Here's the N.W.T.'s plan for the COVID-19 pandemic

A telephone help line, volunteer nurses, and ‘one source of truth’ — all part of the plan for an N.W.T. pandemic.

Territory built new plan on lessons learned from 2009 H1N1 pandemic

In this illustration provided by the Centers for Disease Control and Prevention (CDC) in January 2020 shows the 2019 Novel Coronavirus (2019-nCoV). The Northwest Territories' pandemic plan for COVID-19 builds off their response to H1N1 in 2009. (The Canadian Press)

On Wednesday, the World Health Organization declared the outbreak of a new coronavirus known as COVID-19 to be a global pandemic.

The same day, Dr. Kami Kandola, the N.W.T.'s chief public health officer, said the territory started planning for a pandemic — and the arrival of COVID-19 in the North — "weeks ago."

It's not the first time the territory has been here.

In 2009, a particularly deadly strain of influenza known as H1N1 killed nearly 17,000 people worldwide, including five in the North.

That pandemic tested the limited resources of the territory's health system, but was eventually beaten back by a successful campaign of mass vaccinations.

In expectation of the territory's first cases, the government has developed a new pandemic response plan, building on lessons learned from 2009.

Here's what that new plan includes.

It starts with self-care

The territory's pandemic plan charts a path through the system that members of the public will have to follow if their symptoms grow more severe.

It begins with self-care. Health officials have already started disseminating instructions — on how to self-assess, self-isolate, care for family members, and seek medical help if necessary — on the N.W.T. Department of Health's website.

Visitors pass a sign warning about the spread of germs at the Prospectors and Developers Association of Canada (PDAC) annual conference in Toronto. Delegates to the conference, including several N.W.T. politicians, were exposed to a carrier of COVID-19. (Chris Helgren/REUTERS)

Next, the territory plans to establish a telephone help line, as it did for H1N1 in 2009.

"A telephone advice line will be operationalized and resourced to answer questions, provide self-care advice and to direct people to appropriate clinical assessment and care locations as needed," the plan reads.

That can't happen soon enough — phone lines at some local clinics are already clogged with concerned callers.

If symptoms are severe enough, patients will be asked to go to a local clinic or health centre, where they may be referred on to a hospital.

It's here that the health system's capacity becomes an issue.

Health workers in protective gear in Kirkland, Wash. If the outbreak of COVID-19 is severe, the territory will call on trainees, retirees, and volunteers to make up for short staffing in the health system, and may ask for outside assistance. (Lindsey Wasson/REUTERS)

Trainees, retirees, and volunteers

The N.W.T.'s health systems are overburdened in the best of times — just ask the community of Fort Smith, which was forced to close its community clinic last month due to a worker shortage.

That means in the worst of times — like during the 2009 H1N1 pandemic — the territory can be caught short.

"The lack of surge capacity … places the Territory in a precarious position should the pandemic be more severe and the response more sustained in the future," reads a 2010 consultant's report on the territory's response to H1N1.

That more severe pandemic has now arrived, and the territory's health system "already finds itself with excess capacity challenges," according to the pandemic plan. "Therefore, [it] may need to consider activating emergency … contingency plans early."

It's not possible to plan for every outcome.- Northwest Territories 2019 COVID-19 Pandemic Planning Guide

Those plans call for the creation of "alternative sites," like school gyms, community halls, or "isolation tents," for triaging and testing patients when smaller clinics are overwhelmed.

They also call for activating "all health care workers in front line and in non-front-line positions, trainees, including students and educational staff at Aurora College, retirees and volunteers" to assist with the effort.

When those resources fail, the territory turns to its neighbour.

"A sustained pandemic will necessitate acquiring front line human resources from outside the territory. Severely ill patients will be transferred to facilities in Alberta."

The health centre and community gym in Colville Lake, N.W.T. The pandemic plan calls for the creation of 'alternative sites,' like this one, for triaging and testing patients when smaller clinics are overwhelmed. (John Last/CBC)

Nurses, doctors, and epidemiologists are flown North to assist communities. Patients needing hospitalization are sent back the other way — to hospital beds in Alberta.

The territory's pandemic plan makes clear that "financial support … will be readily available" to contain the spread of the disease.

Everything will need to be carefully tracked, measured, and re-evaluated, to ensure limited resources are heading to the places that need them most.

"It is not possible to plan for every outcome," the plan reads. "Disease emergence and impact may vary from community to community."

'One source of truth'

As long as a pandemic is underway, expect to see a lot more of Dr. Kandola, the territory's chief public health officer.

That's because, according to the department, one of the strengths of the 2009 response was the Department of Health's central control over all communications.

The 2010 consultant's report calls it the "one source of truth" during the pandemic.

That's helpful for government agencies struggling under the weight of requests for information from concerned journalists, organizations, and members of the public.

But there are some downsides to centralizing control.

Expect to see more of Kandola, the territory's chief public health officer. Communication about COVID-19 will be centralized under her department. (Walter Strong/CBC)

One issue identified in 2009 was that senior managers are sometimes not well informed on either the department's own plans or the realities on the ground.

Front-line workers said "other departments or agencies appeared to believe they were more knowledgeable or had more information about infectious disease."

As a result, they were "asked to do things that didn't make sense," according to the report.

Senior managers are also sometimes hard to replace if one gets sick. The N.W.T. went into the last pandemic with no deputy minister of health, no pandemic planner and no chief medical officer.

There can also be downsides for the public. In 2009, Nunavut's health authority decided it wouldn't share which communities had been affected by H1N1, saying there was "no public health reason" to do so.

Kandola said the Northwest Territories plans to take the same approach for COVID-19.

The 2010 report found, for privacy reasons, authorities wouldn't share information on infection rates in certain communities, because they were too small. There was no plan in place for communicating the first death from H1N1, so when it happened, authorities were thrown into confusion.

The pandemic plan makes mention of how media can be a nuisance, increasing demand on health services when there may be no reason for concern.

But it doesn't include a plan for announcing infection rates or deaths, meaning some communities may end up in the dark.