To avoid 'pandemic fatigue,' N.L. needs to change how it manages COVID-19
COVID-19 is almost certain to reappear in province
On June 8, Newfoundland and Labrador entered Alert Level 3, after 28 days at Alert Level 4. The four-week wait was two full incubation cycles of the novel coronavirus, which typically manifests symptoms five to 14 days after infection.
During that time there was just one travel-related case of COVID-19, traceable to a returning resident.
This week, Chief Medical Officer of Health Dr. Janice Fitzgerald announced the province will move to Alert Level 2 ahead of schedule on June 25, if "all continues to go well."
Historically speaking, pandemics come to an end in one of two ways. The first end is medical: incidents of infection decline because a vaccine or natural herd immunity is achieved. Environmental factors may help by making the disease less contagious.
The other end is pandemic fatigue: people become less fearful of the disease. They look for a new normal as the disease runs its course. As fatigue sets in, the social licence or "buy in" for restrictive measures diminishes.
Newfoundland and Labrador is lifting restrictions much more slowly than other provinces that have similarly contained COVID-19. For example, Newfoundland and Labrador's reopening lags behind Manitoba's by more than three weeks.
Manitoba has COVID-19 cases in the single digits, and moved to its Phase 2 on June 1. Bars opened with reduced occupancy. Gyms and yoga studios opened with sensible guidelines. On June 21, Manitoba enters its Phase 3 and will relax restrictions even further. People will also be able to visit Manitoba without a mandatory 14 days of self-isolation.
Good evidence is scarcer than we'd like
Premier Dwight Ball worries that "we have seen what can happen when you reopen or lift restrictions too fast." He is concerned that reopenings in British Columbia and Ontario resulted in increased coronavirus cases.
Consider British Columbia. In the seven days from June 6-12, the province reported 81 new cases. Factoring for population size, this would be equivalent to having eight new coronavirus cases in Newfoundland and Labrador. What is the scientific evidence that eight new cases per week is moving too fast?
Ball claims that decisions are being "based on the evidence and based on the science." This simply cannot be the case without considerable qualification.
Scientific consensus remains tentative around the coronavirus and good evidence is scarcer than anyone might like. Evidence strongly suggests that SARS-CoV-2 — the virus that causes COVID-19 — transmits mainly by heavier droplets, but aerosol transmission is not wholly ruled out. The extent to which COVID-19 is infectious when it is asymptomatic rather than presymptomatic is still not clear. COVID-19 might be more a disease of the vascular system than a disease of the lungs.
Scientific uncertainties are expected. But it also means political decisions cannot be flowing directly from available scientific evidence. The extra-scientific reasons for decisions are not being well communicated.
The government has indicated that it would move back to alert levels 4 or 5 should COVID-19 resurge. No clear criteria have been offered about how the alert level will change in response to either a slow trickle of new cases or a "super-spreader" event.
Nor has clear information been provided about how the province will handle testing when new cases arise. The latest scientific evidence suggests that the common PCR test for COVID-19 may have a false negative rate approaching 20 per cent.
A plan for repeat testing to offset this problem has not been tabled. The government has also declined to specify the conditions for ending the public health emergency.
The poor communication of reasons and criteria in Newfoundland and Labrador's pandemic briefings is in stark contrast with the example of Manitoba.
Just before entering Phase 2, the Manitoba government reached out to citizens in an online "town hall." The meeting welcomed feedback on policies and answered questions. It was more than an hour long and was attended by more than 52,000 people. Manitoba also regularly asks for and gets public feedback via online surveys. The Manitoba government may understand what the Newfoundland and Labrador government does not.
What's the plan?
As the immediate threat of COVID-19 has been contained in Newfoundland and Labrador, it becomes more difficult to maintain broad public support for restrictions.
That we are moving to a "new normal" is jarringly at odds with remaining in a state of emergency. Pandemic fatigue looms. Reducing it requires communicating where scientific evidence ends and political decision-making begins. Increasing public engagement in this way may also lead to a more robust pandemic response.
Reacting to public concerns, Doug Ford's Ontario government moved to a regional rather than provincewide approach to COVID-19 outbreaks. Newfoundland and Labrador's system of alert levels remains provincewide. If there were a serious outbreak in St. John's, it would make little sense to impose restrictions on, say, Corner Brook. Shutting down Happy Valley-Goose Bay would seem even harder to justify.
A lack of attention to input from opposition leaders means that the needs of specific groups tend to be underheard and overlooked. On May 22, NDP Leader Alison Coffin wrote an open letter to Status of Women Minister Carol Anne Haley. The letter highlights the government's sluggish response to the disproportionate effects the pandemic has had on women. The letter has received no reply.
Newfoundland and Labrador has no plan in place to give those over 60 years old special access to services and amenities so that they do not incur undue risks. In Quebec, the province hardest hit by COVID-19, available evidence suggests that a shocking 97 per cent of the deaths were among those over 60. This is a social and political concern that extends beyond long-term-care homes.
COVID-19 is almost certain to reappear in Newfoundland and Labrador. There has been no pandemic in human history that has not had a second wave.
Shutting down society and the economy is no one's idea of a well-planned pandemic response. The shutdown just bought time — at considerable social and economic expense.
When new cases do appear, there will be no excuse for lacking a prepared and proportional response.
Without stronger communication of political decisions and the collaborative formation of political aims, the government runs the risk of escalating pandemic fatigue.
That also risks undercutting the social licence required for the effective management of inevitable future outbreaks.
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