At midnight on Feb. 12, Newfoundland and Labrador returned to Alert Level 5 in response to a sudden surge in COVID-19 cases with the B117 variant, which was first reported in the U.K.
Earlier, on Feb. 10, Chief Medical Officer of Health Dr. Janice Fitzgerald acknowledged that the sharp uptick in case numbers suggested the virus had been spreading in the community undetected for some time.
As unfortunate as the situtation is, Fitzgerald’s quick, sharp response was merited, given the number of positive cases and evidence of community spread. More concerning than the new lockdown itself are recent claims about individual complacency.
The chief medical officer of health was careful to draw a line between complacency and blameworthiness: “I’m not trying to say that they did anything wrong.” It was also emphasized that there is no point levelling accusations against the under-20-year-olds who make up the majority of recent cases.
However, Fitzgerald also said, “I believe that going so long with low case counts of COVID led to complacency and we are now seeing the repercussions.… I think people across the island need to take a lesson here and to really start thinking about how they’re going to reduce those contacts.”
A charge of complacency might also be levelled at the pandemic policies of Premier Andrew Furey’s Liberal government. Rather than implementing an active and robust testing strategy, the government’s main pandemic response has been to create the impression of a cordon sanitaire around Newfoundland and Labrador. This has taken the form of a travel “ban” combined with a mandatory two-week self-isolation period for all arrivals.
Travel restrictions are politically attractive because they seem decisive and have an easily understood logic: stop the disease crossing the border, and stamp out the disease within the borders.
The problem is that these restrictions are only partial at best. Goods must be imported, rotational workers need to go to remote sites, crews arrive to film shows, and residents and property owners are free to move. The travel ban mainly stops the movement of non-residents.
The result is that the province’s borders have always been permeable. This makes travel restrictions epidemiological time bombs. They may slow transmission but eventually the disease slips through. It’s just a matter of time and luck. Unless an active and robust testing regime is in place, it is hard to detect when the borders have been breached.
The disease spreads until there are enough cases that they become visible. At that point, the disease is so entrenched that it is very difficult to contain by contact tracing and testing. There is community spread, and regaining control requires a lockdown.
Roughly how we got back to Alert Level 5
It didn’t have to be this way.
New Zealand also had a recent outbreak of the variant. It too has travel restrictions. Yet, it also has a rigorous testing strategy that caught the new outbreak after only three cases. This means that Auckland will be in lockdown for just three days, allowing contract tracing and testing to catch up.
Before Feb. 11, Newfoundland and Labrador health authorities required individuals to exhibit two or more COVID-19 symptoms before a test would be administered. This policy was in place even though the possibility of presymptomatic and asymptomatic transmission of COVID-19 has been supported by peer-reviewed scientific research at least since September. This policy was in place even though the new, more transmissible B117 variant was identified in the U.K. in September and was known to be in Canada since December.
Only on Feb. 11 was testing policy adjusted as Fitzgerald acknowledged that “widespread testing” and “increased testing capacity” will be needed to get the new surge in COVID cases under control. But what has always been needed is a more rigorous approach to testing.
When people enter Newfoundland and Labrador, there is no mandatory testing, despite there being supplies of point-of-care or “rapid” tests that could be used to quickly screen for COVID-19 at entry points. Some of these tests can return results in less than 20 minutes. Quick tests are less sensitive but they do identify the most infectious individuals, those most likely to be the centre of “superspreader” events.
Much more sensitive diagnostic polymerase chain reaction tests could be used to further detect landed cases of COVID-19 during self-isolation.
If two PCR tests are administered a few days apart, that screening could be 95 per cent effective. Outside quarantine, there could be provision for using “batch testing” to quickly check whole groups for positive cases. This would help in situations when contact tracing has become difficult because large numbers of people have been potentially exposed.
We aren’t alone
Other provinces also aren’t making the best use of available testing resources.
Dr. David Naylor, member of the federal government’s COVID-19 testing and screening expert advisory panel, recently warned, “We cannot be wilfully ignorant when we have the tools that can shed light on what’s going on in these settings where people are thrown together, where the risk of transmission is quite high.”
Before last week’s outbreaks, the regular pandemic briefings held by the premier, health minister and chief medical officer of health had become a kind of “pandemic theatre” with a simple message: new cases bad, no new cases good. That messaging obscured the difference between finding no new cases and having no new cases. Without rigorous testing it is impossible to tell the difference.
Until a significant number of us are vaccinated, testing will be our best defence. It always has been. New variants do not change the situation.
In the midst of a delayed election, a question remains for Furey’s government: why is more rigorous testing being promised only after a surge in cases has returned the province to Alert Level 5?