As N.W.T. prepares for next phase of COVID-19, medical director says physical distancing still key

It wasn't that long ago that things were mostly normal in Yellowknife.

Consider Saturday evening, March 14. Pubs and restaurants were open somewith lineups at the door and patrons carried on as if nothing in the world had changed.

The Polar Pond Hockey tournament in Hay River was underway that weekend. How unimaginable now?

Meanwhile headlines about the novel coronavirus were already dominant around the world.

By the following Tuesday theNWT Brewing Company had closed;the next day the Black Knight Pub announced it was closed as well.Before the week was out, the N.W.T. border was closed andthe first case of COVID-19 was announced in the Northwest Territories.

Since then restrictions on movement have only gotten more severe, with a 30-member task force created to monitor and enforce physical distancing and self-isolation orders.

It's been almost two weeks since the fifth case of COVID-19was confirmed in the Northwest Territories. Two cases have recovered, according to health officials. No more cases have been announced. Spring is in the air, and the novelty of physical distancing and staying at home is bound to wear off.

"My hope is that people will continue to take it seriously," said Dr. Sarah Cook, the territorial medical director for the Northwest TerritoriesHealth and Social Services Authority.

But the worst may still come in the form of community transmission of the illness.

"One of the risks as this progresses week by week [is] that people can get really tired of physical distancing and maybe there's a risk of people becoming a bit lenient,"said Cook. "If we're doing a really good job in the territory and we don't have community transmission and people let their guards down, that's really, I think, the biggest risk for us."

Community transmission is the spread of illness from person to person without knowing where contact with the virus was made. So far, all of the cases of COVID-19 in the N.W.T. have been isolated cases related to travel, and relatively straightforward to contain.

Community transmission would be a newand potentially dangerous phase for the N.W.T.

"As soon as the virus starts to spread between people, we may rapidly start seeing an increase in the number of cases," Cook said.

Community spread could be triggered by a presymptomatic or asymptomatic carrier of the novel coronavirus, especially by someone who is only a couple of days away from showing symptoms of the illness, Cook said.

A person could be shedding the virus, and not even know it.

"That again is why it's so important to maintain that physical distance, washing your hands, making sure you're following all of the advice of the chief public health officer [it's] to prevent any transmission that could occur if someone happened to have the virus and wasn't showing any symptoms."

The only way to prevent community spread is to "keep people away from each other."

New stricter restrictions possible

The streets of Yellowknife are not exactly empty, but weekday vehicle and foot traffic has taken a real dip.

Some businesses have closed, some have changed their approach to providing services, and some are largely open as usual, although with restrictions on how many people can enter at any given time and on how they can behave once inside.

It could happen at any time. It could happen tomorrow ...It all depends on how the public behaves.- Dr. Sarah Cook, territorial medical director

But the N.W.T. is not in a bubble. As essential traffic in and out of the territory continues (trucks, planes, mine workers, people still returning home from away) there are many vectors for the virus to spread.

It could even be here now, hosted by a presymptomatic or asymptomatic carrier able to spread the virus without knowing it. It may have already spread, but we wouldn't know because testing still takes almost four days to complete, and longer in a small community.

Cook says the territory is not only prepared, but expects the eventual arrival of community transmission.

"It's a trigger for another stage in our pandemic response," Cook said. "We have prepared and planned for this and we expect community transmission will occur as it has almost everywhere else."

It could bring new restrictions on movement, and even reassessment of what counts as essential services. Cook said groceries and water will always be available, but putting limits on anything else could be on the table.

"It will certainly be up to the chief public health officer to make decisions around some of the other services that may still be open that may not be deemed essential."

Despite preparation for the worst, Cook says the public's response to health advice around COVID-19 has generally been good and that is cause for some optimism.

"Community spread could happen. It could happen at any time. It could happen tomorrow. It could happen in a few weeks. It's impossible to say. It all depends on how the public behaves," she said.

"If people continue to physically distance we'll hold off community transmission."