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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  • I read your article “NS must be flexible while easing Covid-19 restrictions” this morning with great interest. I agree with you 100%. My husband and I live in the Northern Zone which has the least number of cases in the Province. We too would like to know how many active cases there are at the present time in each zone.

    We are particularly interested in the easing of health restrictions on elective surgery and other procedures. My husband has had a very large kidney stone for several weeks which got infected with sepsis. They put in a ureteral stent and he is waiting for lithotripsy surgery to remove the stone. I don’t believe our Truro hospital has any Covid-19 cases at the present time. There was one man in ICU for 37 days but has since been transferred to the Aberdeen. I believe it should be fairly safe to do elective surgeries at the Truro hospital so I wonder why we have to wait until everything is fine in the HRM.

    I was scheduled to receive a cortisone shot and speak to my orthopaedic surgeon in New Glasgow but it was cancelled the day before my appointment in early March. I hope you reporters keep after Mr. McNeil and Dr. Strang to do the right thing and start to ease restrictions in areas of the province that are safe to do so. Thank you for the excellent article.

    M | May 11, 2020

  • Interesting that you chose golf as an example, and yet golf courses are not open. The only place where golf is social is the bar at the end of the game. I wait for my husband to clear the tee before I get there, he hits one side of the fairway and I the other, we even don’t have similar putting challenges. If you don’t pull the pin, and the course has foam in the hole, there is no opportunity to contaminate playing partners who live in the same household. Why has Nova Scotia not followed BC’s lead on golf but has put it in the same category as a high contact sport, soccer? Golf is an outdoor excuse for a walk, good exercise if you are trying to stay healthy. We should all write our MLAs to question the easing strategy; thank you for starting this conversation.

    Mary Brooks | May 9, 2020

  • I believe that your suggestion that different regions should normalize strategically based on the local effect is correct. I live in a rural community where there has been not one person who has been infected.

    How does one possibly stay physically and equally important, mentally health if the law states, you are alone. There is a one of the most beautiful beaches I know next door to me. Nobody is here, the ocean is beautiful but cold. On the biggest day of the summer there may be 10-15 people there. The beach goes for miles.

    I do not like government controls on my personal freedom. I appreciate what our National government has done to protect all of us but the regional situations don’t necessarily need the hand of the federal government.

    I think my Prime Minister has done a fantastic job. It is however time for communities to make decisions for themselves.

    I guess that is hard to do if you can not walk down a 3 km long beach, staying six feet away from your colleague and find really ways forward.

    I think this is enough. We never thought before that people were responsible. Crimes, deceptions and corruption. I think most of us have proven we are good.

    The point is, Canada is enormous. There is space for us. We are fortunate. Please let me walk on a beach that no one else is on!

    John Power | May 8, 2020

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