Contact tracing and a no-nonsense medical officer: How Newfoundland and Labrador beat back COVID-19

Under the leadership of Dr. Janice Fitzgerald, the province is nearly infection free
Joceline Boulais

This article originally appeared in the French edition of Ricochet and has been translated.

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On April 8, 2020, Newfoundland and Labrador had the highest rate of infection per 100,000 residents in Canada, with 232 cases and two deaths. By June 1, the total stood at 261 cases, with only one new case since May 28, and three deaths. Even though the province is practically infection free, restrictions on movement have been eased only slightly. This prudent approach bears the hallmark of Dr. Janice Fitzgerald, chief medical officer of health for the province.

The Public Health Protection and Promotion Act, adopted in 2018, empowers the chief medical officer to take all necessary measures to protect the population once elected officials have declared a health emergency. Dr. John Haggie, the health and community services minister, has repeatedly asserted how proud he is of this legislation, because it puts public health authorities firmly in charge of policy responses rather than politicians.

A practising surgeon in Gander before entering politics, Dr. Haggie stresses that just because he is a specialist does not mean he is any sort of expert on pandemics.

“Dr. Fitzgerald and her team are the real experts,” he says.

Preparation and quick actions

When news of a novel virus in China first started making the rounds, Newfoundland and Labrador were in the midst of a job search for a new chief medical officer. Dr. Fitzgerald only held the position on an interim basis, but she put her team to work. On Feb. 17, she circulated an eight-page memo to various professional groups — doctors, nurse practitioners, emergency service personnel — informing them the virus would likely be coming to the province and what preventive measures they should take.

On March 9, she sent public health guidelines to every school. Twenty seconds of handwashing became obligatory. On March 14, she announced the first presumed case of COVID-19 in the province, a resident of the Great Northern Peninsula who had just returned to the province. Four days later the province declared a public health emergency. Dr. Haggie warned it was just a matter of time before the virus spread through community contagion. Within days, this was confirmed.

By March 23 there were already 24 cases, with numbers rising quickly to 107 by March 27. Sixty new cases appeared on April 1. The peak was reached on April 17, with a total of 256 cases and three deaths. Since then, there have been five new cases, and only one since May 6. What explains the rapid turnaround?

Caul’s Funeral Home

Three-quarters of the rapid growth in March and early April can be traced back to an infected person who had just returned from a trip and attended a wake in mid-March at Caul’s Funeral Home. According to Dr. Fitzgerald’s team, 83 people, mostly living in St John’s, became infected at the wake or the funeral and went on to unknowingly spread the disease.

The source of this outbreak was quickly identified. On March 25, Dr. Fitzgerald ordered anyone who had been to Caul’s to immediately quarantine for 14 days and to contact emergency services at the first sign of any symptoms. The news spread like wildfire throughout the island and Labrador.

Meanwhile, the appearance of several cases in central and western Newfoundland, outside of St. John’s, allowed Minister Haggie to declare “it is not the townie virus.” (“Townies” are residents of St. John’s.) His message was heard loud and clear.

Fear and tracking

The dramatic outbreak at Caul’s showed just how quickly the virus could spread, which in turn helps explain the broad respect for the strict health restrictions imposed by Dr. Fitzgerald. Fearful, most people stayed home.

But the outbreak was also contained through rapid and efficient contact tracing. Of the 261 cases in the province by June 1, only seven are from unknown sources.

Thanks to this detective work, public health authorities have been able to accurately ascertain sources of transmission and tailor their directives to particular affected groups and targeted regions. The April 22 discovery of a Newfoundlander linked to an outbreak a week earlier at Imperial Oil’s Kearl Lake tar sands project in Alberta illustrates this well. Dr. Fitzgerald ordered anyone who had worked there and returned to the province since March 29 to put themselves in immediate quarantine and to call the emergency hotline. Another tar sands project has since been added to the list.

These cases of interprovincial transmission had the effect of a shock wave. Despite the rapid closing of borders to non-residents, there remained almost constant travel of Newfoundlanders and Labradorians within Canada and beyond due to the jobs they fill. Considered essential workers in mining, petroleum and construction industries, these long-distance commuters now constituted a threat as they came home. Dr. Fitzgerald also imposed quarantines on all returning essential workers outside of their work hours.

Slowly easing restrictions

The new provincial health law empowered Dr. Fitzgerald to develop a recovery plan called NLife with COVID-19, unveiled on April 30. It includes five alert levels, from the most restrictive (level 5) to something approaching normal life (level 1), similar to the model used in New Zealand. Dr. Fitzgerald also recommended that people continue to go on walks, hikes and bike rides while respecting the two-metre social distancing rule.

By this point, the province had flattened the curve, but Dr. Fitzgerald maintained a level 5 alert. Only if the number of cases continued to remain low and it was possible to identify the source of new cases would the province move to a level 4 alert on May 11.

The loosening of the regulations permitted the “double bubble”: members of two households could meet as one. But this was a long-term choice, as a household could only double its bubble once.

No cases, no kitchen parties

On May 11 Newfoundland and Labrador moved to alert level 4. Dr. Fitzgerald’s plan requires 28 days to pass before moving down a level in order to cover initial viral incubation and any possible development of potential COVID-19 cases requiring hospitalization. At level 4, family gatherings and meetings with friends in parks and backyards were banned. Only the double bubble was allowed. Allowing herself a rare bit of self-mockery, Dr. Fitzgerald observed that social gatherings start off with people respecting the two-metre rule, but we all know how they end. Dr. Haggie struck a slightly more sombre tone, noting that moving to a new alert level will mean new cases.

He described it as a calculated risk based on the assumption people will continue to respect social distancing regulations, and that the healthcare system has the protective equipment it needs and can follow up with adequate contact tracing.

As there has been just one new case since May 11, the province authorized moving to alert level 3 on June 8. This allows for outside gatherings of up to 20 people where the two-metre rule can be respected. Sharing food is discouraged, and large indoor gatherings are still prohibited.

The Fitzgerald enigma

During the COVID-19 crisis, “interim” was dropped from Dr. Fitzgerald’s title.

She “passed with flying colours” was Dr. Haggie’s assessment as he made the announcement, without providing any of the usual biographical details.

Despite her renown, earned through daily press conferences since the start of the crisis, Dr. Janice Fitzgerald has managed to maintain a private life. All we know of her personal life comes from a picture posted to Facebook by her teenage daughter. So we know she is a mother. She smiles when there is good news to announce and looks gravely serious when it’s bad. She answers media questions with clarity and concision, never varying her tone. A journalist covering the story remarked: “She remains a mystery. Aside from the fact she likes wearing large scarves, we know almost nothing about her.”

Until recently, heart emoticons populated the government’s Facebook page after each of her press conferences. Now comments are appearing about her intransigence in the face of pressures to return more quickly to a form of normality. Despite the grumblings, she maintains her hard line: “This is the paradox of public health,” she said during the May 19 press briefing. “When we are doing things right, it seems as though nothing is happening, and people are getting frustrated wondering why we must still adhere to the measures in place, when in actual fact the reason we are not seeing any new cases is because of these very measures. If they weren’t in place, COVID-19 would look very different in our province.”

An enigma, but a steel hand in a velvet glove nevertheless.

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