'It can't be life as normal': N.S. Medical Officer of Health on managing the Atlantic Bubble
Dr. Robert Strang speaks on the Sickboy podcast about how he's managing a once-in-a-century pandemic
The Atlantic provinces have been relatively successful at managing COVID-19, thanks to their geography, low population density and the efforts of leaders in government and public health. But that doesn't mean they're in the clear.
Dr. Robert Strang, the Chief Medical Officer of Health of Nova Scotia, sat down with Sickboy podcast hosts Jeremie Saunders, Taylor MacGillivary and Brian Stever for a wide-ranging interview that touched on vaccine rollout, the COVID Alert App, and how the province cared for its most vulnerable populations during the first wave. Here is part of their conversation, edited for length and clarity.
Please note: this interview was conducted before Tuesday, Nov. 17 when Dr. Strang announced the second wave of COVID-19 arrived in Nova Scotia, after finding evidence of community spread in Halifax neighbourhoods.
JEREMIE SAUNDERS: How do you feel about where COVID-19 is at right now in Nova Scotia?
DR. ROBERT STRANG: We're in a pretty good place. Every other province is well into the second wave of COVID, talking about circuit breakers and hard shutdowns. We're not there yet.
We're seeing some slow increase. Almost all of it is people who've traveled outside of Atlantic Canada. And that in itself shows that we need to maintain our borders restrictions. We're small provinces in Atlantic Canada. If we get a significant surge of COVID, we'll get overwhelmed way faster than Ontario or other places. So we need to protect ourselves.
We can't get comfortable or lose focus.- Dr. Robert Strang, the Chief Medical Officer of Health of Nova Scotia
It is very tenuous. This could go south at any time with the wrong case in the wrong place; it doesn't take very long. We can't get comfortable or lose focus.
I get that people are tired of all these impositions and there's no clear end in sight. But we're going to see more little clusters pop up. We've got to accept that, and not expect that we're going to have no COVID. Our goal is to keep them as little clusters and not allow them to spread into big community clusters which we can't control anymore.
BRIAN STEVER: I check the news every day to see the update on new cases in Nova Scotia and even if I see two or three new cases, as long as they can be traced back to existing cases, I feel less anxious. Is that how you feel, too?
STRANG: Yes, as long as we know where a case came from. Often we get secondary cases where somebody has traveled and they're staying in a household and some of those other household members become infected. We expect that. You can explain that.
I think relaxing because we can explain the origin of cases is a double-edged sword because we become too relaxed. We remain safe by having limits on our social gatherings and all those other pieces. If we give up on those, then when we do inevitably get COVID coming in, we've created a condition where it can take off.
So as hard as it is, now is the time for us to be really careful about the choices we make, who we get together with. Try to keep with the same 10 people as much as possible and be careful about masking.
All of us are at risk. There are lots of people in our social circle who may have underlying health conditions we don't know about. We need to have more concern about each other. It's about thinking of others more and what we can do to keep each other safe, and accepting those impositions. We're in a pandemic! It can't be life as normal.
TAYLOR MACGILLIVARY: Are other health authorities looking to Nova Scotia and asking why this little province has been relatively successful at keeping COVID down?
STRANG: I think they look at us perhaps with a bit of envy. There's geography in our favour.
I also think Nova Scotians are compliant. I like to think that the premier and I were able to engage people in a trusting relationship that led Nova Scotians to accept restrictions and take care of each other.
SAUNDERS: It's funny you say that. It makes me think back to the beginning of the pandemic when I was totally locked up in my house. Every single day I tuned in to you and Premier Stephen McNeil. In my mind, you guys were like Bert and Ernie — roommates who hang out all night and think about what needs to be said to the province. And then they wake up the next day, sit down and give their message. [Laughs.]
There was this almost dependent relationship that I developed with you as Nova Scotian. Because you guys came into our living room and offered up answers. There was something really comforting about that.
Before I was tuning in to Bert and Ernie every day, I had no idea who Dr. Strang was. You quickly became a household name in Nova Scotia.
What did your job look like before before we were thrown into this, I hate to say it, unprecedented time?
STRANG: Before, my job was all about prevention. That's what public health is — how do we work with communities to create conditions where people can be as healthy as possible? You get involved in a range of issues directly related to health like substance use, tobacco, how active we are and what food we eat. You get into broad, complex social issues, too.
Now my team is focused solely on COVID. We have a number of other important public health issues that have been put on the back burner. It's a reality of the limited public health capacity in Canada.
MACGILLIVARY: What has suffered because of the attention we need to bring to the massive public health crisis that is COVID?
STRANG: The opioid overdose crisis is the main one. But if you look at it from a social lens, marginalized populations are most impacted by COVID. This pandemic exposed longstanding inequities in income, employment and education. And it's the same groups that are most vulnerable to the harms from substance use. We can create much healthier communities by lifting up those who are most marginalized.
It's an ongoing balancing act. I'm trying to find the right level of control, but also keep things open as much as possible because restrictions have their own set of consequences.
SAUNDERS: Let's say we get an effective vaccine that rolls out in the first quarter of 2021. What is vaccine protocol on a provincial level? How would we get access? Who would get access first?
STRANG: We have a national approach around vaccines. The federal government does all the procurement. They negotiate with the vaccine manufacturers on our behalf and we enter into contractual arrangements.
There's national conversations already about who the priority groups are. We have a national advisory committee on immunization that has said publicly the priority groups are people who are at most risk of getting severely ill and people who are caring for those groups.
In all likelihood, every province is going to get the vaccine in small, incremental amounts initially. We're going to have to be very tight in terms of having public health science say who is at greatest risk and they are the ones who should get it because they're top of the list.
STEVER: Since we've got COVID more under control here, will they wait to give vaccines to the Atlantic Bubble and prioritize places where its more widespread?
STRANG: No, I think we're going to be looking at per capita allotments and then sticking with a consistent priority list. We have three percent of the population, so we'll get about three percent of the vaccine. And then which Nova Scotians get it? That's part of that national conversation.
Still, vaccinating everybody is not going to solve COVID
MACGILLIVARY: Why is that?
STRANG: It's highly unlikely that a vaccine against this type of virus will give you lifelong immunity. We already know that people who get infected probably don't have immunity beyond about three months after their COVID infection. It's just the way respiratory viruses work.
The vaccine will help. We may have to vaccinate people periodically. It does prevent severe illness and keeps people out of the hospital, preserving our health care system- like the flu shot. It would potentially give us a greater ability to lift restrictions and let COVID run its course. We do that every year for flu. We basically go about life as normal for with influenza season, even though several thousand Canadians die every year from it. Part of it is because we have a vaccine that helps protect people.
SAUNDERS: What are your thoughts on the importance of the COVID Alert App? I have it but I've heard a lot of people say 'Well, we don't really have COVID here, so why would I download the app?" Can it play a role in keeping the Atlantic Bubble from popping?
STRANG: It's an important tool. I have it on my phone, too.
We have a multilayered approach. You've got to dress in layers for the cold weather. COVID is like that. Social distancing is one layer. Wearing a mask is another layer. Having the COVID Alert App is another layer. No one layer keeps you warm or is sufficient. But when you build up multiple layers, then you have a nice cozy winter. The app is another layer of protection.
SAUNDERS: There's no such thing as bad weather. There's only bad clothing!