Kevin Patterson is a physician, essayist and novelist. He practises general internal and critical care medicine in Nunavut and on Vancouver Island. Full disclosure: he is the brother of Mike Patterson, the Chief Medical Officer of Health in Nunavut, of whom he is excessively proud.
This week as I walked through Naujaat, a hamlet in Nunavut formerly known as Repulse Bay, located directly on the Arctic Circle, people kept their distance. While southerners have been enduring waves of COVID-19 for almost two years now, the virus only just appeared here. The first case was announced on Jan. 15, and as of Jan. 25, there had been a total of 11 confirmed cases. Naujaat, population 1,082, is one of the last communities in Canada of any size to have the virus arrive, and anxiety is now seeping through the hamlet.
I arrived nine days after the virus as part of my regular work seeing patients at the local internal medicine clinic. There were several cancellations at the clinic by people who preferred not to leave their house. A blizzard had been gusting up to 70 kilometres an hour, with temperatures as low as -32 C. This kept people inside as well. All flights had been cancelled for days. People were huddling together in their crowded homes.
The last time it was possible to travel without anxiety in Nunavut was January, 2020. The internal medicine clinics then were concerned with heart failure and diabetes and chronic obstructive pulmonary disease and hypertension. They were busy and the days went late. Then came news of the novel pathogen causing pneumonia in Wuhan. In the weeks that followed, as COVID-19 began spreading around the planet, many Nunavummiut and health care workers involved with Nunavut worried particularly about how things might unfold here.
The history of epidemic respiratory infections in the Arctic is a melancholy one. The tuberculosis epidemic in the 1950s saw a third of Inuit children evacuated to southern sanitoria – sometimes for years at a time. It was a moment of cultural fracture and, by the early 1970s, there were no more Inuit living year round on the land. Twenty thousand years of nomadism in the Arctic came to an end. Though a horror of pneumonia and a certain ambivalence about doctors echoes on.
Canada is beating Omicron. But the game’s still on
‘I’m done with COVID’ is easier said than done
The respiratory syncytial virus has in subsequent years continued to kill babies in the north at rates higher than it does in the south. Measles, pneumococcus, the Hemophilus influenza bacterium, the influenza virus: all these have remained scourges in the Arctic, far out of proportion to the injury they cause in southern circumstances. So when the trouble in Wuhan began, and then in Northern Italy, and New York, it was tempting to look at those awful experiences and multiply them, when imagining how the new virus would come ashore along the Arctic Coast. Less obvious was the effect that all those years of colonialism would have on the vaccine rollout.
That it took that long for the virus to arrive was surprising – and testimony to both the seriousness with which the matter was treated by Nunavummiut and the effectiveness of the public-health measures put in place to limit its spread. That there was time to get everyone who wanted it doubly vaccinated; that there was even a vaccine available at all was very good fortune. When the influenza pandemic of 1918 came to Labrador, it killed 20 per cent of the Inuit there – by comparison, the death rate in the rest of the country was around 1 per cent. In Alaska, some Inuit communities lost every single soul. Supply ships showed up in the spring and nobody came down to the shore. The dogs had all starved; nothing moved. Emily St. John Mandel’s postpandemic scenes in Station Eleven read as if they were inspired by that stillness.
COVID-19 is a more virulent virus than the 1918 influenza strain: with ICU care and oxygen and steroids and in a mostly immunized, well-nourished population, its case fatality rate has recently been around 1.5 per cent, for the Delta variant. Omicron is lower, perhaps a quarter to half that – but it is also one of the most contagious viruses known. In New York and Northern Italy in early 2020, with the health care systems under great strain, the case fatality rate was more than 5 per cent. In the 1918 influenza epidemic, with no oxygen and without medicines that made any difference, the fatality rate was about a fifth of that. What the world has just been through was bad. But it could have been vastly worse. There has been good fortune at work, in the Arctic, especially.
However, while the influenza vaccination rates in Naujaat prior to COVID-19 approached 100 per cent some years, more people refuse the COVID-19 vaccination than used to refuse the influenza vaccine. This is the subject of some discussion in town.
During my current visit to Naujaat, after days of blizzarding, it becomes difficult to remain inside. Walking through the wind, hunched over, trying hard to remain standing, I see ravens fly low and close. There seem to be more this year than previously; a group of them – the collective noun is “an unkindness” – numbers about 20 and they hover close to the health centre and the hamlet office, rising raucously as I approach. They have always been flagrantly counterintuitive creatures. Other animals – the bears out on the ice, the hares, the foxes, the snowy owls, the ptarmigan, the peregrine falcon – are white in the winter, to elude predators, or to help them predate. These ravens are as jet black as they are huge. They look big enough for a falcon to feed off one for days. It isn’t like they would be hard to see.
Vaccine skeptics who come in seriously ill with COVID-19 infection to the ICU where I work in the South have kept our hospital busy for months. The decision not to be vaccinated in the middle of a pandemic is baffling – but so is addiction to the non-addicted, so is the decision of octogenarians to climb ladders to clean gutters, so is despair thoroughgoing enough that one decides to tie a knot in a rope. ICUs exist largely because of difficult-to-understand decisions. In the exhaustion of the last months, doctors and nurses often express frustration, sometimes frank anger, that the ICUs are being stretched beyond capacity by vaccine skeptics who have rejected modern scientific method and their medical expertise.
It is surprising and disappointing that vaccine skepticism has found a foothold even here, but with satellite television and the internet, every place gets the same messages. It doesn’t make sense to most doctors and nurses, but we don’t either, to the skeptics. Something about the way camouflage and concealment works is different for ravens. The logic of this is not obvious. But ravens exist. They don’t blend in, even though it might be thought to be in their interest. Hopefully, come the summer, when the supply barge comes, we’ll all be here to welcome it.
Keep your Opinions sharp and informed. Get the Opinion newsletter. Sign up today.