Pangnirtung, a small hamlet on Baffin Island, is grappling with the largest tuberculosis outbreak in Nunavut since 2017, according to data the territorial government released on Thursday after refusing for months to reveal the extent of the disease’s spread.
The Nunavut Department of Health said on Thursday that 139 cases of TB have been identified in Pangnirtung in the past 18 months, 31 of which were active, meaning the patients were sick and infectious. The rest were cases of latent or “sleeping” TB, an asymptomatic version of the bacterial infection that isn’t contagious, but that puts patients at risk of developing active TB in the future.
The Globe and Mail travelled to Pangnirtung earlier this month as part of a continuing investigation into health care in Canada’s youngest territory. In interviews, community leaders have expressed frustration at the lack of official information about the TB outbreak, which Michael Patterson, the territory’s chief public-health officer, first declared on Nov. 25 without providing a tally of cases.
The size of the outbreak came as a surprise to Pangnirtung Mayor Eric Lawlor who, along with the rest of the hamlet’s elected council, wasn’t privy to official statistics on the ballooning health problem in his own community.
“The information should have been provided to us regularly to begin with,” Mr. Lawlor said on Thursday. “This is more concerning than COVID, actually. With the numbers being so high, it’s kind of worrisome and bothersome that we haven’t been addressing it more seriously from the government side.”
The Nunavut Department of Health published the figures in a news release a week after receiving a list of questions from The Globe about the ongoing tuberculosis outbreak in Pangnirtung, a community of about 1,600 people an hour’s flight north of Iqaluit, the territorial capital.
“I don’t know why they’re so secretive,” said Madeleine Qumuatuq, Pangnirtung’s community wellness co-ordinator. “You can’t be secretive and then do prevention. I mean, they’ve got to be truthful to us.”
Ms. Qumuatuq was one of several Pangnirtung residents who raised concerns about the pace of the government’s response to the TB outbreak. She pointed out that the health department rented the community hall – one of Pangnirtung’s few public spaces – beginning March 1 for a satellite TB clinic that still isn’t up and running.
“We’re missing out on a lot of age groups that would normally be coming here to play checkers, pool, whatever it might be. And the teenagers hang out here,” she said. “All that is taken away because they’ve rented the space. But they’re not even here yet.”
Danarae Sommerville, a spokesperson for the Nunavut Department of Health, said by e-mail that the delay has been caused by a shortage of skilled workers “required to ensure the Hamlet building has the appropriate wiring and network to set up workstations for staff.” Those workers were waylaid responding to the aftermath of a fire that consumed a government building in another hamlet, she added.
In responses to earlier questions about the outbreak, she pointed out that the Department of Health sent extra nurses and other front-line staff to Pangnirtung to help manage the outbreak – no easy feat during a national nursing shortage exacerbated by the pandemic.
Active tuberculosis infections, which are caused by bacteria that spread through the air and usually lodge in the lungs, can cause fever, weight loss, night sweats, fatigue and a chronic, sometimes bloody cough. Antibiotics can cure active TB and prevent latent cases from turning into serious disease. The infection can be fatal if left untreated.
Tuberculosis is a disease that most Canadians think of as a scourge of the past. But it remains a scourge of the present in Indigenous communities, particularly Inuit communities, where deep-seated poverty, overcrowded housing and limited access to medical care make residents particularly vulnerable.
The federal Liberal government, along with Inuit Tapiriit Kanatami, a national Inuit organization, promised in 2018 to eliminate TB in Inuit communities by 2030.
The most recent data from the Public Health Agency of Canada show there were 72.2 active cases of TB per 100,000 population among Inuit people in 2020, compared with a national case rate of 4.7 per 100,000.
Despite being 15 times higher than the national average, the TB rate among Inuit in 2020 was down significantly, from 188.7 cases per 100,000 in 2019 and from a 10-year annual average of 184.14 per 100,000 from 2010 to 2019. The decline likely reflects cases of TB going undiagnosed in the first year of the pandemic, experts on the disease have said.
Nunavut, which is home to the majority of Inuit in Canada, recorded 34 active cases across the territory in 2020, or 86.40 per 100,000, down from an average of 66 active cases per year territory-wide over the previous four years.
In February, Nunavut’s privacy commissioner ruled in The Globe’s favour after the newspaper appealed the territorial government’s refusal to release TB case counts by community, age and gender.
But privacy commissioner decisions aren’t binding in Nunavut. Health Minister John Main rejected the call to release community-level data, saying at the time that doing so could risk identifying patients and stigmatizing entire communities.
Neither Mr. Main nor Dr. Patterson were available for interviews Thursday.
Chris Puglia, another spokesperson for the Nunavut Department of Health, said in an e-mail that the department doesn’t plan to release TB data by hamlet, except during outbreaks. “Community level data outside an outbreak does not offer additional protection to public health and could further stigmatize the disease and create hesitancy in people seeking testing,” he wrote.
He added that Dr. Patterson’s office decided to compromise in the case of Pangnirtung and release updates every three months that “might assist in outbreak management.” The Department of Health released community-level data during Nunavut’s last major TB outbreak, in Qikiqtarjuaq in 2017-2018. A 15-year-old girl died in that outbreak.
Nunavut Privacy Commissioner Graham Steele said the government should go further and follow his ruling on TB data.
“I continue to believe that the law requires that community-level numbers be released, and not only at a time and place selected by the government,” he said Thursday. “It’s hard to hold the government to account for tuberculosis policy when it holds all the numbers in secret.”
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