Nation-Based Sovereign-Based Government

Change to approach for COVID-19 in First Nations communities

February 28, 2022

Treaty 2 Territory – The provincial public health orders are in the process of being lifted in a phased manner in the coming weeks.  The rational for this change is due to several reasons.  We have seen a reduced effectiveness of contact tracing in the context of the Omicron COVID variant, which has a shortened incubation period and high rate of asymptomatic spread.  There has been an increase of accessibility to vaccines that are effective at preventing severe outcomes and we also have available to us effective treatments for COVID-19, which we continue to strive to improve access to.  These two interventions have resulted in a reduction in severe outcome rates.

It will not be possible to eliminate all the risks due to COVID-19, however it is imperative that we try to limit severe outcomes from COVID-19.  There is also a recognition that we need to scale our public health restrictions based on the risk that is present and we need to lessen the negative impacts that the public health orders have placed on our populations, including mental health, substance use, and economic impacts.

Severe outcome rates from COVID-19 have decreased in First Nations since wave 3 (alpha), with a reduction in rates observed when analyzing epidemiology after Jan 1, 2022.  This is likely due to a combination of vaccine induced immunity, immunity from infection, and a decrease in virulence of omicron variant.  Severe outcome rates continue to be higher for those who are unvaccinated.

First Nations in Manitoba continue to experience a disproportionate impact from COVID-19 when it comes to severe outcome rates.  This is rooted in colonization and structural factors such as overcrowded housing that continue to impact First Nations living in Manitoba.  Many of these structural determinants of health, such as overcrowded housing, or crowding in schools, are modifiable and investments need to be made to decrease the risk of disproportionate outcomes in First Nation communities in the short and long term.

It is likely that COVID-19 will become part of the normal seasonal circulating respiratory viruses, with different variants and seasonality leading to waves of infection. With this in mind, the overall decrease in virulence of Omicron strain is not equivalent to mild illness for all. Some may experience symptoms of post-COVID syndrome (long COVID), and some will continue to need hospitalization, ICU admission or die from illness.  For these reasons public health officials continue to strongly recommend following COVID fundamentals, including isolation when symptomatic, vaccination, masking and treatment for those who are eligible.

COVID indicators will be closely observed and should public health orders be required in the future they could be re-introduced.  When looking at COVID wave 3 in the spring of 2021, we know that it had a significant impact in First Nations communities, especially as it related to severe outcomes.  The reason for this was multifactorial but likely was a combination of a COVID variant (alpha) that was more transmissible and more virulent, lack of widespread vaccines available at that time, lack of access to COVID therapeutics, and underlying structural determinants of health such as overcrowded housing. As we enter a post-Omicron COVID wave in the spring of 2022, health officials are continuing to work on interventions to mitigate future impacts of COVID which includes increasing accessibility to COVID therapeutics, and vaccine campaigns that focus on booster doses for those eligible.  Although a vaccine is not currently available for those in the 6 months to 5 year old age group, processes are in place to roll out this vaccine out in a timely manner should it receive authorization for emergency use in the coming weeks or months.

It will be important to continue to use the layers of protection that we have all become accustomed to such as hand hygiene, masking, staying home when symptomatic, and social distancing.  Communities will continue to have autonomy when making decisions about local COVID prevention measures that may go above and beyond public health recommendations based on local epidemiology.  It is important that the workforce is able to shift towards addressing other urgent non-COVID priorities such as addressing childhood immunizations, STBBI outbreaks and implementing harm reduction initiatives.

COVID Response Measure in FN Communities

Former approach New approach as per Feb. 24

Case isolation

Recommend 7-10 day isolation for fully vaccinated, 10 days not fully vaccinated, 5 days for fully vaccinated essential workers on case by case basis.

Recommend to follow provincial public health orders: 5 day isolation from symptom onset or test day for fully vaccinated as long as symptoms improving and afebrile, must wear medical grade mask when in public, and avoid higher risk settings up until day 10.  10 day isolation for cases who are not fully vaccinated. See orders and provincial website.

Contact isolation

10 days regardless of vaccination status.

Isolation no longer required by public health order. Public health continues to recommend self-isolation for people who live in a household with others who have symptoms or tested positive for COVID-19 but it will no longer be required.  Close contacts and household members should also self-monitor for symptoms. Prevent severe outcomes by avoiding higher risk settings such as personal care homes, assisted living, congregate living, or hospital visitation for 10 days from last exposure to case.

Case investigation

Follow staging document.

(stages 1-5)

Recommend all communities move to stage 3 response – cases notify own contacts, use of abbreviated case form.

COVID testing

Follow staging document.

(stages 1-5).

Prevent severe outcomes by testing symptomatic individuals and referring for treatment if eligible.  Use rapid antigen tests for those who are symptomatic and not deemed to be at high risk. Avoid widespread asymptomatic testing, use for prevention of severe outcomes or to protect essential workforce.

Active Daily Monitoring

Not widely recommended, however if community pandemic team capacity is sufficient, ADM may continue for higher risk individuals.

No change.

Alternate Isolation Accommodation

Prioritize for those at highest risk for severe outcomes who would benefit from being closer to secondary or tertiary care site.

No change.

Northern Travel order

See order. No change.
Community stay at home order At community discretion based on local epidemiology.

Community stay at home order less useful given current context, could be re-considered should local epidemiology warrant in future.

Surge Support

Available upon request for COVID immunization, testing, contact tracing, administrative support, or ambassador support.

Rapid response team not available past March 31.

Travel testing

Recommend PCR or RAT prior to returning to community.

No change.

Proof of vaccination order

Setting specific, as per public health order.

Provincial Plan to lift order March 1.  Community leadership could consider extending this locally past this date. Further discussion with Public Health and/or Medical Officers of Health can occur to provide more specific guidance depending on local epidemiology.

Mask use

All indoor public places as per provincial public health order.

Provincial plan to lift order March 15.  Community leadership could consider extending past this date. Further discussion with Public Health and/or Medical Officers of Health can occur to provide more specific guidance depending on local epidemiology.

Weddings and Funerals 25% capacity if any attendee is not fully vaccinated, 50% capacity if all fully vaccinated.

50 people indoors if any attendee not fully vaccinated, no capacity restrictions when all fully vaccinated or under 12 yo. Provincial plan to lift order March 1.  Community leadership could consider extending past this date. Further discussion with Public Health and/or Medical Officers of Health can occur to provide more specific guidance depending on local epidemiology.

“Nothing about us without us”

Miigwetch, Ekosi

Boh Kubrakovich – Kiniw Lead Keeper

Government, First Nations in Treaty 2 Territory (FNT2T)

Last modified: February 28, 2022

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