In St. John’s on
Monday, chief medical officer Dr. Janice Fitzgerald warned Newfoundlanders
and Labradorians that “as we move around more” we will see more cases of the
disease in the province. Asked by a reporter if there could be asymptomatic
people in the province, Fitzgerald said there as no way to be sure. They could
be out there, infecting people.
That sounds reasonable enough until you realize that
there is only one active case of COVID-19 in the province and that person is in
hospital, where he or she has been for weeks. The last reported cases were on
07 May. Even then, there was some
question that one or both might have been false positives. But in any event, we are now more than the
incubation period of the virus.
Fitzgerald described it as almost three weeks, which would be one and a
half times the incubation period for the disease.
The province’s borders are sealed to all but a handful
of people and those are subject to monitored isolation for two weeks before
they can move around. Health minister John Haggie has described that two-week
wait – the worst-case incubation period for the disease – as the best test
there is for it.
Haggie has also used the prospect of cases suddenly
springing up and swamping the health system as a reason for the very slow
relaxation of the province-wide lockdown.
He hasn’t gone to the spectre once in a while. It is a frequent explanation for the
government’s approach to COVID-19.
You can understand why Doug Ford and his officials
talk of asymptomatic cases or new outbreaks.
They are staring at a dramatic surge in cases after cresting the first
wave and reducing the number of active cases. But in Newfoundland and Labrador,
Haggie and Fitzgerald have gone beyond prudence or a reasonable dose of
caution. They are basically dismissing evidence and justifying their decisions to
restrict just about every aspect of life in the province because they think
there’s a boogeyman out there.
There’s no Boogeyman
Think of it this way.
COVID-19 doesn’t exist naturally in Newfoundland and Labrador. It doesn’t grow on its own. The thing came
from outside. That’s what happened in
March. We know from the information Fitzgerald provided that all but a handful
of cases they haven’t been able to trace came from either travel or from
primary, secondary, or tertiary transmission from travelers. The single largest cluster – from Caul’s funeral
home – accounts for 70% of the known cases.
So, with travel either cut off or severely restricted
and with travelers isolated, there’s virtually no way for the disease to get to
the province. Sure, some random event can occur but there’s no reason to
believe that there is any disease wafting around the province right now waiting
to pitch on someone and engulf us all in a maelstrom of death.
In Ontario, when people mingle, they can get sick
because the disease is there. We know it
is there because cases turn up. But in Newfoundland and Labrador, there’s
zilch. 18 days in a row with no cases.
Just as importantly, though, in the past 30 days, there have been just
four days – April 25, April 26, May 1, and May 7 – on which public health
officials found any cases at all. They
found one on each of three days and two on another. Not hundreds as in Ontario, every day, but
one or two for four days in a month of goose eggs.
Let’s pretend there is one
Take another perspective on it. If Fitz and Haggie are right, then people are
out there, and they are getting sick and infecting others. But they either have
symptoms so mild they don’t notice or think they have something else, like a
seasonal cold or influenza. They aren’t dying
and they aren’t turning up in hospital. We’d spot those.
The evidence we have doesn’t really support that
though. There’s such a level of paranoia
about COVID-19 that people don’t hide if they are sick. Fitzgerald’s people
have tested almost eleven and a half thousand people who thought they had COVID. Turns out the fever, or cough, or whatever
pair of the symptoms they presented with, were just run-of-the-mill stuff. The
number of sick people looking for testing has dropped off, though, so it is pretty
clear COVID-19 has been gone from here for weeks.
Let’s imagine, though, that despite all the evidence, that
there are dozens or hundreds of COVID-19 people we haven’t found. Go crazy and imagine there are
thousands. Pick a number. All sick and
recovered except for a few simmering cases who pass it around despite all the
evidence they don’t exist and – we must add – despite the praise over the past
four weeks from Premier Dwight Ball, from Haggie, and from Fitzgerald that
everyone has been very good at following the rules and getting the cases down to
zero.
So what?
Mitigation Strategy
Fitzgerald is supposed to be applying a mitigation
strategy. That’s the 2007 plan and it’s
the national plan for dealing with a virulent infectious disease for which
there is no vaccine or cure and no prospect of one reasonably soon. The strategy is well known. The Imperial College described it in a
paper released in mid-March. Four
epidemiologists wrote about it in last week’s National
Post.
Mitigation means that you protect the vulnerable –
folks in long-term care for example – and control the spread of the disease so
it doesn’t overload the health system and fill up the funeral homes. You do that by testing people who are sick, confirming
the case, tracing their contacts, and isolating outbreaks that way. Other than
that, you accept that people will get sick, recover, and therefore acquire
immunity naturally.
So, if people are getting sick from Haggie and
Fitzgerald’s boogeyman, there’s no reason to worry and no reason to keep
everyone locked down tight as drum to produce zero cases. In fact, having zero
cases is bad. It makes you *more* vulnerable
to a wildfire outbreak because so many people haven’t had the disease. We’d be
better off if we had a steady level of active cases over a long period of time.
No Plan
“NL Life with
COVID-19” isn’t a plan to manage the disease. It assumes that tight restrictions are the
normal state and arbitrarily relaxes them, slightly, using time periods that
appear to have a logic but that, in fact are just picked for bureaucratic
reasons. The period 28 days does nothing
more than give bureaucrats time to plan the myriad restrictions, rules, and
guidelines, that will accompany the next alert level.
The plan does not lay out a coherent set of graduated
restrictions – look at the Imperial College paper, for comparison – and there
are no identified triggers for moving from one level to another. Even as recently as Monday’s briefing, the
chief medical officer could not explain how she will decide shifting up or down
levels. There’s no valid reason for
that, by the way, but her inability to explain her plan coherently is one of
the most obvious clues that things are seriously off the rails in the
Confederation Building.
The other sign things are off the rails and in the
woods is the emphasis in daily briefings on zero cases and the constant references
to a boogeyman outbreak.
With the problem defined, we can now turn our
attention to the implications of this and the cause of it, as well.
That is the subject of our post next Monday.
That is the subject of our post next Monday.
-srbp-
