Province's former top doc sees 'big reasons' for caution in lifting COVID-19 restrictions

New Brunswick's former chief medical officer of health is calling for more safeguards before the province abandons all COVID-19 restrictions.

Dr. Eilish Cleary says after two years of the pandemic, it's a time for optimism but also for caution.

She agrees with ending vaccine mandates and letting children get back to normal school and extracurricular activities.

But it might be a good idea to keep masking in certain indoor spaces, she said.

Maintaining isolation requirements would "be prudent," and people should have enough supports to stay home if they're sick.

She recommends rapid testing to protect undervaccinated young students, as well as patients in hospitals and residents in long-term care, as well as with ongoing surveillance and communication with the public.

New Brunswick is set to lift all COVID restrictions, including mask mandates and gathering limits, by March 14, when the emergency order ends.

Premier Blaine Higgs announced the move last week. But few details have been released and exactly what it will mean for hospitals and long-term care homes, unvaccinated doctors and government employees, students and teachers in classrooms, and businesses remains unclear.

Supports return to 'somewhat normal life'

Cleary, a Fredericton physician who served as New Brunswick's top doctor between 2008 and 2015 and was part of the World Health Organization team that snuffed out a deadly Ebola outbreak in Sierra Leone, said the province has "come a long way" over the past two years.

She agreed it's time to "transition away from this single focus on the pandemic and COVID-19 and get back to somewhat normal life."

"But I also think that we need to be cautious and there are several big reasons for that."

Although Omicron has been less severe than other variants and there is a high level of immunity across Canada, through both vaccination and infection, there's still a lot of virus circulating — "probably more than we have had in any other time of the pandemic," said Cleary.

Any decisions about transition should not be only about this particular virus, but how are we ready as a system in case another virus comes along.- Dr. Eilish Cleary, former chief medical officer of health

Many people are still vulnerable, we don't fully understand COVID's impacts yet, and we don't know how the virus will evolve, she said.

In addition, we live in a global society and there are still large parts of the world that are under-vaccinated, which poses a threat to the evolution of the virus.

"We have to acknowledge, too, that, you know, we know that there could be other viruses out there that are potentially pandemic.

"And so any decisions about transition should not be only about this particular virus, but how are we ready as a system in case another virus comes along, because we certainly don't want to go back to this stop and start and and disruption that we've had."

Vaccine and masking mandates have played an important role in helping to get the pandemic under control, said Cleary. But generally, mandates don't work long term, she said. They become polarizing, about the mandates and not the interventions  themselves.

"By and large, measures that have been effective over history in public health are one where you can try and have people understand, give people the information they need to make the best decisions that affect their lives."

Cleary sees no need for masking outdoors. There has been very little documentation of transmission of coronavirus outdoors, even in crowded areas, she said.

Indoor places that are poorly ventilated pose the highest risks. The level of virus circulating is also a factor, and masks are known to be useful, she said.

"So we can take that knowledge and say, these are the more appropriate places where you can wear masks, where you should wear masks, where it's advisable to wear masks."

Some period of isolation 'advisable'

Cleary believes the province might get to the stage where people who test positive for COVID-19 don't have to isolate, but she doesn't think we're at that stage yet, noting the virus has "caused a lot of disease and is still evolving."

"Right now it would be prudent to continue to isolate so that it's not circulating in the community."

Isolation is required for other communicable diseases, such as tuberculosis, measles and mumps, said Cleary.

The period of isolation for COVID-19 should be the shortest possible.

"We don't want to impact people more than is necessary," she said. "But some period of isolation, I think, would be advisable for the next while until we move through this transition stage."

The province should also find ways to enable people to say home if they're positive, to reduce the circulation of the virus in the community, said Cleary.

"The best way we can protect the vulnerable is not have people walking around with disease."

Green Party Leader David Coon agrees.

He said he still can't believe the government is removing the requirement for people to isolate when they're infected.

"I mean, people going to work and going shopping when they're sick with COVID, spreading it around, doesn't make any sense, at all."

He contends the province should offer paid sick leave to enable people who "want to do the right thing, to be able to afford to do the right thing and stay home."

A large percentage of the workforce is low-wage and can't afford to miss a few days of pay, he said. 

Coon doesn't understand the decision to remove the indoor masking requirement either, particularly without any commitment from the government to improve ventilation in public spaces.

With the pending loss of the daily COVID-19 dashboard, people won't know when or where there are major outbreaks that might prompt them to don a mask either, he said.

"The same goes for schools. If you've got an outbreak in a school and it's not clear to parents if that's the case, then, you know, they're not going to ensure their children are wearing masks during the outbreak. Surely that would be the sensible thing to do."

Testing is 'fundamental'

Cleary said mandates, such as masking and distancing, are only one component of communicable disease control and as their use decreases, other basic elements should be reinforced.

That includes testing, which she described as "fundamental" for any communicable disease, but particularly for a virus that is "still novel and evolving."

Access to testing is "really important" to help diagnose people and so they have guidance about what to do if they're feeling sick, she said.

Rapid tests could continue to be used in schools, she suggested, yet it's "really important" to have them learning in-person, she said.

The use of rapid tests could also be expanded to "enable us to do things that, you know, in this current uncertain time we haven't been able to do."

Cleary cited hospital patients and long-term care residents who have had to deal without visitors as examples.

She would also like to see ongoing sentinel testing and surveillance, which could be through wastewater testing or asymptomatic testing, to determine the level of disease and spread in the community, as well as the type of virus.

The province should share those results, stressed Cleary.

"Because the more people understand about what's going on, what type of viruses are spreading, how they're spreading, where they're spreading, then the more they can make those decisions for themselves and their family about how to lower their own risk."

Surveillance ongoing, says Health Department

Department of Health spokesperson Bruce Macfarlane said the pandemic is not over, but "we are moving closer to living with COVID-19."

"As we recover as individuals, families, and communities, Public Health will continue to conduct ongoing surveillance. Monitoring will allow us to evaluate our progress, manage ongoing residual risks, and remain ready to respond to new risks like the emergence of new variants of concern," he said in an emailed statement.

"Ongoing surveillance means that Public Health will continue to test for COVID-19 including sentinel testing, and that sequencing and screening will also remain in place, so that we can continue to identify and locate COVID-19 cases in the province, and further monitor its overall presence."

Hospitals still at red alert level

The Horizon Health Network and Vitalité Health Network both remain at the red alert level, and no changes have been announced, despite the government's plans to open up.

"Visitor restrictions and [infection prevention and control] protocols such as mandatory masking remain in place in our facilities," said Horizon's vice-president of quality and patient-centred care Margaret Melanson. 

At Vitalité, no decisions have been made yet, but discussions are taking place with prevention and infection-control teams, said spokesperson Thomas Lizotte.

He expects Vitalité to announce its next steps within the next few days. 

Michael Keating, executive director of the New Brunswick Association of Nursing Homes, said he's still trying to figure out what the provincial changes mean for the industry.

It's unclear if visiting will open completely or be more gradual, with restrictions.

No decision yet on vaccine mandate

Even the government doesn't have any updates about its review of its vaccination mandate for employees, according to Treasury Board spokesperson Erika Jutras.

Last week, Higgs said employees who failed to provide proof of vaccination or a medical exemption, as mandated last fall, will remain on unpaid leave for the time being. 

As of Jan. 19, the latest figures available, 484 employees remained on indefinite leave without pay.

"There is no timeframe on this review and any decisions would be made by cabinet and the COVID cabinet committee after receiving a recommendation from Public Health," Jutras said.

The mandate applies to employees in the civil service, the education system, the health-care system and Crown corporations, as well as staff in long-term care facilities, schools and licensed early learning and child-care centres.

People's Alliance Leader Kris Austin contends it's time to rescind the policy.

"It's clear that the vaccinations certainly do provide protection against severity of disease, but it really doesn't provide much in terms of being infected, and it does very little to nothing in terms of transmission," he said. 

Coon said he'd like to see the risk assessment.

"Government has to be very careful about looking at that because it does come down to occupational health and people's safety and well-being in their workplace," Coon said.

Liberal health critic and the MLA for Edmundston-Madawaska Centre Jean-Claude D'Amours said he hopes the government will let the affected employees and the public know "sooner than later."

Asked for his opinion, he said, "it's a decision of the government and it's to them to make that decision. But hopefully, I hope that they won't wait until the last minute to announce what they will do."