitting viruses from one patient to another.

The plan … to take people who have recovered out of the facility will create more flexibility — first it protects those individuals, it gets them out of an outbreak situation. But as we open up some of those existing COVID units, we’ll be able to bring more people in, and we’ll also create more space and they can create additional COVID units.

We also know that many of the people, even though we know they’re testing negative, it is quite likely that they’re already incubating because as we’re seeing with many people that we test over a series of days they go from negative to positive.

Everything that can be done within that facility to separate the known positives from other people is being done, and the steps that are being put into place are going to enhance that ability.

My understanding is that many people who work at Northwood are simply refusing to show up for their shifts, and in fact, Northwood is now advertising for jobs. McNeil didn’t address that directly, but did say that “40 Nova Scotia Health employees, including nurses, continuing care and rehab therapists, the VON, the Red Cross, and EHS paramedics have also joined the effort. Students about to graduate into health-related professions have answered the call and are offering support as well.”

McNeil went on to thank the health care workers’ unions for supporting the effort, but he dodged a question about paying those workers more. CBC reporter Michael Gorman asked McNeil about the federal program to “top up” the pay of essential service workers working through the pandemic; that program requires a provincial “buy in,” meaning a financial contribution from the province, which would help dictate its terms. “We see that Northwood is advertising for staff, so in light of how dire the staffing need is there — and in fact, some of the jobs they’re advertising are low-paying jobs — are you revisiting the idea about accepting that [federal] offer, and if not, why not?”

McNeil responded:

We’ve looked at that program, it really does not apply to very many health care workers. It may apply to some who are part-time. We put a call and put a focus on, quite frankly, we’ve reached out in our health care system; I can’t tell you how responsive since last Thursday, Friday, into the weekend, all of our partners have been, whether private operators, every union in the province have worked together, our community colleges, universities, to ensure they’re providing staffing into the facility. I’ve said this many times, we’re using revenue to support those who are completely unemployed and how do we best support them as we go through this journey. We’ll continue to focus on that.

Translation: No. Why should we pay health care workers more to go into a COVID-infested death building when other people are offering to do it?

The Northwood complex is only partly long-term care housing; there are also assisted living portions of the complex, and simply senior living. The COVID unit at the complex is the top floor of the Northwood Manor building; the rest of that building comprises apartments for seniors without continuous nursing needs. The tenants of those apartments travel throughout the building, and indeed throughout the community, on bus lines, etc. So I asked Strang if there was a concern that these tenants might further be spreading the disease among themselves or among the broader community. He responded:

I’ve had a long discussion about that with Northwood. They’ve been very clear about two things: That their long-term care beds in their facility have been clearly separated from — they have two other components that are some in the same building, that are more I guess rental units, and then they have a second building which is community living and people living independently. Their long-term care beds, where they’re having a COVID-19 outbreak, is clearly separated, and when they’ve needed to they’ve put up barriers when it’s in the same building. There is no movement of residents or staff from the long-term care facility into other types of beds or accommodations that they’ve had.

There have been no COVID-19 cases at any of the assisted living or any of the independent living segments of Northwood. So yes, there are people going in and out of that building like they would any other independent living apartments or senior facilities in HRM. That’s entirely appropriate, because the long-term care residence is specifically and clearly isolated and separated.

Back on March 23, I asked Strang about his assertion that people who had contracted the disease but then recover have immunity to it afterwards. He responded:

All the evidence says that people develop immunity. This is a viral disease like many other viral diseases. In our long experience with viral diseases, once people are exposed, by and large unless they have some underlying health condition, you develop long-term immunity.

So I wondered today why the emergency plan for Northwood involves moving people who have recovered out of the building. Wouldn’t they be immune to future re-infection? He responded:

We anticipate, I think was my answer, we anticipate that like other respiratory viruses, people will develop long-term immunity. We don’t know that for sure with COVID, it’s a new disease. But especially in the elderly who may have not-as-robust immune systems, it’s even more of a concern that they may not have a longer-term immunity. So the best thing to do is to get them out of the facility — they’re protected, they’re away from the outbreak.

But the other part that does, it frees up beds in the COVID unit so we can bring more people who are still within their illness and put them in the active treatment units. That allows more flexibility behind them on other wards, to do what we talked about early, get greater separation between those who are positive and those who we don’t know what their status is or have a negative test.

So it’s for those two main reasons that we’re moving those residents out. That’s the recommendation. We’ve looked at all the options. Do you move the people who are known positive? Do you move the ones who are negative or we don’t know about yet? Or do you move the ones who have recovered? And consistently the clinical advise is to move the ones that you know have recovered, and then bring in the necessary supports to provide the necessary separation and the active treatment for everybody else within that facility.

Numbers and stats

In response to many questions, and more so to my observations of people’s comments on social media, over the weekend I talked privately with people who have insight into the compilation of numbers tracking the disease and the response to it. This morning I posted a Twitter thread, which I’ll edit for clarity, as follows:

As the discrepancy between the daily nursing home stats and the daily provincial total demonstrates, there’s going to be a lot of in-the-moment confusion. In this case, nursing home stats are collected by the individual nursing homes, each of which will have its own reporting “day” (ending at 5pm? at midnight? just before the call to the province is made at noon?), while the provincial totals are reported as end of day numbers by the lab at the QE2. No one’s trying to hide anything or consciously obscure. But Strang has said they’re trying to get to more consistent reporting.

And cross-jurisdictional comparison of COVID-19 statistics is useless. There are too many testing regimes/protocols, too many definitional and reporting differences.

I know people want definitive stats, but they don’t tell us much comparing two jurisdictions, at least for the moment.

Nova Scotia, for instance, has relatively high per capita testing (the second highest in the nation, after Alberta), but even then, the number of tests probably skews higher in nursing homes (whole floors are being tested when there’s one positive test result on the floor) than in the broader community generally, as compared to other provinces. And another province might have lower per capita testing numbers, and might not being doing much in terms of nursing homes. So it’s impossible to make a direct comparison of the two provinces with only the number of positive tests.

Even the testing labs in different provinces are different, and to some unknown degree will have varying rates of successful tests and false negatives and false positives.

But also, who gets tested is different. Nova Scotia has a relatively high (~3% at this writing) rate of positive results, which probably suggests that the testing is somewhat successfully targeted compared to provinces with lower percentages of positive test results.

And reporting by necessity will vary from place to place, and even within the same province. A sample from a person who gets swabbed in Cape Breton will take most of the day or maybe two days to show up in the lab in Halifax and get processed, which might take most of the next day besides. But someone who is swabbed at the Halifax Infirmary might have a result in hand before nightfall. Some other provinces might take an entire week to process a swab. And how re-tests are reported will vary as well: consider a person who was tested as positive last week, but now is given a second test that likely will be negative (because they’ve recovered) — how is that person recorded during the two-three days the test is being processed?

A year from now, we’ll probably be able to look back and get much better stats, and in that time develop definitions that can apply across jurisdictions. But not now.

That doesn’t mean some stats aren’t useful in the moment. Nova Scotia is reporting consistently. It’s not going to be the same reporting as New Brunswick or Ontario or BC or wherever. But it’s internally consistent, so that helps us understand what’s going on. Not perfect, but nothing is.

I’m writing this because I’ve seen too many people saying stuff like “New Brunswick only has X # of Y! That proves Nova Scotia is fucking it up!” Well, no, it doesn’t. We really don’t know what it means.

Or, as happened recently, a Globe and Mail article showing Nova Scotia is the province with the third highest per capita positive results is held up as suggesting that something is amiss in Nova Scotia, when actually it might show the exact opposite: that Nova Scotia is catching positive COVID cases that other provinces are missing.

We do know that the Nova Scotia lab has increased the number of tests considerably, and now has the second highest per capita testing rate in the country. And the testing seems relatively well-targeted.

We’ve all read newspaper articles that say, “hey the solution to this is random testing!” Well, sure, and the solution to my not having a Maserati is give me a million dollars. However, money is not the limiting factor with testing — the lab has told me directly that they’re getting all the money they need. Rather, personnel and equipment is the limiting factor; it takes trained technicians with the equipment necessary to process tests, and if you want to increase the amount of testing done, you need to increase the supply of those. And that takes time.

Until we can do that, I would argue that “random testing” would be a waste of resources in Nova Scotia at this time. We’d be testing more people we think probably don’t have the disease at the expense of testing fewer of the people we think probably do have the disease.

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