The entire population of the Atlantic Provinces is 2.2 million or 1.7 million on the mainland, all reliant on the free flow of tourists, goods and services, commerce, education, health care, research and the military. The population, spread over a significant land mass, is about the size of Montreal.
Jason VandenBeukel, editor of the opinion pages for the Telegraph Journal, said in an article on June 24 that Nova Scotia’s border rules are nonsense. And he is correct. Thus it has been for the duration of the pandemic.
Imagine a population group the size of Montreal having 4 different approaches to pandemic management, vaccine roll out, and all the hundreds of other elements involved in pandemic management. Tough as it has been in Montreal, at least they had the one common voice of one premier who, with his expert advisors, has provided direction.
We Canadians tended to be smug early in the pandemic as the numbers of cases were rising in the United States with health care workers doing their best to provide care for real cases. The combination of social and electronic media and political polarization made it look worse than it honestly was. The smugness in Canada was palpable in various media sources. But now, people in states like Florida, Texas, Georgia, South and North Carolina, Idaho, Nebraska and more have been getting back to a near normal lifestyle for a few months now with churches, sporting events, retailers and restaurants getting back to a new normal, and more.
To some in the southern states, who might otherwise enjoy coming to the Atlantic Provinces to cool off in summer, the image of the Atlantic provinces as a wonderful place to relax has, in their perception, declined. The attraction of lobster and beaches seems to be overshadowed by “those people are so bound up, still wearing masks, loaded with fear.”
All this, of course, is accentuated in the last couple of weeks as our premiers have had the spats over borders. The very notion of fully vaccinated persons having to self-isolate after crossing the border into a land mass that is 100 yards away from their home just seems ludicrous. My informants in the US indicate that they have enjoyed fairly unrestricted travel between states for many months. Such artificial border restrictions within the same country seem ludicrous and simply cause irreparable economic and personal harm.
But the practices “within the Atlantic Bubble” have been remarkably inconsistent, province to province. For instance, early in the pandemic the rule in Prince Edward Island was clearly established that frail elders in long term care showing symptoms of Covid-19 would be transferred immediately to hospital where trained healthcare personnel with appropriate isolation facilities and PPE were in place. Not so in New Brunswick where the authorities feared, wrongly as it turned out, that hospitals would be overrun so the instruction was given to keep persons with symptoms in their care home. This proved to be a challenge since many long-term care facilities do not have the facilities for isolation nor the supplies of PPE and physical facilities required for isolation.
Consequently, outbreaks have been an issue in some facilities.
Nova Scotia used different methods again although a hybrid of PEI and NB. The Shannex organization led the way in establishing Regional Covid Units (RCUs) and that was adopted by the Department of Health as a provincial strategy. The intent was that individual cases with symptoms would be moved to one of these units rather than try to isolate in the care home.
In the United States, while the federal government made resources and overall direction available, the states each sought to implement practices based on their interpretation of science and the ambitions of various political leaders which made the pandemic more than a disease to control. In that mix, there have been states where economies have rushed back quickly with great performance while others have been engaged in scandal and controversy. Overall, the country seems to be bouncing back to a new normal fairly rapidly with those states focused on people and economic success seeming to lead the pack.
It has remained a mystery as to why, in Atlantic Canada, the entire area could not be managed as a region rather than independent fiefdoms. The apparent lack of harmony seems to make, once again, a strong argument for Atlantic Provinces cooperation in matters of public health. With a small population combined with wide geographic area the need for unity in the Atlantic Provinces is compelling.
At the outset of the pandemic the world was given a new vocabulary, plans and directions by the World Health Organization through, in our case, the Federal Public Health Agency and the Prime Minister. Not only was there a new vocabulary but directions that sounded quite similar whether you were in Los Angeles or Fredericton. Wear a mask, social distance, re-design retail with barriers, sanitizer, close down churches and concert halls, and arrows to direct the population into following detailed directions. The strong urging at the beginning and recited for months was: “just follow the science.”
Now that sounds logical and defensible, but the science has evolved with new knowledge, new understanding, new revelations. Many of the things believed to be true in March 2020 have been changed, abandoned, reversed. Most recently, having frightened the population with original death forecasts, the real number of deaths with Covid as the precipitating cause has been not even close to original worldwide estimates. The CDC reported just a month ago that they had to reduce the actual number of deaths reported in the US previously identified as Covid deaths because the real cause of death was some other pre-existing condition. Remember the mantra from China in January 2020: “Not contagious between people; It’s Controllable and Preventable.”
Testing has had its share of controversy with disturbingly large false-positive testing reported in Florida and other states. The Lancet, in September 2020, pointed out the dangers of false-positive testing.
Here’s the issue: this virus, while a derivative of the SARS strain of viruses, was not well known to public health or medical practitioners for many weeks at the beginning. China withheld critical information that could have been useful to prepare us. The rules of mitigation had to be based on public health experiences with previous viruses and much was not entirely based on science because there really was little science aside from textbook knowledge and clinical experience with previous outbreaks.
So, we saw practices varying amongst provinces and certainly no particular commonality in Atlantic Canada. Imagine the confusion that would be created in a large metropolitan area if there were different rules for each of the sections of the city. Presumably the medical officers of health in each province have been having some interaction but we have still seen 4 different approaches to pandemic management in Atlantic Canada. This was noted, in particular, in the roll-out of the vaccines with the high-risk groups (frail elders and long term care) at the bottom of the list in NB and top of the list in PEI.
The bubble had potential to work but instead it has become a focal point of isolation of the 4 provinces from Canada. Not wise. The Atlantic Provinces may never merge but on matters as important as a pandemic, and this is not the last, they need to function as one so that the virus can be mitigated quickly, corrective steps virtually identical, and certainly no barriers to the normal and essential flow of people for essential economic and domestic purposes. We need to put out an image of having our act together, pushing to be integrated with Canada as an influential part of the country.
Ken McGeorge,BS,DHA,CHE is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News. His email address is email@example.com. His book, Health Care Reform in New Brunswick, can be purchased at several retailers and at www.kenmcgeorge.com
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.