Aggressive testing and isolation rules frustrate Yellowknife families caught in school outbreak

Renee Sanderson's oldest son needs more support than most children. He's nine years old and on the autism spectrum. Changes in routine can lead to changes in mood, aggression and irritability.

So when Sanderson was told that an outbreak at her children's Yellowknife school would keep the family confined to their property for 14 days, and away from her son's usual supports, she knew it would be a challenge — but one she thought her family could handle.

"Once the initial shock wore off, it was like, we're here for 14 days, we can do this. We've got this," she told CBC.

But Sanderson didn't spend just 14 days in isolation. Because of strict new rules on isolation introduced by the Office of the Chief Public Health Officer (OCPHO) in the wake of the Yellowknife outbreak, the family spent 24 full days before they were allowed to leave their home.

Several families have gone public with frustrations with OCPHO's policies, which required children to undergo multiple rounds of invasive testing or be confined to their property.

Despite millions invested in the territory's COVID-19 response, families like Sanderson's couldn't get simple answers or accommodations from public health officials.

"Not once did they offer any other solution," she said. "The emails I sent to them went unanswered. We were just left in the dark."

'I couldn't push it anymore'

Following an outbreak of COVID-19 at Yellowknife's N.J. Macpherson school, families needed to be tested to leave isolation.

Sanderson was initially game, but when she brought her nine-year-old to Yellowknife's testing site, she quickly realized it would not be easy.

"When they pulled the swab out, he just backed into a corner and he wouldn't let us near him," she said. "That's when I was like, 'OK. We got to stop. I can't keep traumatizing him like this.'"

Over the next five days, Sanderson sought an exemption for her family to leave their home, without her nine-year-old getting a test, but the OCPHO hadn't replied.

The rest of her family already tested negative for COVID-19, twice. She had also secured a letter from her school's principal requesting an exemption.

"We are on day 17 of isolation. This is causing havoc on our family," she wrote in an email to OCPHO.

In response, Dr. Andy Delli Pizzi, the deputy chief public health officer, suggested if all other household members took a third test and had negative results, they could leave isolation.

When they contacted Yellowknife Public Health about the exemption, staff insisted, again, on testing her nine-year-old son.

We are on day 17 of isolation. This is causing havoc on our family.- Renee Sanderson in email to the OCPHO

"If you would like I can come to your house and perform a throat swab on your child; maybe doing this in his own environment would work," a public health nurse replied via email.

"Both my husband and I tried to … do the testing on him," Sanderson said. "But again, as soon as he knew what was up … it was just a meltdown and a fight. And I had to stop there. I couldn't push it anymore."

Without a test, the family was required to isolate for a full 24 days.

"It's frustrating because he doesn't have any of the supports … that he needs. Everything is pretty much left up to us," said Sanderson. 

"We had to up his medication because of the increased meltdowns, the aggression, the anxiety," she said. "We now have holes in our walls and our doors, because of the 24 days we had to stay in here."

Other families criticize testing regime

Sanderson is not alone in her frustrations with the OCPHO's strict new isolation rules.

Around the same time Sanderson was in isolation, another N.J. Macpherson parent, Charlene Chapple, posted to Facebook about her own family's experience.

"We were forced to get our entire family tested on Wednesday," she wrote May 15, "even our seven-month-old baby."

"We were told if we did not test everyone in our family that we would be 'escorted by RCMP to a hotel to isolate until sometime in June,'" she wrote.

When her daughter's test returned a false positive because of a lab error the family learned they needed to be tested three more times before they could leave isolation.

Chapple did not respond to requests for an interview, and her account could not be independently verified.

Dr. Kami Kandola, the chief public health officer, was not available for an interview for this story. But Delli Pizzi, her deputy, confirmed infants had been tested multiple times in an effort to contain the outbreak.

OCPHO responds

Delli Pizzi apologized for the often confused messaging families received over the course of the outbreak, but maintained that multiple rounds of testing were "an important safety check."

A first test allows health officials to contact trace positive cases, while subsequent tests allow them to measure spread within households. A third test determines whether someone is clear to leave isolation.

Negative tests do not confirm if a person does not have COVID-19, he said, because "the sensitivity of those tests are not perfect."

We do apologize.... We realized that it really did confuse people.- Dr. Andy Delli Pizzi, deputy chief public health officer of the N.W.T.

He acknowledged that repeated testing can be difficult for some children, but said officials "hope that these tests are not too invasive."

Most tests in the N.W.T. are performed by inserting a long swab into the nose to reach the back of the throat. The process can feel unpleasant and scary for younger children.

But less invasive forms, like a "swish-and-spit" test used in B.C., are not available in the N.W.T. because of the territory's reliance on Alberta labs that can't process these results, he said.

In instances like Sanderson's, where one child was reluctant to be tested, he said public health worked with families to find "an individual solution."

But the policy sent to parents stated clearly that leaving any household member untested would mean a mandatory 24-day quarantine — a full 14-day incubation period, followed by a further 10-day period when a person could be infectious.

"It's really safest if we … presume that they actually develop COVID[-19]," he said.

Public health experts weigh in

Colleen Davison, a professor of public health sciences at Queen's University, said policies like these illustrate the problem of "insufficient evidence" around many COVID-19 control measures.

"When we're talking about policy decisions, we love for them to be evidence-based," she said. "Unfortunately, the evidence for COVID-19-related things is [evolving] day-to-day."

Davison said, ultimately, public health officials must balance "the social and emotional aspects of our lives and the medical … risk."

For some observers, that balance may have tilted too far toward containment — avoiding the emergence of any new cases of COVID-19.

Our medical officers of health everywhere are finding themselves ... damned if they do and damned if they don't.- Cindy Jardine, professor of health risk communication, University of Alberta

"In some cases, the measures are being used in a way as if the goal is total elimination of the virus," said Cara Zwibel, director of the Fundamental Freedoms Program at the Canadian Civil Liberties Association.

"The reality is that it just may not be achievable, or the price of achieving that may be too great."

For others, the backlash to these measures is an example of the "paradox of precaution," where proactive responses prevent the kinds of worst-case scenarios that drum up public support for harsher measures.

"I think our medical officers of health everywhere are finding themselves … damned if they do and damned if they don't," said Cindy Jardine, a professor of health risk communication at the University of Alberta.

"If they don't put severe enough restrictions in place and this disease gets out of control, then they shoulder the sole responsibility."

But equally, Jardine said, health communicators across the country are "not explaining the evidentiary basis for the decisions being made sufficiently for people to understand why they're being asked to do it."

One-in-fifty chance of spread 'far too high': CPHO

In an interview, Delli Pizzi justified the harsher response by saying the one-in-fifty chance that a person could introduce COVID-19 to the wider community — roughly the chance a vaccinated person could still carry COVID-19 — is still "far too high."

One in a few thousand, or one in 10,000 would seem "safe and acceptable," he said. 

Nearly a month after the outbreak, roughly 30 households are still confined in isolation. 

Delli Pizzi said to "mitigate … harms" caused by isolation, his office told families by letter that they can leave their house for short periods, as long as they do not interact with others.

For now, he says the territory is still in "containment mode," which means harsher responses like these will still be the norm.

He said he's mindful of the impact extended isolation is having on many families.

"[Their] selflessness and sacrifice … is protecting the rest of the community and the territory," he said.

For Sanderson, that's just not good enough.

"We need change. We need better," she said. "Our kids deserve better."