Thank you for the opportunity to speak to this committee. I welcome the chance to share Nunavut's experience during the COVID-19 pandemic.
In comparison with the rest of Canada, Nunavut's size, isolation and social determinants of health leave the territory at significantly higher risk of severe impact from infectious disease outbreaks. This is as true for COVID-19 infections as it is for tuberculosis and was for H1N1 influenza. I would like to take this opportunity to illustrate how some of these factors can magnify the impact of outbreaks in Nunavut.
At the onset of the pandemic, testing capacity in Nunavut was identified as a significant challenge, as this territory was entirely reliant on southern public health labs. Combined with decreased airline service, this meant that the turnaround time—the time from collection of a sample to getting results back—could be as long as 17 days. As you can imagine, that lag was not only unacceptable but also dangerous. It put us at risk of having weeks of undetected transmission before a response even started.
Today we can do confirmatory testing in both Iqaluit and Rankin Inlet, and our turnaround time is almost always less than four days. While this is good news, it is not sustainable. We rely on having chartered aircraft on standby, ready to collect swabs from remote communities and transport them to Rankin Inlet or Iqaluit. As of March, the charter aircraft system has cost $2.8 million and is vulnerable to mechanical and weather delays. However, without this charter system, there are limited options for reliable community-level testing that will give Nunavummiut the same kind of surveillance protection as most of the rest of this country.
Isolation was our second major obstacle and one of the areas where we felt the housing burden the most. Nunavut suffers from a shortage of housing, and overcrowding is common in every community. We estimate that less than half of Nunavummiut would have the minimum resources to safely self-isolate at home. We have seen from other jurisdictions and our own experience prior to vaccination that, when COVID-19 arrives in a household, it is common for everyone in the house to become infected.
By the middle of March 2020, it was clear that unchecked spread of COVID-19 infections could easily overwhelm our health care resources. As a result, the decision was made to mandate isolation outside of the territory for most individuals flying to Nunavut. With the exception of exempted workers, most travellers have spent 14 days in an isolation hotel in the south prior to coming here. While this form of isolation is not perfect, experience in Nunavut and around the world shows that it can be part of a successful risk reduction strategy that ensures that the frequency of introduction events is kept to a manageable level.
Out-of-territory isolation is not perfect. While it has been mostly effective, many have struggled with the extra time away from their home and family. For many Nunavummiut, this travel is the only way to meet certain medical needs, even though in doing so they increase their risk of contracting COVID-19 and face two weeks of isolation. This has caused some to delay treatment, and it has increased stress for those who do travel south.
Despite the mandatory isolation system, Nunavut has experienced a few separate introduction events. In November, the community of Arviat, with a population of about 2,700, was one of four communities in the Kivalliq region to have cases of COVID-19. For approximately three months, there were active cases in the community despite aggressive contact tracing supported by public health measures to reduce the spread. This required extra staff and near-daily charter flights to transport samples for testing.
At this time, Iqaluit is also experiencing an outbreak of COVID-19. The first case was identified April 14, with contact tracing showing that there was likely transmission occurring in the city as early as one week prior.
Despite earlier vaccination efforts, there has been a rapid rise in cases. Spread of infection has been driven by household contacts and contact between essential workers, who often work two or more jobs to make ends meet, which is that much harder in a remote northern community.
I hope this short review gives you an idea of some of the unique challenges that Nunavummiut face in their response to this pandemic. I also hope it has reinforced the idea that solutions designed in and for southern Canadian cities may not be appropriate for or applicable to remote northern communities. What is needed is support to develop solutions to local problems, as well as investments to reduce the risk of current health problems and future outbreaks.
Thank you.