Will the N.W.T. ever 'emerge wisely' from COVID-19 restrictions?

With the territory leading the country in vaccination rates, health authorities are moving the goalposts on what will be needed to reopen the territory.

Territory’s health authorities have raised the bar on their own reopening plans

The N.W.T's chief public health officer, Dr. Kami Kandola, pictured on Oct. 21, 2020. (Mario De Ciccio/CBC)

Last week, reporters received a cryptic news release from the chief public health officer, announcing a forthcoming "change to self-isolation requirements."

With recent news that half of adult residents have received a vaccine, some may have wondered whether the territory's two-week mandatory self-isolation could be coming to end.

When the press conference came on March 4, however, Chief Public Health Officer Dr. Kami Kandola instead announced a relatively minor change — two more communities would be allowed to host those in isolation, for a total of six across the territory.

While, no doubt, a welcome development for travelling residents of those communities, the announcement raised the question: what will it take for public health restrictions to end?

Setting a high bar

In their release on the changes, health officials specified how Norman Wells and Fort Simpson met their high standards for places that can accommodate recent travellers.

They had health facilities that could stabilize severe cases. They had twice-a-week wastewater surveillance for signals of an outbreak. They had COVID-19 compliance officers stationed in the community and they had fully completed their vaccination clinics for both doses of the Moderna vaccine.

Fort Simpson, N.W.T., is one of two communities deemed last week to meet the chief public health officer's standards for hosting returning travellers during their self-isolation period. (Hannah Paulson/CBC)

Other communities looking at that list may wonder how they can ever meet that standard for welcoming travelling residents home.

It's a difficult bar to clear — and one that was never established by the territory's reopening plan, dubbed "Emerging Wisely."

Indeed, a look at that plan shows that the territory's prerequisites for lifting COVID-19 restrictions have only become stricter over time.

Stuck in second gear

Emerging Wisely was first released in May of last year. Within a month, the territory moved into phase two of that plan, relaxing restrictions on outdoor gatherings and allowing many businesses to reopen.

But since then, it's been stuck in second gear, remaining in phase two for nearly nine months — and counting.

Phase two bans outdoor concerts. It means events like Folk On The Rocks, Yellowknife's Long John Jamboree, and the Snowking's Winter Festival are forced to cancel, or reimagine themselves to meet the strict COVID-19 prevention measures of the chief public health officer (CPHO).

It also means limits on outdoor gatherings — assemblies, funerals and traditional games — that might otherwise break the isolation and monotony of pandemic life.

It means restrictions, still, on outdoor tourism operators, who face a second summer of travel restrictions that put their businesses on ice.

Snowking's Winter Festival normally incorporates live music and comedy shows, but it's been reimagined this year as an outdoor garden to keep in check with chief public health officer's recommendations on large gatherings. (Bill Braden/Freeze Frame)

The seemingly endless second wave

In the March 4 press conference, Kandola didn't mention phase three until faced with questions from reporters.

When asked for a timeline on when phase three could be coming, Kandola said she would be "considering" relaxing restrictions in late April, by which point most of the territory's adult residents should be vaccinated.

This is well beyond the point at which the plan calls for an easing of restrictions. According to Emerging Wisely, there are just two requirements for phase three: a "robust" ability to test for and trace COVID-19, and the end of a "second wave" of infections in Canada.

Anyone looking at charts of infection from across Canada and the U.S. can see the most recent spike in COVID-19 cases peaked around early January across the continent. While some health systems struggled, all have now more or less recovered.

But the CPHO says that "second wave" is still underway.

"A second wave of COVID-19 infections in Canada and the U.S. has not come and gone," reads a March 5 statement from Darren Campbell, a spokesperson for the CPHO, "and we have not provided a significant portion of our population with a vaccine."

A "wave" of COVID-19 is a particularly vague term — researchers have noted that there is no "common vocabulary" or "working definition" for it, and the World Health Organization avoids use of the term.

Campbell said the CPHO also does not have a specific target that will "define the end of a wave." But he did say if the country saw fewer than 500 new cases a day — as it did between roughly April and July of last year — Kandola would "consider the second wave complete."

After a full year of pandemic measures, and as vaccines encourage governments to ease restrictions across the country, it remains to be seen if Canada can return to last summer's low levels of transmission.

But contained in Campbell's response is also a subtle moving of the goalposts. Vaccination was never, until now, a condition for phase three — in fact, it was a condition for removing restrictions altogether.

Chief Public Health Officer Dr. Kami Kandola receives her first dose of the Moderna COVID-19 vaccine on Jan. 13 in Wekweètì. Health authorities now say 75 per cent of adults must be vaccinated before many health restrictions are eased. (Kate Kyle/CBC)

'Every eligible person'

The Emerging Wisely plan was written in early May, at which time a vaccine seemed a distant possibility. The plan itself guesses 12 to 18 months. In reality, it was more like seven.

To the CPHO's credit, both phase three and four, when all restrictions are lifted, list decreased transmission in the U.S. and Canada as a precondition.

Campbell's repeated stress on the "need to reach our goal of vaccinating 75 per cent of the eligible adult population" before easing restrictions introduces a new variable to the mix.

The original Emerging Wisely plan says just vaccinating seniors and other vulnerable individuals should be enough for the end of "all remaining restrictions." The territory is well ahead of that, having vaccinated half of all adults already.

But based on Campbell's response, the CPHO now takes a much harder line on what will be needed to lift restrictions.

"We need to ensure every eligible person in the N.W.T. has the opportunity to get the vaccine," Campbell wrote. "We also need to see significant levels of vaccination … in other parts of Canada before we can consider easing some of those measures."

That's new, too.

"Significant" vaccination rates in southern Canada may not be achieved until September, according to latest federal estimates.

In a press conference Wednesday, Kandola more or less acknowledged that the original benchmarks of Emerging Wisely were being thrown out the window.

"Vaccine uptake was more of a phase four conversation," she said. "But we'll be updating the Emerging Wisely document come April."

Managing risk

Originally, COVID-19 restrictions were largely about minimizing the burden on the Northwest Territories' small and fragile health system.

In Wednesday's press conference, Kandola acknowledged that a high rate of vaccination inside the territory greatly reduces the risk that the system will become overburdened.

The jury is still out on whether vaccines can prevent transmission of COVID-19, though new data becomes available every day.

But health authorities have known since December that the Moderna vaccine is "highly effective" at preventing those severe cases of the disease which could result in hospitalization.

Campbell said the government will "do everything in its power to avoid a scenario where there is a health system breakdown."

He pointed to new variants, yet to be detected in the N.W.T., but circulating in the rest of Canada, that could complicate the picture.

"That's why the [territory's] response to the pandemic must continue to be strong, and some public health measures must remain in place even as vaccination levels rise in our territory," he wrote.

As with every public health measure, the question is a balance of risks. Does the risk to the health system posed by new variants justify staying in phase two?

For now, Kandola seems to think so. As for what the CPHO's shifting goals mean for residents, it's anything but clear if — or when — that could ever change.


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