26 May 2020

Fighting the Boogeyman with Dwight, John, and Janice #nlpoli

Ontario Premier Doug Ford pleaded with Ontarians to get tested for COVID-19 on Sunday, even if they were not showing any symptoms. He repeated the call on Monday after a weekend gathering saw thousands pack a Toronto Park and the number of new COVID infections climbed for the eighth straight day.

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.