As the Covid-19 pandemic fades as a public health concern three years after it changed the planet’s life, some healthcare organizations are studying the Cree Nation’s successful mitigation measures to better understand how to respond to future emergencies.
Cree Health Board professionals attended two conferences in March to talk about their unique pandemic experiences and responses. On March 15, several team members presented at the Journées annuelles de santé publique (JASP), the country’s largest francophone public health training forum, while some also participated in a pandemic forum the following week in Gatineau.
“At the JASP conference, we talked about how to work with Indigenous communities,” said Robin Gull-Saganash, who facilitated the event. “I discussed the adaptation and formalization of the contact-tracing training offered by the CHB.”
To reduce transmission, healthcare leaders formed contact-tracing teams in each Cree community. Developed by and for the Eeyou Eenou population, this program was accompanied by specialized support and tool development.
Working with nine communities posed challenges for regional coordinators as some were mostly autonomous while others required extensive support. Virtual communication platforms like Teams and Zoom quickly became ubiquitous, highlighting the region’s unequal connectivity.
“One of the challenges was doing training in a fly-in community that doesn’t have as much internet,” explained Gull-Saganash. “I had to be there virtually, adapting material to be simpler, making sure the content, tests and programming were on just one screen where I was used to interacting with each participant on Zoom.”
The Cree Nation Government developed preventive measures months before Covid hit Canadian populations, recognizing vulnerabilities like remoteness, overcrowded housing and a prevalence of chronic health issues. A leadership table united heads of all major entities, which swiftly coordinated responses.
When the pandemic was declared, local public safety officer (PSO) tables and a regional emergency group were ready. Checkpoints were established on roads accessing communities with information on travel and potential symptoms recorded in a centralized database.
“Because of the point of entry, we knew the names of who came in the last three days,” said Jason Coonishish, CHB coordinator of pre-hospital and emergency measures. “From there, we could test the wastewater in an area of the community and pinpoint exactly where Covid came from and contain it fast.”
As the virus replicates in the digestive system and is shed in high quantities often even before symptoms appear, testing conducted by the environmental health department provided an inexpensive method for monitoring without overburdening clinics.
“We had a containment plan that we followed precisely, working with frontlines like our fire departments,” Coonishish said. “We’d go directly to people who were positive and mapped out the community. This information we provided to the police and fire departments.”
Distribution of individual rapid testing kits improved response times. PSOs would contact individuals in isolation to answer questions, make recommendations and ensure basic needs were met – for instance, delivering groceries to their doors then waiting in the car until they were received.
Confidentiality rules meant frontline workers initially wouldn’t know whether Covid was present at houses they visited. Eventually, addresses with Covid would be provided without specific names so workers could adequately protect themselves.
Nonetheless, communities published lists of people who visited “hot zones” and required isolation, which was difficult for those with chronic illnesses who travelled frequently for medical appointments. The CHB limited access to Elders’ homes, where many were passing away.
After restrictions were reduced in 2022, the Omicron variant forced Cree leaders to remain vigilant with isolation and contact-tracing measures. Training for rapid testing was conducted over Christmas and by December 27 all communities were doing testing at fire halls.
“From January to April 2022, we faced Covid, rabies and avian flu at the same time, which impacted our hunters with geese and threatened food security and safety,” said Coonishish. “The Arctic fox with rabies attacked dogs in a couple of communities. With the protocols we’d put in place for three years, PSOs knew how to handle the geese with rubber gloves and protect themselves.”
The pandemic forced the Cree to develop greater emergency expertise but also the confidence to coordinate responses across communities. At JASP, Gull-Saganash explained how public health can support self-governance by identifying community partners and implementing programs with active engagement.
“We’re prepared but we’re also building capacity in the local work force,” said Gull-Saganash. “We have 58 community contact tracers trained from six sessions. Most of them speak Cree. That’s incredible because if we need contact tracers for any situation, we’ll already have the knowledge on hand.”
by Patrick Quinn, Local Journalism Initiative Reporter