A COVID-19 outbreak in remote Ontario First Nations will put immense strain on an already fragile health system, according to a doctor in Sioux Lookout, Ont.

Dr. Marilyn Koval, who has provided care to Mishkeegogamang First Nation and other northern communities over the last 20 years, said the federal government needs to immediately increase funding for nursing services.

Koval said more nurses are needed not only to deal with the potential of a pandemic entering northern Ontario First Nations, but also to provide care for pre-existing chronic ailments that current health care staffing levels can barely handle.

"That is the context in which we are layering this pandemic. Arguably the communities have been left vulnerable by not having the kind of nursing services that should have been in place," said Koval.

Koval was one of more than two dozen doctors from the region who issued a letter to Indigenous Services Minister Marc Miller calling for more nursing resources last Friday.

"Prior to the full appreciation and the naming of COVID-19 as a pandemic, we were already concerned and seeing as physicians that many basic primary care services were being inadequately resourced in terms of there being enough nurses," she said.

Koval said the shortage of nurses in communities has led to a number of children not being immunized, children's growth and development not being well tracked and even cancer screenings are falling through the gaps.

"This backdrop is going to potentially create more challenges in both containing the spread of the virus as well as sorting out even immediate treatment of people, treatment in terms of being able to triage people, making sure there are enough staff at the health centre, nursing station level.

"I think these are all things that need to be considered as we think of these isolated communities."

Deputy Prime Minister Chrystia Freeland (left) and Minister of Health Patty Hajdu. Hajdu said Tuesday the 'fragility' of northern Indigenous communities exposes them to 'higher risk for serious outcomes.' (Justin Tang/The Canadian Press)

Koval said federal and provincial health authorities need to keep this in mind when allotting health personnel as demand continues to ramp up to deal with COVID-19 across the country.

Koval said it's inevitable that the virus will enter a northern community.

"I think it's going to hit our whole country and I don't think that even remote communities will be completely spared," she said.

She said even after the virus subsides, the need will remain acute.

"We are going to need lots of staff to do COVID things as well as over the long-haul of chronic care."

Additional support measures expected

Northern Ontario First Nations are closing schools, postponing fly-in court hearings, stocking up on supplies, designating community buildings as possible isolation centres, curbing travel from the community and banning outside visitors.

Nishnawbe Aski Nation, which represents 49 northern Ontario First Nations, sent the first part of a funding request to the federal and Ontario governments detailing the needs of northern communities in the face of the pandemic.

NAN held a conference call with the 49 chiefs on Monday to gather information on what they specifically need for their communities. That will be included in an updated package to be sent to Ontario and Ottawa. First Nations chiefs don't expect to be able to get additional health personnel to their communities in the event of an outbreak, leaving them to fend for themselves.

Federal Health Minister Patty Hajdu said during a news conference Tuesday that the "fragility" of northern Indigenous communities as a result of lack of infrastructure, underlying health conditions and lack of health care resources puts them at "higher risk for serious outcomes" in the event of a COVID-19 outbreak.

Deputy Prime Minister Chrystia Freeland said Indigenous Services Minister Marc Miller would be announcing additional measures soon to support Indigenous communities.

"If the coronavirus were to get into one of these communities, managing it would be very, very difficult," said Freeland.

"In the measures we have taken already we have absolutely been thoughtful about and listening to what we have been hearing from Indigenous and northern communities."

Freeland said the recently announced cruise ship ban protects northern Indigenous communities that host them during Arctic excursions.