Who should self-isolate? Your questions on COVID-19 in Nova Scotia, answered

• Who should be self-isolating, and how should they do it?
   
• Can someone who is self-isolating go outside?
   
• My employer is forcing me to go to work and I don't feel safe. What can I do? 
   
• I think my neighbour is going out when they shouldn't be. What can I do?
   
• Why aren't we testing more people for COVID-19?
   
• What is Nova Scotia doing to determine whether there is community spread? Is the province looking at broadening the testing criteria?
   
• What trails can I use for exercise now that all provincial, municipal, and national parks are closed? 
   
• A business in my neighbourhood is still operating. I thought it was supposed to shut down. Why is it still open?
   
• Does my business or workplace qualify for an exception to the five-person rule? 
   
• Who is an essential worker? 
   
• Does the order on maintaining six feet of separation include the people I live with? What about my partner or children?

If you have more questions not answered here, check out our other frequently asked questions

• April 1: Can someone else walk my dog? And more COVID-19 questions from Nova Scotians, answered

Q: Who should be self-isolating, and how should they do it?

On March 18, Dr. Robert Strang, Nova Scotia's chief medical officer of health, explained "physical distancing" and "self-isolation" as a series of layers. 

The first layer is physical distancing, also known as social distancing. This is something everyone needs to be doing:

• Keep two metres (six feet) between yourself and other people.
• Keep your grocery shopping or other errands to essential times only.
• Work from home if possible.

People who are social distancing can use their phones, video calling and social networking to support others who are having a difficult time. The people in the first layer must also help those who are in the next layer, which is self-isolation. 

That layer contains people who have travelled recently and must now self-isolate. They may not feel sick or have any symptoms but for everyone's safety, they must not interact with people outside their immediate household.

• They should not go grocery shopping.
• They should not take transit or taxis.
• People in self-isolation may go outside on their deck, balcony or yard, but should otherwise remain indoors.

People who live in apartment buildings or condominiums should stay in their own unit, although being on a balcony is permitted.

A deeper layer of self-isolation is close contacts of a known case. These are people who have a COVID-19 patient in their homes or have interacted closely with a known COVID-19 patient. They may not feel sick yet, but they are at high risk of becoming sick. These people need to be even more vigilant about being separated from other people.

The last layer is people who are sick. They have either gone to be tested and are waiting for the test result, or they've got the test result back and they're positive. Those people need strict home isolation.

They should not be outside their homes. They should not even be interacting with other people in their household. If possible they should not share their bedroom or bathroom. 

A person who has had COVID-19 and recovers will slowly move back into the preceding layers. Once that person is completely well, they will be able to go about their life while observing the same physical distancing as everyone else.

Q: Can someone who is self-isolating go outside?

Yes, as long as that person stays in their yard, deck or balcony. On March 18, public health officials still felt that it was safe for someone who is self-isolating to go outside for exercise if they did so alone or with members of their immediate household, but as of March 25 and going forward, that advice has become stricter.

Q: My employer is forcing me to go to work and I don't feel safe. What can I do? 

Unless your workplace is a type of business that has a specific exemption, your employer is required to provide a workplace that allows you to keep a distance of two metres (or six feet) from others. If that is not possible your employer must limit the number of people entering to five or fewer.

In addition, every person who has travelled outside the province and returns after 6 a.m. on March 23 is required to self-isolate. 

If your workplace is breaking any of these rules, it is in violation of an order by the province's medical officer of health, Dr. Strang. The health protection order signed by Dr. Strang trumps any workplace directives.

The provincial Department of Labour is advising employees to bring their concerns to their immediate supervisor. If that doesn't work, the next step is to report them to your workplace's Joint Occupational Health and Safety Committee, if one exists. If not, people can call the province's safety branch at 1-800-9LABOUR.

If you are in a unionized workplace, you may consider raising your concern with your union.

"If you have no other route, then [contact] your local Public Health Office," said Dr. Strang. "We will help you out."

Q: I think my neighbour is going out when they shouldn't be. What can I do? 

First, stay calm.

Public health leaders have stressed it is important for us to act kindly and compassionately and to recognize that we do not know our neighbour's unique circumstances.

If the person appears to be acting in an unsafe manner, the premier has suggested that you should reach out to them and offer assistance. They may be leaving their home because they feel they have no choice. In a way that feels safe to you, ask that person if you can help them with self-isolation -- for example, bring them groceries or run an important errand. 

Dr. Strang has told us is it is inappropriate to "rat" on our neighbours. 

"We don't want to approach the situation with fear," he said. "We need to approach the situation from a sense of caring for each other and a sense of community." 

Q: Why aren't we testing more people for COVID-19?

The microbiology lab at the QEII Health Centre in Halifax conducts all the tests for COVID-19 in the province. The province has attempted to balance the criteria for testing against the lab's ability to process the samples. 

As of Monday, March 23, the QEII was able to "confirm" results. That means tests no longer have to be sent to the National Microbiology Laboratory in Winnipeg for confirmation, which means people can get their results faster. 

As of Tuesday, March 24, the QEII lab was able to process 400 tests per day, and Dr. Strang said the next goal is to increase the lab's capacity to 1200 or even more. Prior to March 24, the lab could process 200 tests per day. 

Dr. Strang has emphasized that it is not practical or possible to test everyone. The "validity" of a test is at its highest when someone is showing symptoms such as fever and cough. People who don't show symptoms but are tested are at a higher risk of getting an inaccurate result, such as a false negative.  

Q: What is Nova Scotia doing to determine whether there is community spread? Is the province looking at broadening the testing criteria?

As of Tuesday, March 24, Dr. Strang said so far there has been no indication of spread in the community, and health officials are actively looking for it. 

Up until now, when someone is diagnosed with COVID-19, health officials have waited until that person's "close contacts" became unwell before testing them.

That's changing. The province will now test close contacts of COVID-19 patients right away, and the hope is that will indicate whether the disease has been spread to people who aren't yet showing symptoms. 

There are two elements in how a "close contact" is defined. One is physical distance, and one is time. In general, the closer you get to a person and the longer you stay near them, the greater the risk of transmission.

For example, if you have a family member in your home and you lived with them or cared for them while they were coughing or sneezing, you would definitely be considered a close contact.

According to the province's guidelines to health professionals, "transient interactions" like walking by a person or being briefly in the same room carries a low risk of transmission. 

The province is doing some other things to look for community spread as well.

It is starting to test individuals in hospitals who have strong COVID-like symptoms such as cough and fever, even if those people haven't necessarily travelled anywhere. 

Public health is tracking people who go to hospital emergency rooms with "flu-like" symptoms such as fever and cough. As or March 23, the province has not seen an increase in those numbers but they're watching for a spike, which would be a possible indicator of COVID-19. 

They're also looking for outbreaks of respiratory diseases in long-term care homes. So far the province has not found any unusual outbreaks. 

Q: What trails can I use for exercise now that all provincial, municipal, and national parks are closed? 

Any provincial trails not within a provincial park or beach remain open for people to get exercise. In HRM, residential pathways that connect streets, multi-use paths along streets that replace sidewalks, and some trails may be used.

People can only use trails in their neighbourhood that aren't connected to a park, or in a park.  

Other municipalities have closed some or all of their trails, and a more complete list is here. 

In general, the premier has asked Nova Scotians to stay close to home and walk for exercise, not to socialize. He suggested that if a person must drive to a location to walk, they're going too far. 

Q: A business in my neighbourhood is still operating. I thought it was supposed to shut down. Why is it still open?

As of March 23, non-essential businesses are permitted to be open but they must keep a distance of six feet between everyone inside the business.

If a business is too small to maintain six feet of space between the people inside it, it must allow no more than five customers inside at a time. 

Q: Does my business or workplace qualify for an exception to the five-person rule? 

There are some exceptions to the five-person rule. The public health order gives exceptions to businesses and organizations who can maintain physical distancing such as grocery stores, pharmacies, gas stations, convenience stores, construction sites, financial institutions and agri-food and fish plants.

All Canadian Blood Services blood collection clinics have been re-arranged to ensure safe physical distancing and are also exempt. 

The health protection order signed by Dr. Strang on March 24 also recognizes that some workplaces are exempt from the five-person rule and cannot maintain physical distance. 

Those workers who are exempt from both rules include:

• Special care homes for children and youth.
• Organizations that care for people with disabilities.
• Long-term care homes.
• Home care agencies.
• Court and correctional workers.
• Unlicensed daycares (six children or fewer, or eight school-aged children).
• Homeless shelters.
• Doctors, nurses, paramedics.
• People who service or repair medical equipment like wheelchairs.
• Food production plants.
• Fishing vessels.
• Taxis.
• Police and fire.
• Municipal utilities.
• Public transit, and a number of other types of municipal support workers.

For the complete list see the province's health protection order. 

Q: Who is an essential worker? 

The province's health protection order issued on March 23 lists certain workers who are considered "essential to the movement of people and goods." Those people won't be asked to self-isolate for 14 days if they enter the province. Provided they are not sick, they can go straight to work. 

Those people include: truck drivers, crew and maintenance workers on airplanes, trains, or transport ships, offshore workers, people who work in the agri-food and fishing industries, health care workers, medical supply business workers, child protection workers, transition house workers, critical infrastructure workers, law enforcement and corrections workers, military, Coast Guard, RCMP, police, firefighters, and paramedics. 

It is important for everyone else who enters the province for other reasons to self-isolate immediately so these people can continue to go to work without getting sick. 

Essential workers must still practice physical distancing as much as they can, and must self-isolate if they become sick. 

Q: Does the order on maintaining six feet of separation include the people I live with? What about my partner or children?

If everyone in your household is healthy, you do not have to maintain a six-foot distance from each other. But if one of you is sick and you suspect it may be COVID-19, you should take certain precautions. 

Health Canada recommends the sick person should stay in a separate room and use a separate bathroom from everyone else. The sick person should keep at least six feet apart from everyone else, and should wear a mask when interacting with others. The sick person should avoid touching pets so the pets don't carry the virus from person to person. 

The sick person should wash their hands often, clean and disinfect any surfaces or objects they touch often, and don't share objects such as towels, dishes, bed linens, or electronic devices.