Planning for A New Normal: Considerations for Nova Scotia OCMOH, 30 APRIL 2020 CONFIDENTIAL – DO NOT DISTRIBUTE Overview 1. Epidemiology in brief 2. Reopening framework in brief 3. Next steps 4. Bottom line 5. Questions? Figure: All NS cases of COVID-19 (n=999) by exposure status (May 5, 2020) CONFIDENTIAL – DO NOT DISTRIBUTE 5 12 Our Ambition: Early and Rapid Epidemic Control Reduce importation and transmission summer fall winter spring With early epidemic control, responses to outbreaks will likely continue to be required over time CONFIDENTIAL – DO NOT DISTRIBUTE Our goals: 13  There is some risk of increased transmission with reopening sectors of society. Our attempt, in reopening, is to balance this risk with the need to increase economic and social activity for the health of all Nova Scotians.  Every attempt will be made to minimize the risk by rapid identification of cases and contacts as they emerge. CONFIDENTIAL – DO NOT DISTRIBUTE 14 Readiness to lift public health measures is assessed based on 7 criteria from the Public Health Agency of Canada: 1. 2. 3. 4. 5. 6. 7. Epidemic Control Health Care System Capacity Public Health Capacity Management of Outbreak Risks Workplace Prevention Management of Importation Risks Community Awareness and Engagement CONFIDENTIAL – DO NOT DISTRIBUTE 15 Process: CONFIDENTIAL – DO NOT DISTRIBUTE Nova Scotia has, based on the PHAC guidance documents, developed a draft list of system indicators across the 7 criteria that will form the basis of a weekly risk assessment to inform reopening going forward. A table of senior executives (DM level) representing the various sectors impacted will steward the risk assessment and, more importantly, the engagement with sectors, going forward. 16  This risk assessment will help us see when the levels of outbreak activity and system capacity are sufficient to relax measures.  At this time, this is not imminent (days). The first criterion is low-to-no cases for a minimum of 18 days.  Nova Scotia is at a critical time in the outbreak – the capacity to end the measures is highly dependent now on keeping coronavirus out of high risk facilities, as well as not reintroducing it into areas currently experiencing low rates.  It is possible that there are regions of the province that will be ready before that, but there are risks to reopening different parts of the province at different times, the largest being the inadvertent encouragement of travel between regions. CONFIDENTIAL – DO NOT DISTRIBUTE Core personal public health measures must remain in place throughout all phases: 18 Core personal measures will continue throughout all steps of the loosening process Wearing medical mask, or if not available, nonmedical mask or face covering (NMM) if symptomatic and in close contact with others or going out to access medical care. Staying informed, being prepared and following public health advice Practicing good hygiene (hand hygiene, avoid touching face, respiratory etiquette, disinfect frequently touched surfaces) and respiratory etiquette CONFIDENTIAL – DO NOT DISTRIBUTE Ensuring physical distancing when outside of the home Increasing environmental cleaning and ventilation of public spaces and worksites Staying at home (not going to school/work) and away from others when symptomatic and following public health advice Limit non essential travel Considering use of NMM in situations where physical distance cannot be maintained the next decision is what to open Considerations for Nova Scotia 21 Principles  Feasibility  Minimize the number of COVID cases to prevent a resurgence that leads to a) morbidity and mortality b) overwhelm of public health system c) overwhelm of the health care system  Reduce the negative societal impacts of the pandemic response.  Stimulate economic activity  “Rollbacks” may be necessary – assessing the tolerance for these will be key CONFIDENTIAL – DO NOT DISTRIBUTE The potential of the opportunity for Nova Scotia in the midst of these strange events is not lost on public health… For all that has been changed or lost as a result of COVID – what would you want to keep as we go forward? CONFIDENTIAL – DO NOT DISTRIBUTE Once all criteria have been met, start with a set of interconnected elements that are feasible, minimize social disruption and stimulate economic activity including: Allowing some nonessential businesses to open Allowing daycare and education settings to operate/open Phase 1: Elements Allowing additional outdoor activities to resume Allowing nonurgent health care services to resume Allow small essential cultural gatherings (e.g., funerals) Increase permissible gatherings from 5 to 10 person maximum (NS specific) All of these proposed 5 elements would be proposed only if specific conditions can be met that would lower the risk of transmission (e.g., by reducing contact intensity and number of contacts) CONFIDENTIAL – DO NOT DISTRIBUTE 25 33 Beginning week of April 27 “soft launch” May 2 Ensure capacity in place to monitor indicators/threshol ds Develop operational plan with stakeholders Implement first step elements 28 days Risk assessment Ongoing monitoring of indicators/thresholds Risk assessment Next Steps (tentative and subject to change) • Ongoing work on Phases 2-5: Phase 2 including larger gathering size and so increase additional business– this will be targeted at “low risk” businesses Phase 3 – TBD increasing gathering size again – and now “moderate risk” businesses/workplaces Phase 4 – TBD – would include highest risk settings and another increase in gathering sizes Phase 5 – is DEPENDENT on VACCINE availability - all business reopen as desired when vaccine/therapeutics areopen 31 A decision to reopen will be based on the meeting of these criteria and not a “date”. Bottom lines: Reopening will be slow – over multiple phases rather than all at once. Tightening measures again may occur if reopening results in significant “flare ups” of activity. CONFIDENTIAL – NOT FOR DISTRIBUTION Thankyou.