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April 16, 2020 Meeting Summary

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Board of Health Meeting Summary – April 16, 2020

Report of COVID-19 Public Health Response

COVID-19 Update

The Incident Management System (IMS) is functioning very well with COVID-19 as the Health Unit’s main business with 70% of staff being allocated to it.

It appears that we have been able to slow down the movement of the COVID-19 virus through the community with all the provincial restrictions and the social isolation of community members. At some point the restrictions will be relaxed and then we can expect more cases. A widely used effective vaccine against COVID-19 is what will be needed long-term. We are biding time and doing what we can to reduce the risk until it is available. In the meantime there is a lot of research being done that will help us manage this such as looking at antibodies that make people immune.

The Health Unit has experienced incredible collaboration with all of our many partners. We had good partnerships beforehand and this made it easier to adapt collectively to the current situation. The municipalities are making major contributions both to reduce the spread of the virus and to help people cope with a challenging situation.

Surveillance

COVID-19 surveillance reports are available on our website and updated every weekday at 4:00 pm under the COVID-19 tab under the section called surveillance reporting.

The data in the report comes from the provincial reportable disease database called iPHIS. When a case is identified with a positive lab result, our staff open a record in iPHIS on that case that includes contact tracing. The provincial reporting system uses the same dataset for the provincial reports. Varying times when the report is run means that sometimes there are small differences in the reported numbers between our report and the provinces. In these reports we are describing the characteristics of people who test positive, where they live, during what time period they contracted the disease, if they were hospitalized and released, and the overall mortality rate.

The report also looks at emergency department visits for conditions related to COVID-19 and hospital admissions. Currently in Leeds, Grenville and Lanark and across Ontario ER visits are down for all cases, and admissions are down as well. This could be due to social isolation, and there are also assessment centres and screening.

We currently have 5 outbreaks in long-term care (LTC) and retirement facilities and our cases are fairly geographically spread across the region. The median age of our cases is about 76 years. COVID-19 affects the elderly more severely. About 10% of our cases have recovered and this is increasing. About 8% have been hospitalized and 1/3 have required ICU – similar to across Ontario.

Department Updates

Quality, Information, and People Services

Human Resources/Workforce Management

Of the 141 employees at the Health Unit, the vast majority are working in an essential service or reassigned to COVID-19 activities, including: surveillance, case contact tracing and follow-up, outbreak management and support, health care provider and long-term care support, communications, public phone lines, education and enforcement of emergency measures, liaison with municipalities, community partners and other key stakeholders.

We initiated COVID-19 screening of all our staff starting April 1, 2020 using the Ministry of Health’s self-assessment tool before every shift. Since then, the average daily compliance has been 91%. So far, we have not had any employees test positive for the COVID-19 virus.

The province passed by Order in Council on April 1, 2020 a regulation under the Emergency Management and Civil Protection Act that allow public health units in Ontario to take broad powers with respect to work redeployment and staffing, without having to comply with provisions of a collective agreement, including lay-off, seniority/service or bumping provisions. Labour Management meetings are being held with both unions this week to discuss the implications of the Order in Council and our Workforce Management Strategy.

The ‘evergreen’ Workforce Management Strategy is based on several guiding principles and assumptions, with the objective of optimizing the use of internal staff for essential COVID-19 activities and finding alternative strategies should our workforce capacity become significantly impacted. Potential alternatives being explored include: use of medical students for case contact tracing, use of volunteers, and support from primary care.

Occupational Health and Safety Committee

The Multi-workplace Joint Health and Safety Committee is meeting weekly to discuss any COVID-19 health and safety issues.

We have developed a COVID-19 specific risk assessment, based on the RACE model (recognize, assess, control, and evaluate) and the hierarchy of controls. This has been completed on 22 different programs, services or roles.

Point of care risk assessments are also being conducted by our health care providers before service is given and there has been a decision making algorithm developed to indicate to staff when the use of PPE is required.

Numerous controls have been put into the workplace, including screening of staff and third party contractors, enhanced cleaning of frequently touched surfaces, environmental changes and signage in work areas and meeting rooms to facilitate social distancing, staff working from home, hand sanitization, and use of PPE when indicated by point of care risk assessments.

IT and Telecommunications

32.5% of the available workforce has been set up and are being supported by IT to work from home.

We have added 50 SIP phone lines to our Brockville office, with reprogramming to allow outer sites to access Brockville lines. This will spread out our staff to outer service sites from Brockville.

We have purchased 20 Zoom licenses and will have them fully functional this week. We have had to overcome challenges of using Zoom in a virtual environment.

IT has also been supporting meeting room set-up and re-location of staff within the Brockville office in order to maintain social distancing rules.

Redeployment of staff to new roles and departments also requires changes to set-up and permissions for shared folders.

Public Information

Susan Healey, as our Public Information Officer, is leading our communications activities, consisting of:

  • Daily media releases or interviews
  • Daily updates to our website
  • Updates provided to LTC, HC partners, Hospitals Communications and Ministry

Communications

  • Daily social media posts, on both Facebook Page and Twitter
  • Paid ads in local newspapers, radio and online (Facebook and Instagram)
  • We had 62,970 unique visitors on the front page of our website during March and the first week of April – an average of 10,000 per week (week of first case and outbreaks was 38,000)
  • Surveillance reports and maps are the top 8 most downloaded PDF’s on the website at the moment, with a high of almost 1,600 unique visitors on April 9, 2020
  • 3,977 Facebook followers as of April 4, 2020 – Increase of 34% from January 1, 2020 (2,607)
  • 66,486 people have been reached by posts between April 7–13 (number of engagements: react, share, comment)
  • 851 followers on Twitter, increase of 49% from January 1, 2020 (577)
  • Between April 7–13, HU tweets earned total of 4.2K impressions per day, and 33.4K impressions over this 7 day period

Healthy Living and Development

Sexual Health Clinics

We will continue to have staff available to see sexual health clients for priority services during our regular clinic hours. Appointments will be call ahead or call at the time. Clinics have been busy – seeing 5–10 clients in bigger offices with fewer clients in smaller offices.

Harm Reduction

Seeing less than 50 people per week in all sites, needle syringe program is still by drop in.

Smoking Cessation

We are out of nicotine replacement therapy supplies so we are providing referral and counseling by appointment.

Healthy Babies Healthy Children

We have one nurse in Kemptville, Almonte, Smiths Falls and Brockville contacting our post-partum clients within the 48 hour time frame and offering postpartum and breast feeding support over the phone.

We are continuing to support our Infant Feeding Clinics through appointments in all locations.

  • We are seeing about 6 clients per week at all sites
  • We are struggling to keep Moms and Babies breast feeding
  • Continuing with online prenatal classes

Community Liaison

Public Calls

  • Have 12 live lines to answer calls from the public 7 days a week 8:30am–4:30 pm. Call volume has dropped over the last 2 weeks to approximately 80 per day.

Assessment Centres

Brockville Memorial Centre, 100 Magedoma Boulevard:

  • 10:00am–5:30pm, 7 days a week to be assessed for testing.
  • Starting April 17, 2020 moving to a self-present model and appointments or referrals for the centre are no longer required and people can come to the building to be assessed for testing.
  • Any people experiencing symptoms will be encouraged to come for an assessment and possible testing.
  • Individuals are encouraged to complete the online COVID-19 assessment tool before attending the Brockville Assessment Centre.
  • If getting to the centre is an issue, call the Health Unit and discuss your transportation needs.

Public Health Nurses are doing the post swab discharge teaching at the Brockville Assessment Centre.

Smiths Falls and Almonte

Other assessment centres within Leeds, Grenville and Lanark, (Almonte and Smiths Falls) use a referral system. Referrals can be sent by a primary care provider (family doctor, nurse practitioner, or clinic) or by the Health Unit, 1-800-660-5853 extension 2222.

Shelters

Leeds and Grenville

  • The United Counties of Leeds and Grenville is accepting referrals and inquiries for the Temporary Social Distancing Shelter.
  • The shelter has been established in collaboration with a number of organizations (Brockville Police, Leeds Grenville and Lanark District Health Unit, United Way Leeds Grenville, Change Health Care, Victim Services Leeds Grenville and Lanark Leeds and Grenville Addictions and Mental Health).
  • The shelter consists of a staff office and a block of hotel rooms in the City of Brockville. The shelter will begin accepting referrals after 2:00pm on Thursday, April 16, 2020.
    • During daytime hours (for referral or more information) please call: 613-342-3840 extension 2129
    • Between 4:00pm–10:00pm – please call 613-802-3505 (cell)
  • The shelter has come together to provide a temporary option for those in Leeds and Grenville that may be homeless or precariously housed and with no opportunity to socially distance during the COVID-19 pandemic.
  • Testing for clients who screen positive will be done by the Leeds and Grenville EMS Community Paramedic program.
  • Clients who test positive for COVID-19 will be quarantined at the shelter.
  • The Health Unit will be providing:
    • Expertise on infection control, shelter set up
    • PHN support for clients
    • Needle Syringe Program supplies and Nicotine Replacement Therapy supplies
    • Support screening of clients, staff and volunteers and referral to EMS for testing for COVID-19

Lanark County

  • Currently working with Lanark to set up a similar temporary option for those in Lanark County and the Town of Smiths Falls that may be homeless or precariously housed and with no opportunity to socially distance or quarantine during the COVID-19 pandemic.
  • The Health Unit will be providing:
    • Expertise on infection control, shelter set up
    • PHN support for clients
    • Needle Syringe Program supplies and Nicotine Replacement Therapy supplies
    • Support screening of clients, staff and volunteers and referral to EMS for testing for COVID-19

Emergency Child Care for Essential Workers

Workers supported through this initiative include but are not limited to:

  • Health care, including pharmacy and paramedic
  • Grocery stores
  • Police and Fire Services

Lanark Locations:

  • Perth TayCare: 100 Wilson Street East, Perth, Ontario K7H 1M4
  • Smiths Falls Child Development Centre: 73 Thurber Street, Smiths Falls, Ontario K7A 4V1
  • Ages 18 months to 12 years old

Leeds and Grenville Locations:

  • Licensed child care centre spaces in both Kemptville and Brockville
  • The establishment of these centres has been a collaborative effort of the UCDSB, Leeds, Grenville and Lanark District Health Unit and the non-profit child care operators
  • Services will operate from 6:00am–9:00pm, seven days a week
    • Kemptville is operated by Kemptville Family Resource Centre (KAFRC)
    • Brockville will be operated by Kampus Kids Early Learning Centre
    • Today UCLG applied for approval to open a second site in Brockville

Community Health Protection

Essential Services: There are essential services that the department is providing during the Pandemic response:

  • Mosquito surveillance for WNV, ZIKA, EEE starting soon at 8 locations throughout Leeds, Grenville and Lanark
  • Adverse water sample follow up
  • Other emergency responses
  • Ongoing responses to situations such as ground water contamination and similar and respond to new situations
  • Animal Exposures for rabies prevention
  • Food borne illness follow ups; food recalls
  • Infection prevention and control issues follow up
  • Communication with CEMCs and EOCs across the Tri-County area

COVID-19

Department involved in the front lines of the Pandemic response for 81 days to date.

Communicable Disease Response

Testing, communicating results, positive clients and contact tracing; information and support to hospitals, primary care teams, long-term care and retirement homes, assistance with outbreak management in long-term care and retirement homes.

Enforcement of Emergency Measures Orders

Working with partners on this, a table prepared to share with enforcement and other partners to ensure the ability for quick follow up by the most appropriate enforcing agency. Many new regulations under the EMCPA that impact work of the health unit, partner municipalities and agencies.

Planning

Communication with other partner agencies regarding sharing mutual adaptations to COVID-19 and how the Health Unit can help: Municipalities, Conservation Authorities; Ministry of Environment; Ministry of Labour; MNR; CFIA; OMAFRA and others.

Public Response

We respond to complaints within 24 hours pertaining to COVID-19 or Environmental Health related; we track these and where applicable these may be found on the InSight disclosure site on our website. We provide information, media releases and web educational information. We receive public requests via emails, phone calls, webmail inquiries, and the duty desk is available 7 days per week to receive complaints and concerns. After hours on call managers can also receive and respond to complaints.

Food Safety

  • Food safety measures for the public for specific food premises with modifications to public health measures to ensure essential service continues in a manner which addresses the potential risks of COVID-19
  • Fact Sheets for: funeral homes; group homes; grocery stores; take-out food premises; infection prevention measures for premises Public Health Inspectors do not routinely inspect

Water Safety

  • Continuing with water sample facilitation with modifications due to COVID-19
  • Ensuring closure of public pools and spas

Health Environments

  • Radon gas follow ups
  • Working through complaints/concerns about public and recreation places (boat launches) and working towards consistency with the provincial requirements for closure; alternate suggestions to circumvent prohibition to gatherings being reviewed
  • Entering the season of large gatherings and fairs – will wait for the direction we receive from the province

Land Control Part VIII

  • Municipalities have received their annual dashboards of service received through this program for 2019
  • The first quarter of 2020 has been the busiest in terms of applications for permits in 8 years
  • Some changes have been made to legislation temporarily to allow for longer periods of time to process various items such as sewage permits; also to slow down applications

Other

  • Issues identified through other Health Units such as concerns about types of businesses opening; concerns about LTC non-compliance; first tickets issued under the EMCPA and disclosure of that action on health unit websites.

IMS Health and Safety at this phase of Pandemic

There is a productive partnership with the Multi-workplace Joint Health and Safety Committee (MWJHSC) which is meeting weekly to tackle important and timely issues. Important protective measures are in place for workplaces associated with LGLDHU work locations as well as Risk Assessments for staff involved in outside “work places” requiring modification due to the issues of COVID-19 – social/physical distance, wash hands often, avoid touching eyes, nose and mouth, clean frequently touched surfaces, use alcohol based hand sanitizers, cover cough or sneeze. Working on Psychological Health and Safety issues as the pandemic evolves and staff are fatigued and facing the emotional issues involved with COVID-19.

Finance and Property Update

Facilities

Due to COVID-19, there is an increase in the number of hours people are working within the Health Unit. People are working from various locations and during weekends in an effort to decrease potential risk of infection. This is resulting in challenges being experienced within the Health Unit for increased cleaning services to be provided.

To address this, we have hired 2 new casual caretakers as Health Unit staff. Additionally we are also in the process of recruiting at least 1 more person for casual caretaker duties. This is in addition to the 3 full time caretaker staff we normally have who work within our Brockville and Smiths Falls sites.

While cleaning services are already being provided by our Almonte and Kemptville hospital partners in our clinical sites, the Health Unit is also engaging in short term contracts with professional cleaning companies to ensure safe and healthy work environments are being provided at an even higher than normal standard.

Procurement

We have been encountering significant challenges within the various supply chains in the purchasing of many items. This includes the sourcing of Personal Protective Equipment such as N95 masks and gowns, as well as disinfectants and materials used by our caretaking staff.

Supply Management

To allow for greater control and stewardship of the constrained items being received, and ensuring they are redirected to where they need to go in as timely a basis as possible, all goods are being received at the Brockville Site and then redistributed to our various satellite offices. This also greatly reduces the risk of exposure to the COVID-19 virus by a larger number of staff by exposure to non-staff such as delivery persons and couriers.

On March 27, 2020 the Ontario Minister of Health issued an order that requires health care providers and health care entities, which includes our Health Unit, to provide information respecting supplies of PPE in stock, ordered and received. This is done to better address the shortages within the supply chain, and is submitted by spreadsheet on a daily basis to Ontario Health.

Finance

As a result of COVID-19, various Ministry partners have relaxed their reporting requirement deadlines. This in no way removes the reporting or stewardship requirements, but allows Health Unit management and staff to more fully concentrate on the pandemic for this critical period.

In order to better track costs related to COVID-19, we are tracking expenses separately as they are incurred. At an as yet undetermined time by the Ministry, we will report these expenses with the expectation of ministry reimbursement.