Monday, 20 April 2020


There is a risk that we will come in contact with COVID-19 but there’s absolutely no risk that the Province will do anything except "follow the leader" - Ottawa . The best opportunity to control spread - mass testing - accompanied with physical distancing and/or quarantine, is not even on the table.

Testing is not without its critics however, some of them highly credible, including B.C.'s officer of public health, Dr. Bonnie Henry. A common problem is that COVID-19 tests result in a high number of false negatives. "The false negative rate can be as high as 30 per cent early on in infection", stated Henry in an April 14th CBC news story. "Testing in B.C.," the story continues, "is currently being limited to those who develop coronavirus symptoms who are hospitalized, residents or staff of long-term care facilities, part of an outbreak investigation, or health-care workers" - not unlike the testing regime here.

Last week our own Chief Medical Officer, Dr. Janice Fitzgerald, broadened the testing criteria. Now, individuals who present with two or more of symptoms, including fever, cough, headache, sore throat, runny nose, will be administered the test. The change still makes access to testing highly restrictive. It is unlikely to alter Canadian testing statistics which puts NL just above last place Ontario in tests conducted per 100,000 population (see exhibit below).
Concerns about false negatives, however, need to be balanced with the plethora of reasons why they arise, especially in the U.S. where “a shortage of supplies and material for the tests ...may impact results”, suggests a Bloomberg story about false negatives. To this, and many others, is added “the challenge of getting an adequate sample from a patient.” 

Poorly administered tests, resulting in less virus material than necessary for the purpose, is more common than anyone would like. Dr. Fitzgerald described the same problem in response to a reporter's question last week, stating that was the reason they are "testing only symtomatic people". The earlier news story referred to quoted the head of emergency medicine at Jacobi Medical Center in New York, Dr. Jeremy Sperling, who thought it a problem where invasive procedures into the pharynx are often conducted by “people not typically trained to do so…” Having avoided inundation with infected patients, hopefully, medical personnel in this province are using the opportunity for teaching the precise procedures here. 

The problems causing false negatives, however, are many and complex. But, does the problem justify not carrying out mass testing, at all? It does have the appearance of an all too typical bureaucratic justification for flat-footedness when other, equally credible, health professional counsel a very oppositite position.   

To begin with, Eastern Health can't even report test results to everyone among the small number it tests. One person, with whom I am personally familiar, after returning from Spain and Morocco, was tested four weeks ago. Three telephone inquiries later, the person is still not in possession of a report!  

Our health system is hardly overburdened with COVID-19; the current number of infections are relatively small and personnel have been freed up from performing non-emergent procedures. What does such poor responsiveness say about our actual readiness to deal with a major COVID-19 outbreak? What does it say about our capacity to test - and report - even if the Chief Medical Officer has concluded that the number of false negatives make mass testing inopportune? 

In contrast, Iceland implemented, according to the Iceland Monitor, “an aggressive program of mass testing, tracking and isolation measures to contain the epidemic.” The Country’s strategy is also aimed at early testing. Importantly, the similarities of the distribution of both populations is compelling, without which the comparisons might be less beneficial.

It seems that Iceland has no difficulty obtaining the kits necessary to carry out their Plan, the island country (population 360,000), having already conducted tests on more than 1o percent of residents. Iceland employed the screening services of deCode Genetics, a local leader in human genetics research. A random test on 2283 people (which served as a baseline with which to compare the results of the broader program) was included in the 37,386 tests completed to April 15. That is 7 times the number administered in this province (5,370 reported April 17). 

Hit hard early in the pandemic, Iceland reports 1771 confirmed cases of infection, against 257 in this province.  It is hard to imagine, therefore, that we have nothing to learn from that Country. The chart below (produced by Johns Hopkins University) indicates Iceland's flattening curve and, presumably, the basis for lifting the restrictions on its economy, never having completely shut down. Iceland Monitor reports that "while the efforts of the public health system have been effective so far in mitigating the spread to date, more data, including massive population screening, will be key to informing efforts to contain the virus in Iceland in the long run.”

COVID-19 Confirmed Cases of Infection
With testing for the virus deemed integral to its economic health, too, someone in NL will soon have to address this question: is it cheaper to mass test, notwithstanding the problem of false negatives, than to flatten the economy with possibly unfathomable consequences?

In this context, the Los Angeles Times reports that researchers at Harvard University suggest "the United States cannot safely reopen unless it conducts more than three times the number of coronavirus tests it is currently administering over the next month." Similarly, Canada will need something other than social distancing to prevent a second spread of the virus.  Dr. Ashish Jha, Director of the Global Health Institute at Harvard University, states forecfully: 

Dr. Nirav Shah, Director of the Maine Center for Disease Control (CDC) subscribes to this view, too, and is "rolling out" a new rapid test manufactured by Abbott Labs, according to Maine Public Radio. New Mexico has also enhanced testing capacity "bolstered by drive-up sites at hospitals" and is beginning to test asymtomatic people, the previous hesitancy "driven by concerns  about the availability of testing."  Atlanta's CDC Director is concerned about asymtomatic people, too, suggesting that they may amount to to "as many as twenty-five per cent...And we have learned that, in fact, they do contribute to transmission". 

The same CDC Director still has concerns about negative tests for those having come in contact with others testing positive for COVID-19 but suggested that "there are now equal concerns, or questions, about what the public health response should be..." and while awaiting federal CDC to grapple with such questions is "ramping up for testing".  

In contrast, Dr. Haggie has dismissed the new Spartan Cube, which can provide results within an hour without the use of a lab. Though Spartan credits Ottawa with having expedited its review and approval, and despite Ontario, Quebec and Alberta having reached supply agreements with the Company, Haggie is not satisfied because the new testing equipment “still have to be validated and assessed for effectiveness…in a pandemic environment.” Presumably, Haggie’s standards invalidate those of Health Canada and the other Provinces. Is he suggesting that he is protecting our residents while Ontario, Quebec and Alberta are foolishly taking risks with theirs?

The control of returnees, which ought to have been the Province's first initiative, might now warrant another look, too. The Prime Minister announced on Tuesday that “any Canadian who returns from abroad and is not able to explain a credible quarantine plan will be required to quarantine in a hotel.” That is exactly what this Blog has been trying to get the Provincial Government’s attention on from the start. Instead, it has allowed a ‘free-for-all’ to occur at airports and at the CN Ferry terminal. Hopefully, the Premier finds inspiration from thr PM. 

These are not times when anyone relishes levelling criticism at the Government. The battle against COVID-19 is too important to be sideswiped by anyone looking for the perfect response, however well-intentioned.

But the Government's flat-footedness on the implementation of a plan to revive the economy of this province risking, in the process, the vast investment that so many people have made and the disruption to their lives and finances, is unacceptable.

COVID-19 did not make this place less an island, or, in the case of Labrador, any less remote. That means we have options - including mass testing - that make it unnecessary to risk destroying what is left of our economy in the feint hope that it will miraculously rise again. 

A call to Iceland - rather than Ottawa - might offer an earlier dividend, though - and I say this with the greatest of deference - we will need Ottawa, too.
* Editor's Note: I am grateful to an Uncle Gnarley reader for supplying some of the references used in the writing of this piece.