Strang: “We may well have had the peak”

News

1. Murderer escaped Portapique within 10 minutes of police arriving

Tim Bousquet provides an update on what we know about the mass murder which started in Portapique, Nova Scotia on April 18, based on new information released yesterday by RCMP Support Services Officer Darren Campbell.

New information includes:

• 435 witnesses have been identified, and about half of them have been interviewed;

• it’s not known if anyone assisted the murderer, who we’re calling “GW,” in planning or preparing for the attacks;

• GW was wearing authentic RCMP slacks and a shirt; it’s not known where or how he obtained them;

• GW has two relatives who are retired RCMP officers; both have been interviewed, and it’s not believed either is involved in the crimes;

• GW did not hide his replica RCMP police cruisers from the public, but so far the investigation does not show that any police officers knew of them; the cruiser that was used in the killing spree was purchased (probably at an auction) last fall;

• the killer had at least four weapons, two semi-automatic handguns and semi-automatic rifles; at least one of the weapons came from the U.S.;

• GW seems not to have lived at his residence and shop on Portland Street for some time, but rather lived “primarily” in Portapique;

• police believe that the first fire in Portapique was GW’s own house, and may have started as a result of ammunition he had stored there catching fire; Campbell did not say how the other fires started;

• the first victim was GW’s “common law spouse,” who was injured but survived; it is not clear what the status of their relationship was on April 18, or if she was living at GW’s house or another house nearby; she is speaking with police;

• besides his common law spouse, Campbell said GW did not single out women particularly, even though most victims were women.

Bousquet goes on to update the details of the timeline with new information from the RCMP, including the fact that GW left the Portapique area within just ten minutes of the police arriving on April 18, and that he spent the night at an industrial area in Debert, very close to where he would later murder two VON workers, Kristin Beaton and Heather O’Brien.

Read the full story here.

2. Daily COVID-19 update: three more deaths at Northwood, schools will remain closed until May 19

Yvette D’Entremont reports for the Examiner from the daily COVID-19 Nova Scotia briefing:

Three new COVID-19-related deaths were announced by the province on Tuesday, all having occurred at Northwood long-term care home in Halifax.

That brings the total number of deaths to 27. The province also announced 15 new confirmed cases of COVID-19, bringing Nova Scotia’s total to 915. Twelve people are in hospital, three of them in ICU.

The total number of recovered and resolved cases stands at 522 (or 57% of all cases), something the province’s chief medical officer of health Dr. Robert Strang described as good news. He also urged caution, noting that while we’re “making progress,”we’re not in the clear and it would be premature “to start to robustly lift our public health restrictions.”

Strang responded to questions about whether or not Nova Scotia has hit its peak yet, writes D’Entremont:

On April 6, Strang suggested the province could see a peak of COVID-19 cases sometime around the end of April or beginning of May. On Tuesday, he was asked if we’d yet hit that peak.

“We may well have had the peak at about the time we said, within the last week or two,” Strang said. “We have to watch that very carefully though, a peak may not be just one very defined distinct piece, a peak can be quite jagged with some ups and downs and can go on for a period of time.”

Strang ruled out any lifting of current restrictions, saying it would be, “absolutely premature for us to open things up significantly at this time, or even in the next couple of weeks.”  Premier McNeil announced that schools and licensed daycares will remain closed until at least May 19.

D’Entremont asked about testing and housing for people who are currently living in shelters. Strang said the province is “in the process of testing residents and staff throughout the HRM area in terms of all the shelters.”

On the housing front, Strang’s answer was less encouraging, indicating that so far the only action taken has been for the shelter resident who tested positive last week, and their close contacts.  “There are certainly discussions going on about how we can do a better job supporting the homeless population in general, minimizing their risk of being exposed to COVID-19,” said Strang.

Read D’Entremont’s full update here.

3. Reopening hospitals

This item is written by Jennifer Henderson.

The province declared a State of Emergency March 22. Major hospitals such as the Victoria General and Halifax Infirmary had weeks before begun holding beds and finding alternative placements for difficult, long-stay patients in preparation for a potential surge of patients related to the outbreak of COVID-19. All elective and non-essential surgeries have been postponed since mid-March.

Cancer treatments and surgeries remain priorities and have continued as usual. A month ago, Dr. Brendan Carr, CEO of the Nova Scotia Health Authority, said hospitals were operating at about 70% of capacity and ICUs hovering around 50% in readiness.

Thankfully, our acute care hospitals have not experienced a flood of COVID-19 patients, although the flow of new cases has not stopped: 27 new ones Monday, 15 Tuesday. Meanwhile, the highest number of people hospitalized at any one time due to COVID-19 was 13. Today it is 12. Most days, three or four patients are receiving life-saving treatment in Intensive Care Units.

As the postponement of other surgeries and medical procedures continues and the wait-time and backlog grow, many citizens are asking when restrictions will be eased to permit a resumption in service. Here’s the answer we received Monday from Brendan Elliott, communications officer for the Nova Scotia Health Authority. The NSHA operates hospitals across the Province.

We continue to assess the situation to determine the safest and most responsible timeline to prevent the spread of illness and support our COVID-19 response.

Despite the fact we have not yet seen a high volume of hospital admissions, or a significant number of cases in communities outside the Halifax area, many members of our surgical teams have been reassigned and are actively supporting our COVID-19 efforts. For instance, members of our surgical services teams are working in testing and assessment sites in our communities and we have also temporarily reassigned an entire inpatient team to support the outbreak at Northwood.

We are concerned by the increasing number of people who will be waiting once services resume. We are also very mindful of the impact this situation is having on our patients, including the potential that some patients’ conditions may change while they wait.

We encourage patients to reach out to their surgeon if their conditions have changed.

Our teams routinely triage cases to prioritize which surgeries move forward each day. By working with our surgeons’ offices and our surgical information systems we are able to track all scheduled cases that have been postponed. This, and other data, will help us assign OR time and prioritize cases that will proceed in the recovery phase of our COVID-19 response.

Clearly this is an issue that is receiving some attention, as it should. And patients themselves will have to be their own advocates.

4. Free counselling available for those in distress over mass murder

A roster of psychologists who have volunteered to provide “brief, free services following any disaster in Nova Scotia,” has been activated, writes Yvette d’Entremont, and will be collaborating with the NSHA to deliver support to those affected by the rampage of murder through Nova Scotia on April 18 and 19.

d’Entremont writes:

As with so many things, COVID-19 is impacting and forcing them to change the way they deliver their post-disaster services.

“Our normal method of delivery would be to get a few, maybe half a dozen people, to go to the site of the disaster. That’s the normal post disaster psychological services plan,” [Victor] Day said.

“It is not possible for us to go there…So this is different. It’s a wider number of people who will have to do things by video conference or phone, although the benefit of that is that it means any psychologist in the province can be involved.”

The free-of-charge service starts on Wednesday and will operate Monday to Friday from 9am to 3pm. Day said when people call the APNS office, the goal is to be able to pass their contact information to one of the psychologists on their roster and within 48 hours have the caller receive an offer for a session.

Read the full story here.

5. The New Brunswick plan to reopen

The debate is just getting started over how provinces will move forward into the next few months of pandemic control, with plans but not timelines announced in Ontario, and an aggressive move in Quebec, where they have announced schools and daycares outside of Montreal will open on May 11.

Our neighbours in New Brunswick have also started to ease restrictions, and have announced a multi-phase plan for how things will unroll, complete with colour coding.

One of the key components of the plan is a slow expansion of household bubbles. New Brunswick Medical Officer of Health Jennifer Russell has said the idea is inspired by New Zealand, and currently means that households in New Brunswick may choose one other household with which to be in close contact. The relationship has to be exclusive, so that each household in a bubble only interacts with the other. The idea, says Russell, is to help reduce isolation while still maintaining control of close contact networks.

Nova Scotia has not yet announced what plans are afoot for eventual relaxing of rules. As Yvette d’Entremont reported yesterday:

While addressing the current situation in the province with regards to the number of COVID-19 cases, Strang said there’s still a “significant amount of virus activity” in the province, and it would be “absolutely premature for us to open things up significantly at this time, or even in the next couple of weeks.”

He added that any decisions must be based on Nova Scotia’s epidemiological data, not on what might be happening and/or leading to an easing of restrictions in other provinces or countries. He reiterated a point he’s made several times in recent weeks, noting that any easing of restrictions “will be a very phased and slow process.”

6. Sue Goyette is Halifax’s new Poet Laureate

HRM has appointed a new Poet Laureate to serve as “an ambassador and advocate for literacy, literature and the arts,” and reflect “the vitality of our community through appearances and readings of poetry at a number of civic events and other activities.”

Goyette has a long list of awards and honours for her work, which includes six books of poetry and one novel. She teaches creative writing at Dalhousie, and has a new collection called Anthesis, coming out this year on Gaspereau Press.

Goyette is the eighth Poet Laureate of Halifax, preceded by Dr. Afua Cooper, Rebecca Thomas, El Jones, Tanya Davis, Shauntay Grant, Lorri Neilsen Glenn, and Sue MacLeod.

7. Halifax will take months studying increasing pedestrian space to accommodate social distancing (meanwhile New York will open 65 kms of streets in the next month)

Halifax council approved a request from councillor Shawn Cleary for an “expedited” report on temporary installation of tactical bike lanes and active transportation routes at today’s virtual council session, despite recommendations against by CAO Jacques Dubé and Transportation and Public Works director Brad Anguish. Dubé objected to the request on two contradictory accounts, first saying that a report was moot because staff were already considering measures, and then saying that measures would work against provincial public health orders.

The request passed 12-5, with Councillors Streatch, Hendsbee, Karsten, Adams, and Whitman voting against.

Meanwhile, elsewhere in North America, the predicted longevity of social distancing measures is inspiring rapid and temporary changes to city streets and sidewalks.

“Over the next month, we will create a minimum of 40 miles of open streets,” Mayor Bill de Blasio told New Yorkers on Monday. “And then the goal during the duration of the COVID crisis… is to get up to 100 miles of those open streets.” De Blasio said they will be expanding sidewalks in some cases, and also continuing to build more “early action bike lanes”.

De Blasio said the plan is to focus first on streets in and around parks, but also to open local streets “where we can safely open up some space and have it be enforced.”

Here in Canada, it’s been a few weeks since the Vancouver Park Board closed off roads in Stanley Park to cars to allow for more active transportation space. Edmonton has converted at least two traffic lanes to vulnerable road uses. Victoria is removing parking lanes to allow more space for pedestrians. Brampton is closing off curb lanes to vehicles to allow for temporary cycle lanes. Not to be outdone, Toronto has announced CurbTO, an initiative to create more pedestrian space as well extra room to allow for vehicles doing curbside pickups in retail areas.

Brad Anguish sent councillors an email outlining a long list of reasons why he is not recommending opening up streets (or closing them, as he puts it). The list is similar to, but longer than, one sent to me last week from HRM communications.

Here’s the email, posted to Twitter by local reporter Zane Woodford, who is covering council for Saltwire:

I can advise the following:
HRM staff continue to monitor national and international traffic management responses to the COVID crisis through our various membership affiliations and through direct benchmarking with colleagues in numerous Canadian cities.
At this time, HRM staff is not recommending to close streets based on the information gathered from other jurisdictions. The primary reasons are as follows:
In general, the closing of streets (whole or partial) opposes the provincial guidelines to stay (the blazes) home, especially now that we are escalating toward peak infections.
Closed streets encourage significant public gatherings unless it can be done on a wide enough scale and somehow controlled such that people do not travel to streets in other neighbourhoods.
Closed streets draw upon critical traffic resources to establish and maintain, and front line responders to enforce.
Closed streets require appropriate separation devices to achieve necessary pedestrian/cyclist safety. There are some supply concerns around barricades and bollards in jurisdictions where construction continues such as Halifax.
There is potential interference with business, especially in Halifax where the province is trying to keep more businesses open.
There is potential interference with bus and emergency response routes.
Sidewalks in most areas of the municipality are low in demand when considered over the course of the day and safe distances can be maintained when combined with low traffic volumes.
Most medical officers of health are advising that the risk of transmission is negligible from people passing on a sidewalk.
There is potential increase in demand for masks.
Finally, we are aware of at least two cities who regret establishing open streets for several of the reasons city above. The majority of Canadian cities are not proceeding with such Initiatives at this time. Ottawa has announced it is not closing streets for example.
And yes, from a political perspective, everybody will want one, creating a whole other level of distraction and frustration at a time when we should be focused in our approach.
The above said, staff will continue to monitors….
Hope this helps….
Cheers
Brad

Anguish argues that opening up streets, even in part, “opposes the provincial guidelines to stay (the blazes) home,” as if the Strang-McNeil plan is to have Nova Scotians remain on their couches slowly atrophying for the next several months. Indeed, they are recommending the exact opposite.

Here’s Tim Bousquet recapping the Premier on March 23, where he indicates what people are being asked to do is drive less:

Walking and exercise

McNeil said people can still “go for a walk around your neighbourhood.” In response to a request for clarification, McNeil said: “If you have to drive to get your exercise, you’re going too far. What we need you to do is walk for exercise, not to socialize, and you can do that in your community. If you live near a trail, go on the trail. But if you’re driving to go to the parking lot — stay in your own community. Walk the block, walk around your house, walk along the side of the road that you live on. What we’re asking people is not to drive to public spaces. It’s tough enough to control the volume of people there; when you add to that you allow motor vehicle traffic to go to the parking lot, it just compounds and we get what we had this weekend, where we had hundreds of people gathering in places. That defeats the purpose.”

Anguish also says that opening up streets to create more space for pedestrians might, “encourage significant public gatherings.”

I mean, he’s not wrong… the more infrastructure you build for a mode of transportation, the more you induce use of that mode, as a general rule. It’s a phenomenon that’s been observed over and over in relation to vehicle traffic, and it quite possibly also applies to people on foot. Under normal conditions, the easier it is to walk to work (relative to other modes), the more likely you are to walk to work. The easier it is to drive, or take the bus, or bike… you get the idea. But unfortunately for all of us, conditions are not normal right now.  And people aren’t asking to gather on sidewalks, they just want enough room to pass others without contact.  Anguish is responding here as if this is about street parties. As if all the cities opening up streets across the country are hosting parades and road races instead of simply responding to physical distancing requirements.

I can’t help think that Dubé and Anguish are kidding themselves that they will not have a big problem on their hands as the weather warms, and more and more people are compelled to take their daily constitutional out in their neighbourhood, instead of hunkering down indoors. People need exercise. It is, no matter what your city administration tells you, essential.

Views

1.  Larry Haiven on Lean Healthcare

Larry Haiven writes in the Nova Scotia Advocate about how a management concept originating in the Japanese auto manufacturing sector found its way into Canadian health care systems, and helped reduce our capacity to handle a pandemic like the one we are experiencing now.

It started with factory production management, writes Haiven:

From the late 1970s, faced with increasing competition from the Japanese, North American manufacturers began adopting a strategy called variously “management-by-stress,” “continuous improvement,” or “lean production”.

The strategy called for a relentless diminution of “waste” in workplaces just short of breakdowns occurring. Factory management wanted to see just how close production could come to failing without failing completely.

But this concept of “lean” eventually made its way into the public sector, writes Haiven, giving the extreme example of Saskatchewan, which hired a “lean healthcare consultant” — author of the book, “The Toyota Way to Healthcare Excellence” — to improve their healthcare system.

Saskatchewan found out that to save money, you gotta spend money — on lean management consultants and training. And it turned out that the savings didn’t materialize, nor did the system improvements.

Even by the standards of cost-saving, the Saskatchewan Lean project was problematic. The provincial auditor general reported that there was no evidence the Lean programs produced better service, or value for the money spent. Indeed, the government was not keeping track of results. The A-G stated, “They’re unable to show us whether or not Lean is achieving what they’re hoping it’s achieving.” The auditor pointed to 100s of Lean events and 5,000 days of staff time expended on the project, with no results recorded.

A report in the International Journal for Quality Health Care calculated that for every dollar saved by Lean, Saskatchewan spent $1,511. The article also claimed that “Outcomes reported a statistically significant negative effect of Lean on nurse engagement, usefulness, patient care, time for patient care, workplace issues, availability of supplies, workload stress, and patient safety.”

Haiven writes that it’s not just Saskatchewan; austerity and lean production has taken a toll on health care systems across the country:

One indicator of capacity is hospital beds per 1000 population. The World Health Organization recommends 5.0. The current OECD average is 4.8. As of 2017, Canada stood almost last at 2.52 compared to Japan at 13.05, South Korea at 12.27, France at 5.8 and Norway at 3.60. Nova Scotia has 2.7 and, after Saskatchewan’s Lean venture, that province has only 2.2 beds per 1000.

Another indicator of capacity is the proportion of total healthcare spending disbursed for hospitals. From a high of 44.7% in 1975, Canada has dropped steadily to 26.9% in 2019.

Haiven finishes off with an interesting take on the chart we’ve all been looking at, encouraging us to flatten the curve so that our collective COVID-19 peak does not blow past our health care system capacity. Haiven points out that the curve is not the only thing on the graph that can move: our health care system capacity is where it is because of the decisions of a succession of governments. “A huge problem with the “flattening the curve” chart is the way it treats “healthcare system capacity” as a constant,” writes Haiven. “It ignores the reality that system capacity is a mutable phenomenon,” and that, “over the past half century, capacity has been in political play, and not in a good way.”

Noticed

The Coast has done something truly wonderful, and boiled down yesterday’s council debate on temporary active transportation space expansion into a one-minute TikTok video.  Please do yourself the favour of taking 60 seconds to watch this.

Government

No meetings.

In the harbour

10:00: MOL Maneuver, Acontainer ship, arrives at Fairview Cove from Norfolk
11:00: X-Press Makalu, container ship, arrives at Pier 41 from Valencia, Spain
moves from Pier 9 for Thialf, a crane ship anchored just outside the harbour
15:00: Asterix, replenishment vessel, sails from Dockyard for sea
19:00: Maersk Maker moves back to Pier 9
20:30: AlgoNova, oil tanker, sails from anchorage for sea

Footnotes

Feeling for some of those New Brunswickers facing awkward conversations to explain their expanded bubble choices.