28 April 2020

Bursting bureaucratic bullshit bubbles #nlpoli

The daily average for new CVD cases
has been declining since late March.
In one of the provinces hardest hit by COVID-19,  Ontarians got a roadmap on Monday on how the provincial government will loosen restrictions on their daily lives.

One of the indicators used to make the judgment will be two to four weeks of lowering daily numbers of infections.  Not zero cases, mind you, but a clear downward trend that was about half of the current rate, according to Ontario's chief medical officer of health last week.

Two other key indicators will a decrease in cases not traced to a source and a decrease in new hospitalizations.

In one of the provinces least affected by COVID-19, people in Newfoundland and Labrador found out on Monday that they could be locked down for weeks and potentially months more before provincial government bureaucrats and politicians will consider easing any of the restrictions imposed on them in mid-March.

That chilly outlook came from politicians Monday afternoon after a presentation by one of the government’s key advisors that confirmed:
  • we are now in the fourth week of declining and lately low numbers of new cases per day,
  • only two percent of cases across the province cannot be traced to a source, 
  • that there have been no new hospital admissions for COVID-19 for more than a week (it's actually two weeks), and 
  • no deaths for more than two weeks.
In Ontario, a decision to loosen restrictions will also depend on available capacity in the health care system to handle a surge of new cases.  In Newfoundland and Labrador, health managers emptied half the beds across the province by halting elective and non-urgent surgeries and postponing treatment for a wide variety of other conditions.

Of 650 beds available for CVD patients, use rates peaked at two percent
on one day and have been less than one percent for two weeks.
The 650 beds freed up by the move have sat empty for weeks although the number of COVID-19 patients needing hospitalization peaked at two percent of available beds on one day only.  Since mid-March bed utilization has been less than one and a half percent of capacity and currently sits at less than one percent.

Monday’s presentation in Newfoundland and Labrador also confirmed that, as SRBP has noted since 13 Apr 20,  the effective transmission rate (called Rt  in the presentation) for COVID-19 in the province is less than one and has been “for more than two weeks”.  It is actually closer to three weeks.

So while Newfoundland and Labrador is in far better shape across the board than Ontario and several other provinces, its politicians and bureaucrats are still struggling to make sense of what all the numbers mean let alone make a decision to even free up a tiny fraction of the beds currently waiting for an onslaught of gravely ill and dying patients that never showed up.

And in those beleaguered provinces still in the grips of the first wave of the pandemic, politicians and officials can lay out a clear and measurable plan to shift the province from its crisis stage to a lower readiness posture.

There are 34 active CVD cases in NL today.
What was particularly disturbing from the presentation on Monday in Newfoundland and Labrador was the way both politicians and bureaucrats appeared to tie the easing of restrictions to public acceptance of a telephone app that would spy on their movements and those of people around them.  

The app would be used for contract tracing but raises enormous and thus far unconsidered privacy concerns.  Debating those would take weeks or months even though the app itself is not crucial to successful measures to combat COVID-19.

The provincial government in Newfoundland and Labrador has had nothing to say about those more important efforts, although other provinces have, including Ontario.  Far more important in Newfoundland and Labrador than invasive spy software will be:
  1. Restrictions on and testing of out-of-province travelers to limit the potential for new infection to arrive in the province. According to chief medical officer Dr. Janice Fitzgerald (14 Apr 20), 98% of COVID cases in Newfoundland and Labrador were from travel or direct and indirect contact with infected travelers.  The Caul’s cluster alone produced 69% of all cases to date (178 of 258) from a single traveler and direct and indirect contact.
  2. Testing, contact tracing, and quarantine of new cases. Existing capability dealt effectively with a virulent cluster and the less virulent spread of cases unconnected to that single traveler who visited a funeral home in the middle of March.
  3. Access to adequate supplies of personal protective equipment for health care providers as well as the promotion of non-procedure masks and similar measures for the public.  Some of this equipment can be manufactured locally and widely distributed both for health care workers and for anyone else in the community.
  4. Protection of vulnerable populations such as residents of long-term care homes by sustaining current restrictions.
All of these measures would be harder in a large province like Ontario, but they have been and will be much easier to implement in a relatively small province like Newfoundland and Labrador with relatively few points of entry.