IQALUIT — It has been just over two weeks since Nunavut declared its first case of COVID-19, but it’s still unknown how 109 people were infected so quickly in the territory.
Nunavut is home to about 39,000 people. Its 25 fly-in only communities are spread over three time zones.
Arviat, on the western shore of Hudson Bay where about 2,800 people live, had 80 cases as of Saturday. Dr. Michael Patterson, the territory’s chief public health officer, says it’s the only place where there’s evidence of transmission from household to household within the community.
There are also 13 cases in nearby Rankin Inlet, 14 in Whale Cove and two in Sanikiluaq, although the territory reported on Saturday the Sanikiluaq cases had recovered. But those cases are all within the same households.
John Main, who represents Arviat-North and Whale Cove in Nunavut’s legislative assembly, says it’s “hard to see” how housing issues wouldn’t have contributed in some way to COVID-19’s rapid spread.
“It’s no secret that we’re in a housing crisis. We’ve had issues around housing for many, many years … Things like multiple generations of families living in one unit, people sleeping in areas that are not meant to be bedrooms,” Main says.
But Main says it’s not just housing that makes Nunavut more vulnerable to COVID-19. Food insecurity, a high unemployment rate and low educational attainment levels are all contributing factors, he says.
“We know that there’s all these things that are working against us, these things we have to battle alongside COVID now.”
Nunavut Housing Corp. figures show 56 per cent of Nunavut Inuit live in overcrowded homes. A recent report on Nunavut’s infrastructure gap from Nunavut Tunngavik Inc. also notes 41 per cent of homes need major repairs.
Cynthia Carr, an epidemiologist and health policy expert based in Winnipeg, says with a long incubation period, usually four to six days, it’s easy for an asymptomatic person to spread the virus without knowing they’re infected.
“All it takes is one case to get in,” she says. “When you’ve got many people close together within a building, that’s exactly the risk factors for spread.”
Last week, Nunavut ordered a territory-wide two-week lockdown to control the spread. Carr says looking at other countries, it usually takes 18 or 19 days to see the effects of a lockdown.
“It will be interesting to see if it’s different for Nunavut,” she says.
The territory’s only hospital, Qikiqtani General Hospital in Iqaluit, is more than 1,200 kilometres from Arviat. It has 25 beds, but no intensive care unit. Rankin Inlet has a health centre with six beds.
Patterson says if someone needs to be hospitalized because of COVID-19, they would be brought to Rankin Inlet or transferred to the South.
“If anybody is in a situation where they need ongoing fluid, oxygen, or life support, they obviously can’t stay in a health centre and will need to go to a southern hospital,” Patterson says.
Typically, Nunavummiut who need medical care not available in the territory are flown to Edmonton, Winnipeg or Ottawa. But with cases rising in Southern Canada and hospitals in Manitoba reaching full capacity, Patterson says his team is looking at other options.
Last week, Patterson said the territory’s capacity to respond to its COVID-19 outbreak is “stretched” and the federal government is ready to step in if necessary.
Main says although cases in Arviat continue to rise, he’s confident Nunavummiut will “get through this,” as they’ve done before.
“Elders have been sharing their life lessons putting things in context, the younger generations need to keep this in mind,” Main says.
“Hardship is not a new thing and it’s not something that will beat us.”
This report by The Canadian Press was first published Nov. 21, 2020.
This story was produced with the financial assistance of the Facebook and Canadian Press News Fellowship
Emma Tranter, The Canadian Press
The 1976 U.S. swine flu vaccinations may offer lessons for the COVID-19 pandemic – CBC.ca
For Pascal Imperato, a communicable disease epidemiologist who in 1976 was in charge of immunizing New York City against a potential swine flu epidemic, the effort to vaccinate the population against COVID-19 feels like a familiar challenge.
“We were going to vaccinate six million people in six weeks,” he said in a phone interview. “And we were absolutely certain we could pull it off. And we would have.”
Would have, because, ultimately, the largest national immunization program that had ever been undertaken in the U.S. was cut short as the epidemic never materialized, and public skepticism about the program began to mount.
Still, while the COVID-19 pandemic is very real, and the population is much larger, the vaccination program of 1976 may offer some lessons as governments around the world prepare to inoculate the public at large.
“If the program is well organized, mobilizing all of the resources that are capable of administering this vaccine, there [shouldn’t] be any problem whatsoever,” Imperato said.
In March 1976, the administration of then president Gerald Ford launched a $137 million US nation-wide vaccination program to immunize every American citizen by the end of the year.
The diagnosis of swine flu on a New Jersey army base had led to panic among top U.S. scientists and officials who feared the disease could spread and potentially precipitate a health crisis similar to the deadly Spanish flu outbreak of 1918.
Even though it was cut short, by December 1976 more than 40 million Americans — about one-fifth of the population — had been vaccinated, and about 650,000 in New York City.
Utilizing volunteers, setting up sites
Imperato said that on any given day they had about 900 people who were involved in getting the vaccine out to the general public. That included 500 to 600 volunteers who were recruited each day through the city’s chapter of the American Red Cross.
University graduates, sanitary inspectors and public health nursing assistants were also hired and trained to use automatic jet injectors and to give cardiopulmonary resuscitation.
Sixty vaccination sites were established in places that included schools and police precincts.
“Anywhere we could,” said Imperato, who is the founding dean and distinguished service professor at SUNY Downstate Medical Center School of Public Health.
As well, 15 mobile teams were created to vaccinate over 40,000 people in more than 200 nursing homes and about 100,000 people in 150 senior citizen centres.
“This required military organization, if you will, and we were able to put together a team and put into place the people that we needed to bring this about,” he said.
A great deal of administrative and clerical support goes into a program of this kind, he said.
“We have to have people register. We had to have as much information about them as possible, because we needed to know who we were vaccinating and if any of them had any reaction. We had to have teams of people checking on adverse events.”
Local capacity can be the ‘weak link’
Nationwide, however, there were some logistical problems, said Harvey Fineberg, a physician who was tasked with co-authoring a review into the 1976 Swine flu vaccine program.
The actual immunizations were quite erratic in their frequency in different communities, he said.
“So a lesson that’s still relevant today, whether in different provinces in Canada or different states and counties and the U.S., is the local capacity,” he said.
“That last mile, getting the immunization into the arms of the recipients, that’s the weak link in the chain.”
What made the difference was the degree of organization and capacity of the public health departments in each community to plan and administer the vaccine, Fineberg said.
“So it wasn’t that it was only cities or only rural, rich or poor, it boiled down to ability to deliver.”
WATCH | Experts discuss strategies for Canada’s COVID-19 vaccine rollout
Dealing with ‘coincident events’
But one of the more significant problems of the program was the poor job officials did in communicating to the public when headlines emerged linking potential adverse effects to the vaccine, experts say.
“There are definitely — and this is going to be true this coming year — there will be coincident events,” Fineberg said.
“Preparing the public for expected coincidences simply because stuff happens every day, that’s really, really key,” he said.
During the 1967 vaccination program, three elderly people in Pittsburgh had heart attacks after receiving their vaccine. The publicity and headlines it generated led to a handful of states suspending their vaccination programs while they investigated a potential association, said George Dehner, an associate professor of history at Witchita State Univeristy and authour of Influenza: A Century of Science and Public Health.
While no link to the vaccination was found, polls at the time showed a significant decrease in the number of people who said they would get the vaccine because they feared some adverse effect, Dehner said.
There will be a certain expected death rate of people of a certain age on any given day, Pascal said. And what one has to look at is the death rate above the expected rate when running an immunization program.
“And so the CDC in this particular case did not do a good job of anticipating that and explaining that,” Dehner said.
But the vaccination rollout also saw dozens of people come down with the rare neurological disorder Guillain-Barre syndrome at a much higher rate than would be expected. Unlike the heart attacks, where no link was found, a scientific review has found there was an increased risk of Guillain-Barre syndrome after the swine flu vaccinations, according to the CDC. The exact reason for this link remains unknown.
In a 2009 interview with the The Bulletin, the health journal of the World Health Organization, Fineberg said those cases wouldn’t have been “a blip on the screen had there been a pandemic but, in the absence of any swine flu disease, these rare events were sufficient to end the programme.”
Focus on science, not politics
When Guillain-Barre syndrome increased, some members of the public “became very skeptical and saw the whole thing as politically based, and not science-based,” said Richard Wenzel, emeritus chairman and professor of the Department of Internal Medicine at Virginia Commonwealth University.
“There was a concern that maybe politics was driving some public health responses.”
“One of the things that I would say we’re still trying to learn is policy should be scientifically based. What I mean is that whoever gives the message has to say, ‘Here’s what we know, here’s what we don’t know. And here are the assumptions we’re making currently that guide our policy.
“That sounds simple, but it’s rarely done, even today.”
Dozens infected after BC hockey team brings COVID-19 back from Alberta | Offside – Daily Hive
A recent trip to Alberta had unintended consequences for an adult hockey team from British Columbia.
BC Provincial Health Officer Dr. Bonnie Henry highlighted what she called “another cautionary tale” during her media briefing today, as the province reported another 834 new COVID-19 cases. Alberta, by contrast, reported more than double that number today.
“We know that there are sports teams in BC that have travelled to other provinces despite the restrictions that we’ve put in place,” said Henry.
“There’s a hockey team in the interior that travelled to Alberta and has come back and now there are dozens of people who are infected, and it has spread in the community,” said Dr. Henry. “We need to stop right now to protect our communities and our families, and our health care workers. This is avoidable and these are the measures that we need to take.”
While adult hockey was allowed to continue, this team was in clear defiance of the provincial health order, which bans “travel for teams outside of their community.” Dr. Henry said the players who contracted the virus in Alberta have since spread it to their family members, workplaces, and community upon return to BC.
“Making an exception for yourself, or for your team, or for your recreational needs puts a crack in our wall and we see that this virus can exploit that very easily,” she said.
While adult hockey was allowed in the most recent health order, it appears that will be changing very soon.
“We are putting additional restrictions on adult team sports indoors as we are recognizing that these are indeed higher risk activities as well. What we will be focusing on is structured programs or sport for children and youth, recognizing how important those are for our young people.”
Dr. Henry said there have been “several incidents that are similar to this,” and as such, she didn’t want to give away which specific region they came from or where they travelled to.
“I’m asking in the strongest of terms, to stay put,” she said. “To stay in our communities and to protect our communities.”
Origin of Revelstoke cluster unknown, but some visitors did test positive for COVID-19 – BC News – Castanet.net
Interior Health has not been able to identify how a large cluster of COVID-19 cases were introduced to the community of Revelstoke, however, the region’s chief medical health officer admits some non-residents have tested positive for the virus.
During a Zoom press conference Wednesday afternoon, Dr. Albert de Villiers said a “patient zero” has not been identified, despite Premier John Horgan stating earlier in the day that the cluster was caused by people travelling for recreation.
“What we can say with the numbers that we have seen that, yes, there are some people that are not residents in Revelstoke that sadly are infected as well,” said Dr. de Villiers.
“But having said that, we have also seen there is no one specific incident that led to the bigger number of cases. There are some that have been household clusters, some people picked it up when they went to a worksite, some people may have gone to a private function. There are rumours out there we haven’t been able to substantiate that someone went to a hot spring somewhere.
“I think there are different pieces of this. It’s not just one person that travelled in and caused all of this, I don’t think it’s as simple as that.”
Dr. de Villiers says people travelling in from other communities has been a factor in cases in other communities, which is why, he says, part of the provincial recommendations are for people not to travel outside their community if they don’t absolutely have to.
“Sadly, skiing is not essential to most people,” he said. “For recreation purposes, try to stick to your own community and stick to your own ski hill.”
Dr. de Villiers also addressed an online post out of Revelstoke where an individual asked to be infected with the virus so he could become immune.
He says they’ve seen it before with chicken pox and the measles, but it’s a bad idea with COVID-19 because people don’t know how they’ll react.
“Most people will have a relatively mild form of the disease…but there are people, relatively healthy people, that can develop complications. We’ve had people throughout Canada of all ages that have passed away,” he said.
“I don’t think we want to put people at risk unnecessarily.”
The doctor also explained why it took two weeks for IH to publicly disclose the cluster in Revelstoke.
He says over a two-week period there were only 10 cases, one every day or second day, which isn’t abnormal within communities.
“But, all of a sudden in one day, there were 12 more cases,” he said. “That’s why when we did announce it, it was 22, because there was one day that had more than usual.”
He said they do expect cases to pop up in communities, but the large one-day jump was reason to believe there may have been an issue.
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