An evidence-based Alert system #nlpoli

 

Communication remains the single biggest chronic failure of the province’s COVID-19 response.

As regular readers of these e-scribbles know, that means it is really a management problem.

Government officials have a hard time explaining things clearly because they do not have a clear idea of what they are doing. 

You can see this problem most clearly in the “Alert” system announced last spring.  Many countries, states, and even cities use alert systems like this for emergencies.  They are easy to understand – when they are properly put together – and all the people who need to act can know what to do, when to do it, and why they are doing it.

In the case of a pandemic alert system, people reading it should be able to see what types of restrictions went with what level of risk. There’s an internal logic to the system:  a low risk goes with very low restrictions or rules.

 In Newfoundland and Labrador, the Alert system fails all the basics of a functional Alert system. That’s because it was never intended to be a proper staged system for easing or increasing restrictions in responses to changes in the risk of COVID.  The Chief Medical Officer cobbled it together in response to a political demand. 

Worry, fear, and the Zero Risk Bias #nlpoli

 Accepting that life is all about risk is the first cognitive step.

Mark Kingwell, On Risk (2020)

The reporter just wanted to confirm how many active cases there were in the province. 

The question at last Monday’s news conference was simple enough.

 It’s a figure the Chief Medical Officer’s staff releases every day when they update the government’s COVID 19 page.

Dr. Janice Fitzgerald chuckled. 

She didn’t know.

And what’s more, it’s not a number people in public health pay attention to, according to Fitzgerald. 

People talk about it publicly, Fitzgerald said, but what public health is “worried about” are “the cases we don’t know about.”

She said the same thing a couple of days later at the next news conference that started with her rattling off the total number of cases since March, the number recovered, and the number of active cases.

So if Fitzgerald worries - her word - about unknown cases and things like active cases don’t bother her, then why does she talk about them?

A pandemic of fear #nlpoli

 In Newfoundland and Labrador, politicians and public health bureaucrats are dealing more with a pandemic of fear than of disease. It is one they helped create.  It is one they sustain in the way they talk and act.  Let us hope that Monday’s news conference is not another of their super-spreader events.

On Saturday, the Deer Lake town council held an emergency meeting and decided to close the town hall and a local recreation centre for two weeks.  They also decided – apparently without consulting public health officials - to encourage all businesses in the community to shut for two weeks for all but essential sales and services. They’ve told people to stay home.  The local seniors home has stopped allowing any visitors.

Former Premier Dwight Ball tweeted a message from the town council Saturday evening (right).

There have been five new cases of COVID-19 in western Newfoundland, presumably Deer Lake.  They are all in the same household as the initial case, who brought the illness back from outside the province where he works.

The people of Deer Lake are afraid.  In that fear, they are like so many people across Newfoundland and Labrador. Their fear is not, as one might expect, the healthy respect of people who know a deadly disease when they see it.  Rather, their fear – like all fear - is borne of ignorance and suckled by misinformation, the most pernicious form of which comes from the provincial government on a steady basis.

Rumpole and The Old Bull #nlpoli

Mr. Justice Don Burridge
(Not exactly as illustrated)

Supporters of the travel ban won a victory last week as Supreme Court Justice Don Burridge said it was okay to ban travel into the province during an emergency even though it violates the Charter of Rights and Freedoms.

They might want to hold off on their celebrations.

In his ruling, Burridge adopted the provincial government’s wording for the travel ban, which lumps it together with other restrictions on travel. 

[4]            On 29 April 2020 the CMOH issued Special Measures Order (Amendment No. 11), to take effect on 4 May 2020, limiting entry to residents of Newfoundland and Labrador, asymptomatic workers, and those in extenuating circumstances.  On 5 May 2020, the CMOH issued Special Measures Order (Travel Exemption Order), expanding those circumstances when entry into the province would be permitted.  As neither Order served as an outright ban on all travel, I will henceforth collectively refer to these two special measures as the “travel restriction”.

The result - and even though he refers to both things as being distinct at different parts of his ruling - Burridge ignores the very important distinction between travel restrictions and the order than bans mainlanders from coming to the province. 

And that makes all the difference.

Illusions of knowledge #nlpoli

Last week, testimony in the travel ban case by the province’s chief medical officer Dr. Janice Fitzgerald and epidemiologist Dr. Proton Rahman confirmed the extent to which decisions taken by the provincial government in the first wave of COVID-19 were *not* based on evidence and analysis.

This is extremely important reasons.  First, it is emphatically not what the public was told all along.  To the contrary, government officials – politicians and bureaucrats alike - insisted that they were acting based on evidence and sound information.

Second, the testimony confirms the SRBP post in June that government officials ignored available evidence in managing COVID-19.

What really nails the point about decisions made by government officials without evidence is a series of presentations made by Rahman. Tom Baird obtained them through an access to information request in late June.  

The facts of the case #nlpoli

From the start of the pandemic, the provincial government  took decisions for political reasons, not medical ones.  It continues to do so.  It is clear that the provincial government has maintained very tight restrictions on the public far longer than necessary and that far more extensive efforts to control the public since 30 April are not based on evidence and medical necessity.

This is fundamental mismanagement that is harming the province and its people. 

The root of the problem is the political divisions in cabinet. The prospect of a new Premier to replace Dwight Ball brings with it the chance to sort out the problems and get the province ready to deal with COVID-19 for as long as necessary.  

The current situation is unconscionable.

Whatever it takes

The government's own advisors give evidence
that contradicts government's decision.

The Chief Medical Officer disclosed the first case of COVID-19 detected in Newfoundland and Labrador on 14 March.  The woman had recently returned from a cruise in the Caribbean.  Public health officials had tested 114 people half of whom had tested negative for the disease.  They and another eight besides were quarantined at home as a precaution.

The government’s first action attributed to COVID-19 came two days later.  At a news conference, Premier Dwight Ball, health minister John Haggie, education minister Brian Warr, and chief medical officer Dr. Janice Fitzgerald sat literally shoulder to shoulder behind a long desk.

We are “in uncharted waters” Ball told reporters.

Effective immediately, Ball and Warr announced, they had closed the province’s schools and daycares as well as College of the North Atlantic.  The move sent 74,000 children home along with thousands of adults across the province from the post-secondary college.

Haggie told reporters that effective immediately, the province’s health system had stopped all elective, diagnostic and surgical procedures. 

Ball said that public servants were also going to work from home, effective immediately.

“We will do whatever it takes, when necessary, to ensure your safety,” Ball said.

Asked about the impact of public cries to close schools as other provinces had done, Ball said "You always listen to people. We want to do what's best."

Ball and his ministers made the decisions to close schools, hospitals, and the provincial government that Monday morning.  There was a single case of COVID-19 in the province.

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.

Ferkakte #nlpoli

In the past 36 days,  the Government of Newfoundland and Labrador has reported no new cases of CVD-19 on 21 of them.

Three weeks worth of zero.

More than a month in which the reproduction rate for the virus is well below the level in which the disease would be considered under control.

The number of active cases n the province outside hospital all date from the middle of April and later, for the most part.  The four cases in hospital have been there a long time and likely are four people with very serious illnesses besides CVD.

And yet the provincial government lowered its restrictions very slightly on Monday, warned that it would take at least 28 days to see if it might be possible to safely loosen up restrictions a bit more.

The ferkakte alert system announced by the provincial government on 30 April 2020 is full of contradictions and confusion. There are too many to list.  The "plan" is full of other things, too.

Troubling travel ban may be illegal, unconstitutional #nlpoli

Government of Newfoundland and Labrador
 guards at COVID-19 Border Check Point
(not exactly as illustrated)

No other province in Canada has banned travel into the province by non-residents in the way Newfoundland and Labrador has done during the current public health emergency.

Under Special Order No. 11, issued on 29 April 2020, “[a]ll individuals are prohibited from entering Newfoundland and Labrador, except for the following:

a.  residents of Newfoundland and Labrador, 

b.  asymptomatic workers and individuals who are subject to the Updated Exemption Order effective April 22, 2020, and 

c.  individuals who have been permitted entry to the province in extenuating circumstances, as approved in advance by the Chief Medical Officer of Health.”

There is a definition of resident provided in the order.

There is provision for an exemption granted by the Chief Medical Officer but no indication of the reasons why such an exemption might be granted, or the time delays involved.

The power to do this comes from section 28 (1) of the Public Health Promotion and Protection Act.

In making the announcement, the chief medical officer offered no explanation or justification for the except that she felt it necessary to amend the existing restriction on individuals entering the province in order to deal with COVID-19.

There have been no confirmed reports of travelers violating the ban.  Rumours about tourists, covered by news media the day before the new order, lacked any evidence either that tourists had entered the province.  There is no information in public that any travelers had violated restrictions on people entering the province and caused a new outbreak.

To the contrary, the number of active cases in the province continues to decline, with very few new cases having been reported in the past two weeks.

In response to a reporter’s question about the constitutionality of the ban, health minister John Haggie replied on Monday that section 13 of the public health protection law says any measures imposed during an emergency should be limited to what is necessary. 

The trouble with bubbles #nlpoli

Another type of Bubbles

Stay in your bubble.

A cute, clever little phrase that Newfoundlanders and Labradorians have been hearing for weeks.

We all assume it means something like protect yourself as you go about your daily life. 

Or stay at home unless you have to go out.

And if that’s what it meant, if that’s all the phrase was, then the notion of a bubble is innocent enough.

Last week, though, Newfoundlanders and Labradorians found out “bubble” was something else.

As the province’s chief medical officer unveiled what she called the strategy for living with COVID-19, she outlined a series of what she called Alert Levels.  In Alert Level 4, people would be able to mix their one bubble with another bubble.

Except that the bubble mixing was allowed to start while we are still in the current state of alert with all its greater restrictions.

People wondered if they could safely mix with more than one bubble.  Like say, in families with two sets of grandparents close by.  Would they be able to go over and check on both of them without having to look at them from outside the house?  What if they had to go over and help out with a problem with the house. The kids would love to see nan and pop and maybe that would boost morale.

No, came the reply.  One bubble and one bubble only.  You pick.

Bollocks said your humble e-scribbler.  Inherently and in the circumstances in the province mixing more than two bubbles at the moment has about the same risk as mixing one bubble.

Whoa there, said someone else. There was a mathematically knowable risk of mixing more than one extra bubble right now.  Better be safe than sorry.

Not a mathematical problem at all, said your humble e-scribbler in reply.

Oohhh yes, it is, said the knowledgeable one, missing the point.

The difficulty is not in the math but in the concept.

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.

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.

Doctor Aggie's H'Answer #nlpoli

“What do I have to do to get you to listen?” health minister John Haggie asked rhetorically and with considerable exasperation at Monday’s daily COVID-19 briefing.

Haggie was ranting once again about people across the province who he claims are flouting the restrictions on public comingling during the current health emergency.

On Monday, though, Haggie’s daily rants started to sound a bit more shrill and more than a bit condescending.

Anyone can appreciate his deep concern to prevent an outbreak of COVID-19 of the sort people have seen in Italy, New York City, or even Quebec.

But Dr, Haggie has the problem that the measures put in place so far have worked so well at containing the disease across the province that no one can see the danger in front of them.

And to be honest it is hard for the ordinary person to see the immediate danger, at least in the extreme way Haggie apparently sees it.

Number of active COVID cases in NL declines dramatically #nlpoli

Newfoundland and Labrador is already emerging from the first wave of the COVID-19 infection.

The data from the provincial government’s daily COVID-19 media briefings is clear.

Starting on April 6,  the number of new cases detected was less than the number of recovered cases.  As the week progressed,  the number of recovered cases increased as rapidly as the infections had increased two weeks before. 

The result, shown in the chart at right, is that the number of active COVID-19 cases (cumulative total less cumulative recovered and deceased) has been declining steadily.  

By the end of this week,  the number of active cases should be about the same as they were before the massive increases started on 23 March 2020.

The most likely thing that could change that forecast drop in active cases is an increase in the number of tests conducted by provincial health officials.  But to produce a dramatic increase in the number of new cases – on the order of what we saw in the middle of March – the province would have to test thousands of people a day.

That’s because a consistent testing effort yielded a steadily declining number of new cases. An average of 177 daily tests the week of March 23 produced an average number of 18 new cases daily. 

The following week 208 daily tests yielded an average of 12 new cases per day.  In the first full week of April, though, an average of 178 tests a day produced only an average four new cases.

Experience Counts - COVID Economic Balls-Up Edition #nlpoli

Update:  The links below don't work any more.

Both the screwed up one (March 20) and the revised one (March 21) appear to have disappeared from the government list of orders issued during the emergency.

___________________________

On Friday Premier Dwight Ball took a question from reporters about the Liberal leadership that is still underway.

In a moment of egotistical boasting, Ball said it “takes experience to get through this crisis that we're dealing with. Someone said to me this morning it takes experience to do that job, and not often do you see a card on the back of a fire truck saying 'Novice Driver’”.

On Friday,  the provincial government issued an order under the Public Health Protection and Promotion Act that directed individuals entering Newfoundland and Labrador from out of the province – either originating or returning – to enter a mandatory period of isolation for 14 days regardless of whether they were exhibiting symptoms of COVID-19 or not.

Problem:  The Friday order, as written, effectively shut down the provincial economy and cut the province off from supplies of food and fuel.

All individuals arriving in Newfoundland and Labrador from outside the province must self-isolate for 14 days, including those individuals arriving from other provinces and territories in Canada.

The original order applied to *everyone*:

•  crews on Marine Atlantic ferries,
• tanker crews, including the folks coming to Come by Chance and the refinery, 
• OCEANEX crews and other shipping companies that bring food, fuel, and essential supplies into the province,
• people who work on one side of the border in Labrador and live on the other,
• people involved in supplying electricity to the province, 
• crews working on and supplying the offshore platforms,
• medical personnel arriving to help treat patients or back-fill positions, 
• airline crews and passengers of all kinds,
• helicopter crews servicing the offshore rigs, which are outside the three-mile limit that is the province's jurisdiction, and
• truck drivers who bring everything and anything into the province and who take manufactured goods out again.

No one in the provincial government, least of all the people who wrote up the order or the ones who approved it, realized what they were doing.

And so, after some uncertainty in the world outside government and a bunch of frantic calls and emails, the provincial government issued a second order the next day exempting all those people needed to keep the province running and keep people fed.

Someone check for a Novice Premier sign on the back of Dwight's car.

-srbp-