How Nunavut's COVID-19 outbreak is highlighting long-standing health inequities in Canada's North

As the number of COVID-19 cases continues to climb in Nunavut, the territory's finite health resources are being tested.

Chief Public Health Officer Dr. Michael Patterson said in a press conference on Wednesday that Nunavut is reaching its limit in terms of what it can handle. Three contact-tracing teams are racing to reach out to people in the four communities which have cases of the virus: Arviat, Rankin Inlet, Whale Cove and Sanikiluaq. 

"If there are more cases, our ability to manage it is going to depend a lot on the size of the outbreak, the size of the community and how much work is needed to get it under control," Patterson said. 

The outbreak is highlighting long-standing health disparities in Canada's north. 

None of the Nunavut communities with COVID-19 infections have a hospital. The only hospital in the territory, in Iqaluit, is more than 1,000 kilometres east of Arviat — the community with the most infections — and Iqaluit's hospital doesn't have an intensive care unit. 

So, just like in medical situations unrelated to COVID-19, Nunavummiut who get seriously ill will need to be flown south — hundreds of kilometres from home — for specialized care. 

It's a problem that Barry Pakes, an assistant professor at the University of Toronto's Dalla Lana School of Public Health, is familiar with.

"The thing that everyone is worried about is the fact that medical infrastructure to care for people who are severely ill is really quite limited in some places."

Pakes was Nunavut's deputy chief medical health officer in 2016 and 2017. At that point, he saw how crowded, poorly ventilated housing led to tuberculosis and whooping cough outbreaks. Those same conditions can put small northern communities at risk of the new coronavirus. 

These are challenges that those in the North or in many remote communities elsewhere in Canada face.- Barry Pakes, Dalla Lana School of Public Health

But Pakes also said those issues give Nunavut doctors and bureaucrats the related skills and experience to handle this outbreak.

"It's not like this is coming out of the blue, or that these challenges are challenges only with COVID-19," he said. "These are challenges that those in the North or in many remote communities elsewhere in Canada face ... This is just that much more urgent."

Pakes said it may be hard to make sure Nunavut patients get the care they need quickly if their well-being quickly goes downhill, because patients have to travel south for intensive care or other specialized techniques.

"Sometimes arranging for that to happen and that happening quickly can be a barrier to getting the proper treatment on time," said Pakes. "Hopefully ... those kind of unfortunate circumstances won't happen."

Reliance on provinces a challenge

Epidemiologist Cynthia Carr, who is based in Winnipeg, says the rise of COVID-19 cases in the South may also strain Nunavut's health-care system.

"The challenge for a territory like Nunavut relying on other provinces for care is not just the transportation ... but who is in a position to accept those patients at this time," she said. "In Winnipeg, we are in a very serious situation ourselves, with our hospital capacity at kind of a very high threshold."

Nunavut has entered a territory-wide lockdown in an effort to get a handle on the outbreak and avoid overwhelming Nunavut's small, isolated health-care centres. The lockdown is expected to last two weeks.

Carr says there are examples around the world that show a two-week lockdown will likely not be long enough to curb the spread of the virus.

"One incubation period doesn't typically do it," she said. "Unfortunately, there needs to be sort of another one after that, because remember, the cases we're seeing today, those are related to behaviours, an opportunity where the virus could be three days ago, five days ago, and more so there could be more cases coming." 

So far, Nunavut has not asked for help from the federal government. But Nunavut Health Minister Lorne Kusugak says the territory is in constant communication with Ottawa, and the federal government is able to send the military as a last resort.

Health officials say things are still likely to get worse before they get better.