A large and isolated region of northeastern Canada entered a lockdown this week as cases of COVID-19 creep up in parts of the country with limited access to advanced medical care.

More than 80 cases have been identified this month in Nunavut, where around 39,000 people, predominantly Inuit, live in communities scattered across a territory the size of Mexico. The worst-hit area, Arviat, has 58 cases in a hamlet of fewer than 3,000 people.

The new lockdown started Wednesday and is set to last two weeks.

"I am asking Nunavummiut to stay strong and to stay focused," Nunavut's premier, Joe Savikataaq, said on Friday, referring to the territory's residents. "Please do not give it a chance to take more of a hold in any of our communities."

Many of Canada's northern regions had kept the pandemic at bay with strong travel and isolation rules. Coronavirus rates have generally remained lower among First Nations than other groups in the country.

But there are signs the dam is starting to break this fall, as cases rise nationally. In October, the Canadian government's department of Indigenous services identified an"alarming rise in the number of new and active COVID-19 cases" on First Nations reserves.

The risks are far higher once COVID-19 reaches fly-in communities, said Dr. Anna Banerji of the University of Toronto, who studies respiratory disease in Canada's Arctic Indigenous communities.

"Almost any chronic condition, they have higher rates," Banerji said, including comorbidities from diabetes to tuberculosis. "If it spreads, then I think that you're going to see much higher rates of morbidity, more severe infections, higher rates of ICU admissions, higher rates of death."

Nunavut has just one hospital with 35 acute care beds. Residents of the territory must routinely fly south to urban centers like Winnipeg and Ottawa for specialized care. For patients with severe COVID-19 symptoms needing hospital care, "for some of them, there could be huge delays," Banerji said.

Nunavut's chief public health officer, Dr. Michael Patterson, noted that if testing needs increase beyond local capacity, samples may need to be flown to laboratories in the south. (In Calgary, researchers are piloting delivering testing kits and personal protective equipment by drone.)

Like many regions of northern Canada, housing shortages mean many people live in large households, making isolating COVID-19 patients challenging. In northern Saskatchewan, the CBC reported some communities have deployed RV campers.

For all these reasons, Banerji argues residents of these regions should be prioritized to receive vaccines, once they become available.

Patterson said the territory and federal government have discussed the possibility of Canadian military assistance in the case of a worsening outbreak.

"Obviously the higher the case rate or infection rate is in southern Canada, the more risk of having further events like this where it comes [north]," Patterson said.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

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