An Arviat resident has been confirmed as Nunavut's fourth case of COVID-19.
The person had arrived to the hamlet after completing two weeks of isolation in Winnipeg, Nunavut's Chief Public Health Officer Dr. Michael Patterson said during a Friday news conference. About a week after returning, the individual developed symptoms, which rapidly worsened.
The person was medevaced to a Winnipeg hospital for treatment. The person was then tested for COVID-19 and a positive test result was confirmed Thursday. The individual is still outside of the territory isolating.
They were not tested in Arviat, because Patterson said they didn't show standard symptoms at the outset of their infection.
The case is similar to another person who tested positive in Rankin Inlet, Nunavut, earlier this week.
About a week after returning to Rankin Inlet in late October following isolation in Winnipeg, the individual developed symptoms and tested positive for COVID-19.
The government of Nunavut uses two isolation hotels in Winnipeg for Nunavummiut to stay in before returning home from the South.
Officials are reviewing how the two individuals contracted the virus, but have not yet determined how transmission occurred.
There's no known link between the two cases, according to Patterson.
He said it's likely the exposure happened after the two isolated or at the end of isolation because the majority of COVID-19 cases have symptoms that show up five to eight days after contracting the virus.
An incubation period of longer than 14 days is very rare, which is why two weeks is the international standard for isolation, he said.
Miss Friday's news conference? Watch it here:
There are no changes planned for isolation protocols in the territory at the moment.
Patterson recommended anyone who has gone through any of the southern isolation hubs should be self-monitoring for 14 days after their return to the territory.
Self-monitoring people are allowed much greater freedom than those who are self-isolating, because they can go to work, but should be maintaining physical distance at all times or wearing a mask and if they can't. If they develop symptoms they should alert health officials and begin isolating.
Self-isolation is staying at home for 14 days after an exposure happened, which ideally means staying in your own bedroom and using your own bathroom, Patterson said.
So far, Patterson says the people who have been required to isolate in the territory feel comfortable isolating where they are, but he says the government is reviewing its stock of empty housing units and is prepared to move someone to a different location to isolate, if they feel they can't isolate at home.
As a result of this case, tighter restrictions will begin across the Kivalliq region. All non-essential businesses are being asked to close, masks will be required outside the home, indoor gatherings are prohibited and outdoor gatherings are restricted to a maximum of five people.
"We had the concern earlier, but we felt with one case we wanted to take the time to sort out what was going on and not make inappropriate or random decisions," Patterson said. "With two cases, it raises a concern that there will be more COVID[-19] in the region, so we felt we needed to act before we got all the information."
Gas stations, post offices and other essential businesses will stay open.
Starting on Sunday, travel will be restricted between Kivalliq communities, with only emergency and cargo flights permitted.
Anyone who has a critical need to travel out of the Kivalliq, after Sunday, will need to contact the office of the chief public health officer for permission via email: firstname.lastname@example.org
Hunters will be allowed to leave their communities, but they cannot travel to another community.
Grocery stores will be able to remain open, but with reduced hours.
Restrictions for Iqaluit stay as they were announced on Thursday, because Patterson says they haven't been able to identify anyone who has travelled up from Winnipeg — the area of high risk — through to Iqaluit.
"There's still a risk, but it's not as high as it is for the other Kivalliq communities," Patterson said.
These new restrictions were announced a day after restrictions were tightened across the Kivalliq region and in Iqaluit, following a confirmed case of COVID-19 in Rankin Inlet, Nunavut on Wednesday.
Two other cases have been confirmed in Sanikiluaq, Nunavut.
Nunavut managing healthcare needs
Contact tracing has "barely begun" in Arviat and a rapid response team is on standby to support the community if needed, Patterson said.
Nunavut has the ability to deploy three rapid responses teams, and two are currently deployed, Patterson said.
"Beyond this we'll be looking at deploying nurses from other health centres," Patterson said. He also said there may be more reliance on virtual public health nurses, if needed.
Sanikiluaq was well-prepared for its confirmed cases as a new health centre was recently completed and Rankin Inlet is a health-care hub for the region.
Arviat's health centre usually has six or seven community health nurses (who have an expanded scope of practice compared to most registered nurses), two public health nurses and most of the time there's a physician in town, Patterson said.
It does not have the capacity to admit people for care, it can only stabilize people while they wait for a medevac to a hospital in Southern Canada.
"Health care systems can get overwhelmed, like they did in New York and Italy, and we all know that we have less capacity," Patterson said.
The BioFire testing machines in both Iqaluit and Rankin Inlet are now certified to confirm COVID-19, so tests in the territory no longer have to be sent to a southern lab to be retested.
With the BioFire and the GeneXpert testing machines in Rankin Inlet, there is the capacity to process about 80 tests a day, if a technician is moved from their regular job to staff the machines.
Iqaluit has the capacity to do around 120 COVID-19 tests per day; more than that combined total and tests would have to be sent to Southern Canada labs, Patterson said.
Kivalliq schools closed
All schools in the Kivalliq have been moved to stage four of the Department of Education's COVID-19 response plan, meaning no students are to attend in person. Nunavut Arctic College campuses across the region are also closed.
There are 3,102 students in the region, according to a spokesperson for the government of Nunavut. Nunavut has ordered 3,000 laptops and tablets to assist students in remote learning.
However, Rankin Inlet — the first community in the region to lock down — is still waiting for those devices to be shipped to them.
Nunavut's Minister of Education David Joanasie said in a press conference Thursday that until the equipment arrives, students will be receiving paper learning packages to work on at home.
Schools will not close in all parts of Nunavut because Patterson says the risk to communities not served by the Winnipeg-Rankin flight path is low.
"It would not be sustainable to close schools across the territory for a long period of time based on two cases," he said.