New Brunswick should further seal the Atlantic bubble by eliminating blanket quarantine exemptions for those who work outside the province, say two epidemiologists who have been following the success of the bubble.
"You've got a good set-up, don't mess it up," said Raywat Deonandan, a global-health epidemiologist and an associate professor at the University of Ottawa.
Infection control epidemiologist Colin Furness had similar advice.
"If you keep that policy in place, you're going to see cases."
But how can New Brunswickers know what to think?
A travelling worker is one possible source of the outbreak in Moncton at the Manoir Notre-Dame special care home, where 19 people — residents, workers and family members — tested positive for COVID-19 the first week.
And the public isn't being told how the outbreak started.
Citing privacy, Dr. Jennifer Russell, the chief medical officer of health, has refused to divulge the nature of the transmission at Manoir Notre-Dame, including whether it began with a traveller who didn't self-isolate properly or with a travelling worker who was exempt from self-isolation.
Without having to self-isolate, an infected traveller could have gone about his or her business and unknowingly infected someone who then visited the special care home.
Deonandan said it's important for the public to know how the Moncton outbreak began so that people can adjust their behaviour if necessary. Knowing will help prevent repeating it in the future, he said.
"There is something to be said for making public the mechanism of transmission so that people understand the seriousness of it," said Deonandan.
He said it's a balancing act that Public Health has to master — between protecting the public at large versus protecting an individual's privacy.
"I'm sympathetic to Public Health's job here, but if you were to ask me, I would err on the side of being transparent about the pathway of infection."
Ottawa Public Health has been more forthcoming — and graphic — with the information it releases. The belief is that the public should fully understand how not following the rules can impact so many.
A recent graphic tracks the spread after a person with mild symptoms attended a wedding in September, where there were no masks and no physical distancing.
Fifteen days later, 207 people were self-isolating and required testing. There were 22 confirmed cases and one presumptive.
That outbreak from a single case at a wedding infected eight households — including five members of one home — a school, and a group home. It also forced the self-isolation of students in a second school because of a presumptive case.
"Kids missed school, their parents couldn't work & testing lines were longer. Our. Actions. Matter," stated the tweet.
All of that information was released publicly, said Katie Bourada, a registered nurse who does communications for Ottawa Public Health.
She said the intent is to educate the public and illustrate how one person can affect hundreds of others by not following the rules.
Doctor shares good news
Russell has been asked at recent briefings how the virus got into the Manoir Notre-Dame, but has only ever said it's travel-related. She said the only reason she shared that information was because it was good news — it means the case wasn't community-transmission, which would mean they don't know the cause.
Russell hasn't always taken such a firm position. For months, she announced almost every new case by saying it was travel-related and the person was self-isolating.
But not in the case of the Manoir Notre-Dame.
Reporters have never asked Russell to identify the person, only to describe what the person did wrong.
As recently as Friday, the Department of Health was asked to clarify the source and specify whether someone hadn't properly self-isolated.
Public gets what's 'pertinent'
Department spokesperson Bruce Macfarlane responded by email on Friday afternoon, saying Russell had provided what the public needs to know and has been as transparent as possible, while protecting private information.
"Throughout this pandemic, Public Health always provided the pertinent information the public needs to take measures to protect themselves," Macfarlane wrote.
Public Health's stance, which is backed by Premier Blaine Higgs and three other political party leaders, doesn't address whether the public is getting enough information to know if government measures to protect people are adequate. More knowledge about the Moncton outbreak, for instance, might help the public consider the travelling worker exemptions.
Higgs dropped requirements in June for people to self-isolate after returning to New Brunswick from working in parts of Canada outside the Atlantic bubble.
But even a returning worker who doesn't have to self-isolate isn't supposed to visit any kind of long-term care facility. The province's rules say they have to "avoid contact with vulnerable individuals."
Deonandan said blanket exemptions such as those given to travelling workers are risky.
Parents had to miss work, kids had to miss school & 105 more people in line for testing. All from a BBQ. Our actions matter - Ottawa Public Health
"You want a bowl, not a sieve," he said. "You want a solid barrier with controlled access, not leaky borders that introduce potential super-spreading events."
Furness called the exemptions "reckless." In fact, he said, there's an argument to be made that travel for work is even more dangerous than travelling to visit family.
Travelling for work usually involves taxis, staying in hotels, eating in restaurants. And if it includes air travel, the risks are even greater, he said.
"Travel for work is one risk after another, all piled on top. If anything, I might suggest that people should be more compelled to self-isolate."
Self-isolation done incorrectly is another possible source of the Notre-Dame outbreak.
Regardless of what the local rules are for travellers when they return home, Furness said people should self-isolate for 14 days.
Ideally, they would leave their car at the airport and avoid contact with taxi drivers and even family members.
He said they should also really take self-isolation seriously — that means absolutely no contact with anyone else. For those who live with others, it can become tricky, especially with shared bathrooms and confined spaces.
If contact can't be avoided, the entire household should self-isolate, he said.
7 days better than none
Furness acknowledges the financial and mental health toll that such an approach can take. At the very least, he said strict self-isolation should last seven days.
"There might be an argument for lessening the quarantine period," he said.
After all, he said, the majority of people who catch COVID-19, show symptoms within the first seven days. The second week acts as an extra precaution to catch all possible cases.
"If the current guidance says don't isolate at all, then seven days is infinitely better," said Furness.
And, regardless of what rules are in place, travellers should "not go visit grandma."
What happened at a barbecue
"You need to think about your obligation to people around you. And that's where going above and beyond guidance would be a good idea."
The stakes are just too high, he said.
After all, according to another graphic from Ottawa Public Health, this is what community transmission looks like: "a 40-person BBQ in a park led to 105 high-risk contacts in schools who had to self-isolate for 14 days & be tested. Parents had to miss work, kids had to miss school & 105 more people in line for testing. All from a BBQ. Our actions matter."
That, too, was a real case, with all of the details shared by public health officials.