'Don't pollute your haven': Experts advise cautious approach as P.E.I. emerges from COVID restrictions

P.E.I. is in a better position than any other province to begin easing back COVID-19 restrictions and restart its economy, according to a professor of epidemiology from the University of Ottawa.

But Prof. Raywat Deonandan, who specializes in global health, says provincial health officials have to develop "an enormous capacity" for testing and be ready to reinstate restrictions if there's a spike in cases. 

He and other experts are also suggesting the province itself remain in relative isolation from the rest of the world, at least for now — a key advantage so far, they say, in minimizing the local threat from the disease.

"I'm quite bullish on P.E.I.'s prospects here," said Deonandan. "I think you've got a good chance of being a thriving, active economy well before [other provinces] like Ontario and Quebec are."

As of Monday, P.E.I. had reported 26 positive tests for COVID-19, all of those related to travel outside the province. All but two of those cases are reported as recovered. The last new case in the province was reported April 15.

Premier Dennis King has said this week his government will put forward a detailed plan to ease restrictions and restart the economy in stages.

That effort is set to begin May 1, starting with the resumption of elective surgeries and an allowance for Islanders to take part in some outdoor activities.

P.E.I. 'the envy of many other jurisdictions'

Thus far, only one per cent of P.E.I.'s 2,773 COVID-19 test results (as of April 27) have come back positive. That ties with New Brunswick for the lowest rate in the country and a number that makes P.E.I. "the envy of many other jurisdictions in North America," said Deonandan.

But ideally, the "thriving, active economy" he's imagining for P.E.I. is one that exists in relative isolation — a "self-contained economy," and thus one without much of a tourism industry.

"You have kind of the perfect experiment right now," said Jeanna Parsons Leigh, assistant professor in the faculty of health at Dalhousie University.

A medical sociologist by training, Parsons Leigh is also a critical-care researcher. She's currently studying how vulnerable populations in Nova Scotia have been affected by the outbreak of COVID-19.

She refers to P.E.I.'s ability to close itself off as a "protective mechanism" helping the Island maintain its status as a jurisdiction where COVID-19 does not appear to have created a significant foothold, so far.

"But as soon as you open the floodgates," said Parsons Leigh, "you're then one step closer to other provinces that have drastically different situations."

Public health officials began screening at P.E.I.'s points of entry March 21, asking all those arriving in the province to self-isolate for 14 days. 

By April 1, the province was turning away travellers deemed non-essential.

Not a floodgate — more a dimmer switch

Like other jurisdictions beginning to open up, including Saskatchewan, P.E.I. has signalled it will loosen COVID-19 restrictions in stages.

"It's not opening the floodgates of the economy, it's tweaking a dimmer switch," said Deonandan.

"So you open the switch a little bit, let some people out and see what happens … and if things get rough, you turn the dimmer switch down again, close some businesses, send people home again.

"No one's done this before at this scale, in the history of civilization," said Deonandan. "So there's a bit of a learning curve here for all of us, and I think it behooves us to be cautious as we do it."

Expanding testing

Last week public health officials said P.E.I. now has the capability to conduct up to 2,000 COVID-19 tests per week — meaning in theory, the province could double the current number of Islanders tested since the outbreak began in as little as 10 days.

Deonandan suggests two specific ways P.E.I. should expand its testing regimen. 

One would be to test random samples of the population to try to detect whether or how COVID-19 is moving through the community.

P.E.I.'s isolation makes the province an ideal test bed, Deonandan said, and the results could have significance well beyond P.E.I.'s borders as researchers across the globe try to better understand how COVID-19 spreads.

The second way Deonandan suggested P.E.I. expand testing is by swabbing everyone who enters or leaves the province.

'Don't pollute your haven'

"Anyone who crosses that bridge I think should be tested at this point," he said, noting there are tests becoming available that can provide results in as little as 45 minutes.

"Anyone who is delivering packages off a plane, that sort of thing…. You've got a haven. Don't pollute your haven."

In the event of a fresh outbreak, Deonandan said health officials need to keep "a finger on the cancel button to compel everyone to rush back inside."

But Kevin Quigley, scholarly director of the MacEachen Institute for Public Policy and Governance at Dalhousie, said it would take a psychological toll on Islanders to have to deal with a second wave of COVID-19 infections and related restrictions — all the more reason, he said, to proceed cautiously right now.

"If people think that, 'oh we've got this thing licked' and then all of a sudden we go out, and then it sparks up again, and then people feel, 'Oh my God, I can't believe that we've just taken a big step backwards now.'"

All options involve risk

Quigley's area of expertise is in risk governance — how governments respond to disasters, crises, and pandemics like COVID-19.

He said six months ago even he could not have imagined the way this pandemic has unfolded, and the extraordinary steps taken by countries around the world in response.

He said each of those responses introduces risks of its own, something researchers talk about as "risk trade-offs."

"By managing down the risks associated with COVID-19 we might be exposing people to other health risks," Quigley said, for example by restricting access to other health services such as elective surgeries.

"On a larger scale though what you see are trade-offs around mass layoffs and closures where people are losing their jobs, albeit hopefully temporarily, because this is our particular approach to managing this risk."

As more is understood about the risks of COVID-19 and how it spreads, he said P.E.I. and other jurisdictions will be able to "recalibrate this risk trade-off" if and when it comes time to reinstate restrictions to prevent further spread of the disease.

In other words, a better understanding around the risks from COVID-19 might allow for targeted policies to contain it that produce less collateral damage, be it to the economy or something else.

"That's a nuanced dance that's going to happen as we move from what is a highly precautionary approach right now into something that's going to ease us back hopefully into something that looks a bit more normal."

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