20 April 2020

The three CVD19 pressures the NL government will face #nlpoli

Last week, SRBP raised the likelihood that declining numbers of active cases of CVD19 in Newfoundland and Labrador will put pressure on the provincial government to ease the current restrictions on daily life and the economy.

Officially, government officials like the Premier and health minister blew off the idea of restrictions with concern that supposed bad behaviour on the Easter weekend might trigger a renewed climb in numbers.

More testing.  Fewer cases.
Well, we are a week past Easter and the average number of daily cases is at two, down from three the week before.  At the same time, health officials completed two of the largest days of testing at the end of the week.

The number of active case son Sunday was 62, down from a peak on 06 Apr of 192.  Basically, the active cases on Monday date from infections dated after 01 April.  That is, they date from just before the peak.

Governments across Canada faced choices when responding to CVD-19.  They had two extreme choice, neither of which was politically nor practically feasible.

The 1918 solution would be to let the disease run wild.  Lots of people would get sick, the health system would be swamped, the economy would shut down and the death toll would be measured in the tens of thousands.  But the whole thing would be over in a few weeks or months.

Black and White:
The number of active CVD19 cases in NL continues to decline steadily.
The other extreme would be a complete lock down.  That would be impractical since Canada doesn’t have the public temperament or the police and military forces to enforce such an authoritarian solution.  Such an approach would also raise the spectre of destroying the economy since it would require keeping the country completely locked down for years.

The only viable option was something in the middle.  Essentially, that middle option entailed containing the spread of the virus to hold down deaths as well as hospitalization and ICU rates to levels the health care system could manage, while at the same time continuing as much of normal life as possible.

That worked very well in Newfoundland and Labrador, largely due to the fact that the main source of infection in the rest of the country (spring break travelers) didn’t hit Newfoundland and Labrador.  In this province, the spring break is tied to Easter, which this year came almost a month after the lock-down started.  In every other province – including the most severely hit – the spring break travelers came in March just as government-imposed restrictions on them all.

In Newfoundland and Labrador, people also apparently abided by the restrictions quite well.  Despite the lurid – and entirely anecdotal – reports used by the province’s health minister in his daily harangues against the public,  the infection rates suggest that the overwhelming majority of people went out of their way to comply with both the spirit and the letter of the restrictions.

Nova Scotians, by contrast, have been flouting the restrictions and paying the price with a double-digit number of new, daily infections.

The result is that in early May, the government in Newfoundland and Labrador will face mounting pressure to loosen the noose.  Other provinces and some American states are already talking about relaxing the restrictions gradually.  A province that is *clearly* doing well in its fight against CVD19 will have a hard time resisting the pressure, even if it didn’t already have a reputation for caving to any public pressure.

We can also add two other pressures to that one.  Economically, the province cannot afford to strangle the economy slowly much longer.  Some of it has stopped already, but most businesses are still working at some level.  With the immediate health threat seemingly past, expect pressure to let people get back to work as part of the loosening of restrictions.

Government itself will be feeling a need as well to get some much-needed tax revenue. The recent Bank of Canada commitment to buy up $50 billion of Canadian provincial bonds may sound like a licence for the provincial government here to borrow like mad.  But that sound would be more like a dull thud than a bell.

The province is already too heavily in debt.  It needs to limit its borrowing even in these times.  With oil bringing in less direct revenue, the provincial government could look to other parts of the economy to give it some extra income.

The third pressure will come from the health care system itself.  In order to free up beds and people to tackle an anticipated influx of CVD19 patients, the province’s health system had to shut down all but the most critical non-CVD19 care.  Hospitals that were working at above 100% capacity now have bed occupancies closer to 50%.

The CVD19 patients never showed up. Early on, hospitals had a total 15 patients across the province with three in intensive care.  For most of the past four weeks, though, the number of patients in hospital has been around six to eight with three and sometimes four ICU patients.

Those three pressures are going to be hard to resist.

Loosening restrictions will come with risk.  There is always the possibility of a spike of infections that will swamp the health system.

What mitigates against that is the experience that government health care managers have over the past month if they are willing to look at it.  In itself, looking at their own experience – as opposed to be chasing phantoms or looking at what happened elsewhere – is going to be an enormous challenge.  They won’t have very much, if any, political support.

Make no mistake, local politicians will take rash decisions if pushed into it by news headlines and widespread complaints on social media.  But when faced with taking a sensible decision based on evidence in the absence of that popular will, the couple or three people currently running the entire province will balk if there is even the tiniest, most hypothetical chance of something going wrong.  The only other thing that might persuade them to act is if the federal government and a few other provinces can give them a checklist and an example to follow.

So, what might we expect in May?

Well, nothing unless current trends hold.  But if they do, we can expect some gradual relaxation of restrictions. 

That might mean a re-opening of restaurants, for example, or general retail provided retailers and restaurant owners limit the number of people in their establishments as grocery and other retailers have been doing for the past month.

There might be a requirement for people to wear masks when out in public.

Offices might be allowed to re-open with reduced staff numbers or with rotating shifts working from home and working in the office. 

Since the school year is written off already, there’s no need to open schools again.  But with some flexibility in the workplace, parents would be able to find a way to provide child-care and resume a more normal office work routine.

Cross-border travel restrictions would have to stay in place, but internal travel restrictions could ease.  That will stimulate the economy while allowing people to increase their social distancing with some time at the cabin.

The experience of the past month could allow health care managers to respond to an outbreak more efficiently than they did the first time.  They might be able to localize outbreaks and impose restrictions on some parts of the province while lettings others continue unaffected. And in the worst-case scenario, it would be easier for people to go back to the broader restrictions if needed.  Now that they know what it means and that they can survive comfortably, it is not going to cause them as much fear as the first clamp-down did.

Over time, the public could adapt to *that* sustainable lifestyle - loosened restrictions with intermittent and localized clamp-downs - far more readily than they would accept living with the current level of restrictions indefinitely.

To have the greatest chance of being the most effective, any move to relax restrictions should come with a public discussion of issues and options now.  It would mean bringing the public, generally, into the decision-making tent and let them see and understand the issues and the implications of what everyone is talking about as government officials are working through the options.

Unfortunately, there is little chance of such openness. Government officials in Newfoundland and Labrador have a penchant for secrecy almost as strong as the love of paternalism, despite evidence in examples such as the Cameron Inquiry or the LeBlanc inquiry that neither works.