Covid-19: Opening Up Choices Need To Reflect Regional Differences
Posted May 8, 2020
Many jurisdictions across Canada and elsewhere are beginning to reduce their Covid-19 public health restrictions. Nova Scotia began last week.
The first tentative steps allowed parks, trails, and gardens to open but not campgrounds. Boating preparations, sport fishing, and golf driving ranges (but not the golf course) can begin, as can praying from the comfort of your socially distanced car. It’s hardly back to normal.
The number of new cases grew rapidly in April. The cases were primarily among residents and staff of long-term care homes and unlicensed seniors’ (LTC) facilities, who accounted for three-quarters of the 368 of the new cases. The vast majority are associated with the Northwood home in Halifax.
Meanwhile, the reported number of recoveries grew rapidly, at the end of April. Growth slowed with reported positives reached crossing the 1,000-mark on Thursday. The number of active cases, which excludes those who died or have recovered, has dropped almost as rapidly, falling to 240 on May 8th. Of these, only 45 are unrelated to LTC facilities.
There is an uneven distribution of infections across the province. The Central zone has six out of every seven cases. It has a much greater share of newer cases with the numbers in the other three regions barely budging in recent weeks. The Western region has not reported a new case since April 23rd.
It appears that there are very few active cases outside of the Central zone, perhaps less than 10. Within the central zone, there is modest spread outside of the LTC facilities.
It is unfortunate that the Department of Health and Wellness, which has until now been a model of transparency, declined to answer questions about the number of active cases by region for this article.
The communications led by Premier McNeil and Doctor Strang have been effective in building support for a difficult regimen of confinement, particularly when case counts were spiralling upward.
Now that the number of active cases is rapidly decreasing Nova Scotians will want to experience an easing of that regimen that is commensurate with the reduction in risk. The profound geographical differences in active case counts should inform the next steps the province takes in easing safety protocols.
Consider for example the case of schools. It may be judged unsafe to open schools in Halifax. But it may be very reasonable to do so in Yarmouth, Kentville, Antigonish. The same could be true for hair salons, dentists, and physiotherapists who could be allowed to open for their existing local clients.
Protocols that differ by region are happening elsewhere. Montreal schools will remain closed while other schools in Quebec reopen.
In Saskatchewan, which discloses the number of active cases by region, there has been an outbreak in the north and far north. That has not stopped them from moving forward with loosening in the rest of the province.
The demand on hospitals has been less than expected, with the number of Covid-19 inpatients never exceeding a dozen. It is usually much less and is dropping; on May 8th there were five. Government is already working with the IWK and the Nova Scotia Health Authority to identify how to move the system back toward normal.
That will mean more work for underemployed family practitioners and many specialists such as orthopedic surgeons, and a resumption of needed care for patients whose procedures have been on hold.
Zones having little or no demand for Covid-19 treatment in their hospitals should be allowed to resume elective procedures for their patients more quickly than those that do, probably just Central.
There is an advantage in starting new protocols in parts of the province. The first version may be imperfect and need some tweaking.
If despite precautions, there is an outbreak there will be a better chance of containing it if it is in a smaller zone. The right response to new community spread may be to restore some of the restrictions in that zone.
With the important exception of the serious outbreak at Northwood, the province has done well in limiting spread of the virus. Nova Scotians have adhered to the directives because McNeil and Strang have been credible and persuasive based on facts, particularly when case counts were rising.
If the government insists on the same rules province-wide regardless of the data differences they risk losing popular support for and adherence to the constraints. It might make sense to decide about golf courses on a province-wide basis. But allowing schools in Liverpool to open or dentists in Amherst to treat their existing patients will not cause extra traffic from Halifax.
When making their next choices about reducing restrictions the province should be willing to have differences by region when the data point in that direction.
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