Long a pandemic leader, Nova Scotia is now a COVID-19 hot spot

Nova Scotia's past success at managing the COVID-19 pandemic is also one of the reasons why its daily case counts have never been worse, say two infectious disease experts.

The province has long been lauded for its handling of the pandemic, but daily case counts from the highly transmissible Omicron and BA.2 variants have been rising since late February. They have accelerated dramatically since the Nova Scotia government lifted most public health restrictions on March 21, including gathering limits and mandatory masking in most public places.

"The fact that it continues to go up and the percentage of people that are positive in that group means that there's really a lot of virus out there," said Dr. Lisa Barrett, an infectious diseases doctor and researcher at Dalhousie University in Halifax.

Last Thursday, the most recent COVID-19 weekly reporting date, the province announced an average of almost 1,000 new daily cases, an all-time high since the pandemic began.

Barrett said the lack of mandatory masking rules in most settings combined with a large swath of the population without a previous COVID-19 infection has made Nova Scotia especially vulnerable.

"All those people who hadn't really been exposed before are getting infected, pretty much all at once, which was really what we wanted to avoid," said Barrett.

As well, despite high two-dose vaccination rates in Nova Scotia, booster uptake hasn't been as strong, said Barrett. Among Nova Scotians over the age of 18, only 63.9 per cent have had a booster dose, according to the provincial COVID-19 dashboard.

Officials in Nova Scotia have stressed that the emphasis should be on COVID-19 hospitalizations, not case numbers. But experts point out that as infections rise, hospitalizations are sure to follow. 

"The problem is that by the time they're going up, it's too late," said Tara Moriarty, an associate professor and infectious diseases researcher at the University of Toronto.

While the official new daily case count for Nova Scotia was around 1,000 as of last Thursday, Moriarty believes it's more in the neighbourhood of 10 times that. She's developed a public spreadsheet that uses modelling to provide a more accurate picture of the COVID-19 situation in Canada.

"Since we've really started testing a lot less, I and others have been trying to develop methods that give us a sense of how many infections are actually occurring on a daily basis and how many hospitalizations, for example, ICU admissions and deaths we might expect from those," said Moriarty.

She said data reporting is poor across the country, so it's difficult for people to accurately assess what the risk levels are of contracting COVID-19.

"It's really quite serious," she said. "And a lot of Atlantic Canada has been far worse off over the last month than most other provinces."

That could extend to North America.

The New York Times tracks COVID-19 case counts for Canada and the U.S., and makes per-capita calculations. According to its figures, Nova Scotia has one of North America's highest per-capita daily case counts at 108 cases per 100,000 people.

The U.S. state with the most cases per capita is Alaska, at 28 per 100,000 people. Quebec has the same rate of 28 cases per 100,000 people, according to The Times.  

Barrett believes Nova Scotia's numbers are higher than parts of the United States and Canada because of the amount of testing it is doing.

"No. 1, we're looking," she said. "And No. 2, we give out a lot of rapid tests and we can confirm those and have people report them."

No plans to reintroduce restrictions

Amid spiking case counts, officials have said they don't plan to reintroduce restrictions.

"I know a lot of people want to hit the panic button [but] I'm not anywhere near that button," Premier Tim Houston said on April 5.

The premier said he continues to work with public health officials to monitor the situation.

"I believe Nova Scotians have the tools they need to keep themselves safe," he said. "I do not believe that it's necessary for the government to put mandates in place today, based on the information we have today."

Moriarty is concerned people aren't getting the right message, believing that because restrictions are no longer mandatory, those precautions are no longer needed.

"They didn't have as many people infected in January and early February, so there was more of the population that was vulnerable to be infected once those measures were relaxed," she said.

To help increase understanding surrounding COVID-19 and break down disinformation, she regularly hosts public Zoom sessions that anyone can join.

Barrett is encouraging people to get their COVID-19 booster shots, as well as follow the steps Nova Scotia used to great success earlier in the pandemic, which includes wearing masks and limiting social contacts.

"If it's not legislated or mandated, then we're just going to have to, I think, for the next seven, eight weeks, pick up the slack and do it ourselves," she said.

'We shouldn't need mandates'

Without restrictions, the province is encouraging people to do what they were required to earlier in the pandemic.

"We still need to do what we can to contain the spread of COVID-19 and protect the people around us," the province said in a statement to CBC News.

"We need to get vaccinated. We need to stay home when we're sick. Wear a mask in indoor public places. Keep our social circles small and consistent. And use rapid tests. The pandemic isn't over — and we shouldn't need mandates to tell us how to do the right thing."