I recently returned from Northwest Territories, where I’d been working as a physician for six months. Now, back in Nova Scotia, I’m reflecting on what it’s been like to have worked in areas of Canada with relatively few cases of COVID-19. A large part of my work is hospital medicine. As the name implies, a hospitalist is a doctor who cares for patients admitted to the hospital. Often, we work seven days in a row, with a few of those nights being on call. Hospitalists care for patients with a variety of conditions. Examples might be pneumonia, heart conditions, or a broken hip. In addition to my work as a hospitalist during the pandemic, I was also able to witness the approaches of two separate Canadian public health departments. Just like they do in different U.S. states, laws in Canada vary across provinces. In two particular Canadian provinces, Nova Scotia and Northwest Territories, there happened to be more similarities than differences. Here are some approaches that have worked quite well in both regions. First, both locations have a mandatory two-week isolation period, and it is taken seriously. This is similar to the 7-day isolation period that the CDC instructs U.S. citizens to return from international travel. Before traveling to Yellowknife, I had to submit a self-isolation plan, and my documents were checked upon arrival. Only essential workers were permitted in the territory. From the airport, I had to go directly to my hotel. My food was delivered to my door. Rule-breakers received fines in the thousands of dollars. I have now completed my two weeks of self-isolation back in Nova Scotia, where the rules are very similar. At Halifax Stanfield International Airport, I had to give my email address. On a daily basis, I had to check-in online to report any symptoms. Northwest Territories had a comparable online check-in system. In both places, testing is very accessible. Nova Scotia Infectious Disease leaders made headlines in recent months after opening pop-up test sites. A Halifax nightclub was converted to a test site one night for people who were out downtown. In both Nova Scotia and Northwest Territories, public health leadership is strong. Dr. Kami Kandola and Dr. Robert Strang are examples of excellence as Chief Medical Officers of Health. They are role models. Their efforts strengthen trust and organization down to the levels of hospitals and communities. Early on in the pandemic, while working as a hospitalist in Antigonish, I witnessed the physicians, nurses, and staff working tirelessly and collectively to prepare for the unknown. In Yellowknife, my colleagues took the pandemic very seriously even though there were usually no cases. They went above and beyond to advocate for their patients. In Yellowknife, an Indigenous elder taught me about the importance of traditional knowledge and the link between health and the land in his culture. Some Indigenous communities in the territory responded to the pandemic by building on traditional knowledge such as hunting and fishing. This would help ensure safe food supplies if the pandemic resulted in the halting of goods coming in. This intelligent approach is on the backdrop of a tragic history. In 1928, a decade after the 1918 flu pandemic, the Hudson Bay Company’s ship, the SS Distributor, brought supplies up the MacKenzie River. The company also brought a particularly deadly form of the flu, killing up to 15 percent of the territory’s Indigenous population. The 1918 flu is estimated to have killed at least 3,200 Indigenous people in the United States. Indigenous communities across Canada and the United States have suffered greatly during previous pandemics. This is not forgotten in Canada’s north, and it should not be forgotten elsewhere. Days before departing from the Northwest Territories, I learned that Air Canada, Canada’s largest airline, had stopped their passenger service to Yellowknife, so my flight was switched to another carrier. This meant my trip back to Nova Scotia took place over the course of three days. As I boarded my flight to Edmonton, Alberta, my sense of alertness was heightened. In Toronto, I didn’t leave my hotel room. Once on the plane to Halifax, I didn’t take my mask off the entire time, not even to take a sip of water. (I recognize that was likely overly strict. Given what we know so far, the risk of catching COVID-19 on an airplane is probably low). But I felt a strange sense of ease and safety when I looked out my airplane window to see my home province. The excellent pandemic management in these two regions of Canada does not mean we remain unaffected. In both Nova Scotia and Northwest Territories, the hospitals have visitor restrictions. It is heart-wrenching when patients cannot see their loved ones in person, especially during their final hours. Non-urgent appointments and surgeries were postponed, and sometimes patients’ medical conditions worsened as a result. Many clinics have shifted to provide more virtual care. While this has some benefits, there are also many challenges. According to the territorial government website, Northwest Territories had an increase in alcohol-related medical visits from May to July in 2020, compared with 2019. Despite low numbers of COVID-19 cases, anxiety and depression rates for Nova Scotians during the pandemic have been among the worst in the nation. Worsening mental health and substance use outcomes during the pandemic are something we’re seeing widely, including in the U.S. Public health officials do not have an easy job. They are often the victims of bullying and even threats. A man from Alberta is being charged with threatening Dr. Kandola, for example. Dr. Strang has received personal threats as well. Last march, Canada closed its entire border to the U.S. (excluding the movement of essential goods and some essential workers) for the first time in history. Prime Minister Trudeau has claimed that the Canada-U.S. border will not be reopened until the pandemic subsides globally. With the United States leadership changing hands, I hope that the U.S. government and community members alike support public health officials and listen to the science. As we grapple with our losses and the general changes that our society and our world has faced this past year, I have been privileged to work in two regions of Canada where the public health leadership is strong, and so are the people. Source
