Atlantic chief medical officers discuss future of COVID-19 restrictions in online panel

The Atlantic provinces should consider taking a more targeted approach in their COVID-19 restrictions to minimize the "unintended consequences" on the economy and public health, according to some regional chief medical officers.

With a surge in COVID-19 cases outside the Atlantic bubble, the four senior health officials from each of the Atlantic provinces cautioned the public in an online discussion Thursday night to remain "vigilant" in order to ward off a potential second wave on the East Coast. 

But a broad shutdown should be avoided if possible, said Dr. Robert Strang, Nova Scotia's chief medical officer of health.

"Now that we know much more about how the virus is spread, what are the types of restrictions needed? And what are the ones that aren't so necessary?" Strang said during the panel discussion on lessons from the pandemic hosted by Dalhousie University.

"If we do have to strengthen our public health measures again, our goal is to do that based on a good, local epidemiology and, if at all possible, avoid a broad shutdown."

He said that could mean a more "focused and targeted response" for a particular geographic area, a certain subpopulation or specific settings with a greater risk of spreading the virus.

"We have to learn to live with COVID-19," he said. "We could never sustain the lockdown in the spring. We tolerate a certain level of transmission. We have to tolerate a certain level of risk from COVID, and it's all about finding the balance.

"What is the necessary balance of COVID control, but also the right balance that allows us to minimize the harms from all the other consequences that happen if we have too strong restrictions."

Dr. Janice Fitzgerald of Newfoundland and Labrador also said more attention should be given to the "unintended consequences" of the emergency restrictions and a more "refined approach" should be employed when reviewing them. 

In addition to the economic downturn, she said the measures have had a negative impact on mental health — particularly in long-term care homes — and the reorganization of the health-care system, which has led to backlogs in testing, treatment and procedures and the deployment of government resources and personnel to manage the COVID-19 crisis. 

The future of the bubble

The four senior health officials from each of the Atlantic provinces explained in an online discussion Thursday night how the region successfully dealt with the first wave of the pandemic and what the public should expect in the months ahead. 

According to Dr. Jennifer Russell, New Brunswick's chief medical officer of health, the public should know officials are "not in a hurry" to relax border restrictions and, if needed, will strengthen public health measures. 

"We have a huge vested interest in continuing the down path we have been on so far in terms successfully avoiding big outbreaks and a surge right now," Russell said.

"As the numbers increase in the areas around us, it becomes more and more difficult.

"I don't think we'll be able to avoid the wave entirely, but, my goodness, we really, really have to manage it aggressively if and when we do have an outbreak." 

Russell said the province has previously acted quickly to curb the risk of a large outbreak. New Brunswick recently hauled back travel exemptions for two Quebec counties bordering the northern part of the province, and tightened restrictions on the Campbellton health region during a summer outbreak that led to more than 40 cases and the province's only two deaths.

Knowing the health-care system's capacity, Russell said a surge comparable to other Canadian hotspots would devastate the system and provincial economy.  

"If one of the Atlantic provinces has an outbreak, we'll be looking at re-establishing the border measures in between the Atlantic provinces, which we don't want to do, either," she said. "So, there's a collective need to keep the Atlantic bubble as protected from outbreaks … because our resources are so limited."

'Good health is good economics'

Strang struck a similar tone.

"We may not need to strengthen things just yet, but we certainly need to be very vigilant about keeping things at the level of the restrictions on gatherings, especially social kind of events, as well as having everybody, as much as possible, doing their own personal protective measures," he said.

""That's how we keep ourselves in this safe space."

Strang noted that would be a concern for those keen to see a full economic recovery sooner than later, but he said, stealing a line from Nova Scotia deputy minister of business Bernie Miller, "good health is good economics."

"If we stay tightly restrictive and get through the next six to nine months," he said, "we're in a position to actually be in an economic recovery much sooner than many other jurisdictions who have been overwhelmed."

Keeping the trust

Each doctor emphasized the importance of earning the public trust and acceptance of public health and emergency measures since the March shutdowns. 

"They are changing messages, they are difficult messages and to try to communicate that has been really key and being honest and earning the trust that goes with that," said Dr. Heather Morrison of Prince Edward Island.

Fitzgerald lauded provincial decision-makers as well in often deferring to public health experts.

"It's given us a consistency in our messaging, which has been really important, and it has assured us that, for the most part, our decisions are being made on evidence and science," Fitzgerald said.

"I think that's really important for ensuring that we continue asking the people for their trust and they continue giving it to us."