SASKATOON -- It would be devastating if COVID-19 started moving through northern First Nations communities, an Ontario expert says. David Fisman is a professor in the Division of Epidemiology at the Dalla Lana School of Public Health at the University of Toronto. After making comments on Twitter regarding the outbreak, he responded to questions from CTV Saskatoon via email.

While the province  reported  just one new case of the virus in the far north on Thursday, 50 of the province's 88 active cases are concentrated in the region and two La Loche long-term care residents  have died from the virus.

There are outbreaks all over the country. What was it about the La Loche outbreak that caught your attention?

The La Loche outbreak is the first I am aware of in an isolated Northern First Nations community. These communities may have been protected in part by their remoteness, but COVID-19 spreading through such communities is potentially disastrous. Many lack strong health systems and resources at the best of times; COVID-19 causes severe lung disease that often necessitates intensive care. It is very difficult to med-evac large numbers of people south for ICU care. If this begins to cause epidemics in isolated northern communities many folks will die up north or die on the way south to care.

Crowded housing has been an issue in many northern communities as well; that makes it very difficult for folks to isolate or distance, which has proved effective in limiting COVID-19 spread elsewhere in Canada.

We saw this play out during the 2009 H1N1 pandemic, particularly in northern Manitoba communities. I fear that La Loche suggests we may start to see a similar dynamic with COVID-19.

The Saskatchewan government announced plans last week for a phased re-opening of the province's economy. In light of the La Loche outbreak, as well as other cases in the north, should that re-opening be postponed?

I think the Saskatchewan government has to make its own decisions. There's a lot of geography in Saskatchewan and a relatively dispersed population. Different approaches may be appropriate in different parts of the province; but I would think that you'd want to limit travel within the province to prevent hot spots from igniting other areas, especially in the north. We have seen what "linkage" of vulnerable populations can look like with our nursing home epidemics here in Ontario. That has caused a lot of death.

You need to try very vigorously to protect the north by ensuring lots of testing for situational awareness (e.g., testing folks flying into northern communities before they go), limiting movement between communities, doing whatever you can to keep disease out. Because once it gets into remote communities it's going to be awfully difficult to control, and you're going to lose people who can't be brought to care.

How has the Saskatchewan government done in terms of fighting COVID-19? Any particular strengths/areas of improvement stand out?

I don't know the details of the Saskatchewan response but we do cross-Canada forecasts each morning. Until this past week Saskatchewan had stood out for the rapidity and effectiveness of control of COVID-19 so this is clearly a setback.

What have we learned about the coronavirus/COVID-19 since it appeared in Canada?

Expect the unexpected and declare victory prematurely at your own peril.

What do we have to see before life returns to normal, ie. an end to physical distancing? Or is this what the new normal looks like?

This is it. We are going to be going one step forward, one step back for a while yet. We will figure this out, but a vaccine is a ways away (keep your fingers crossed … promising results from some early vaccine work). Distancing has proved to be very effective, but clearly has great economic costs, so we will be walking the tightrope for a while.