Board of Health Meeting
Chair Keith Egli – Verbal report
April 20, 2020
Good evening, bonsoir, Kwe,
Thank you all for joining us tonight for our first ever
“virtual” meeting of the Ottawa Board of Health.
I would like to begin today’s Verbal Update with some
good news.
Heather Crowe Recognition
Femmes remarquables Ottawa
Distinguished Women is a collaborative volunteer initiative
currently comprised of over 50 community leaders from various cultural
communities and backgrounds with a shared passion for creating a lasting legacy
and conduit for recognizing the outstanding contributions and professional
achievements of exceptional women in Ottawa.
Last month, my office was
advised that Heather Crowe was being recognized for her Life Time Contribution
following a nomination I submitted last year, which was supported by Dr.
Etches.
For those who may not be
familiar, Heather Crowe was a
driving force in protecting us all from second hand smoke and Canadians across
the country are privileged to be living in smoke free environments thanks to
her determined efforts and unwavering legacy.
Heather worked in an Ottawa restaurant as a
waitress for decades and, having never smoked a day in her life, in 2002 she
was diagnosed with lung cancer. At the time, smoke-free policies in restaurants
were practically non-existent, leaving those workers exposed to the harms of
second-hand smoke. Heather fought hard to change these polices, but succumbed
to cancer in 2006, four days before the Smoke-Free Ontario Act came into
effect.
When Heather Crowe began her campaign, only
about 5% of Canadians lived in places where every worker was protected from
second-hand smoke. Four years later, laws were in place to protect 80% of
Canadians from second-hand smoke in their workplaces.
Heather Crowe was truly
outstanding in her selflessness and commitment to a bigger cause. Her
contributions have left each and every one of us with the assurance of living a
healthier life free of harmful second-hand smoke, greatly reducing that concern
for our future generations to come. Her public service was both courageous and
altruistic.
We are grateful for her
legacy and for her recognition by Femmes remarquables Ottawa Distinguished
Women.
City of Ottawa Response to
COVID-19
Next, I wanted to take this opportunity to update Board
Members on the City’s response to COVID-19.
I would like to extend my heartfelt thanks to all staff
of Ottawa Public Health, under the leadership of Dr. Etches, for the incredible
work they are doing in our community to respond to this pandemic. Let’s also
not forget to thank their loved ones who may be supporting them through these
times, taking on extra tasks at home while they put in countless hours.
I wanted to also share my thanks to our entire community
for following the important guidance provided by Ottawa Public Health, and for
coming together to support one another in this unprecedented time. We have seen
neighbours, businesses and community groups bring forward innovative ways to
stay connected and support each other with essential needs. I am incredibly
proud of this City and how we have responded to this pandemic together.
As you know, on March 25th, Mayor Watson
declared a State of Emergency for the City of Ottawa, which aligned with
Premier Ford’s announcement of March 23rd about expanding the
Province’s Statement of Emergency by shutting down all non-essential services.
Declaring a local State of Emergency
helped the City deploy its emergency operations and staff in a more nimble
fashion and enabled a more flexible procurement process for the purchase of
equipment and resources needed by frontline workers and first responders. At
the same time, City Council approved
a property-tax relief package and a grace period for the payment of
water bills to provide relief for residents and small businesses impacted by
COVID-19.
While all parks and their
amenities, such as sports fields and courts,
play structures and park equipment, are closed by Provincial Order, the City has
also closed municipal facilities and services such as recreation centres,
childcare centres, OC Transpo customer service centres, public library
branches, theatres, in-person public consultations, and more.
The City’s By-law Services
have been enforcing rules with respect to city parks and amenities as well as
any restaurants continuing to offer dine-in services whereas the Ottawa Police
Service is providing enforcement with respect to the Quarantine Act and any
businesses operating without an exemption.
The City
has continued to support residents experiencing social isolation, homelessness and those who are at risk of becoming homeless through
emergency shelters, support services and outreach while our housing providers are checking in with vulnerable tenants over the
phone.
We have established a Human
Services Task Force to ensure we are responsive to the emerging needs of the
community and have opened the Routhier Community Centre
in Lowertown as an isolation centre to help protect Ottawa’s homeless
population.
The City has also created
an Economic Partners Task Force, which is co-chaired by Mayor Watson and
Councillor El-Chantiry. This Task Force has been
advising City staff on how we can help the business community as this pandemic
evolves.
In partnership with the Task Force, we
have launched an online promotional campaign to encourage residents to support
local small businesses by doing things like shopping local online, buying gift
cards for later use, or ordering delivery or takeout from locally owned
restaurants.
On April 9th Mayor Watson
hosted a virtual town hall. Participants included myself and Dr. Etches, as
well as City Manager Steve Kanellakos, the General Manager of Emergency and
Protective Services, Tony Di Monte, and Police Chief Peter Sloly. It was an
opportunity to provide an update to the public and to answer residents’
questions about the City’s response to COVID-19.
And most recently, the
City launched three provincially funded emergency child-care services for
essential and critical service workers at no cost to families. These services are being
offered at three locations – one in Ottawa’s east end, one in the west and one
in the south.
Ottawa Public Health Collaboration with Renfrew and
District Health Unit
Lastly, the topic of Public Health Modernization has been
front and centre for the past year, with updates having been provided on this
subject at every Board meeting since April 2019.
Members will be aware that, as part of Ottawa Public
Health’s formal written submission to the Province, one of the key themes
focused on the establishment of regional service and collaboration hubs to
improve consistency and equity of public health program and service delivery
across Ontario to ensure system sustainability.
In late February, Vice-Chair DeGiovanni and I met with
representatives of the Renfrew County and District Health Unit Board of Health
to discuss opportunities for collaboration between our two health units and on
March 31, the Chair of the Renfrew County and District Health Unit Board of
Health followed up with a letter indicating that their Board would welcome the
development of a collaborative approach to become stronger together. Board
Members will have received a copy of that letter along with their Agenda
package for today’s meeting.
As a result of these discussions, and in light of the
ongoing COVID-19 pandemic, which has highlighted the importance of a strong,
collaborative and consistent public health system, I am recommending that this
Board of Health formally express its support for exploration collaborations
with Renfrew following the current COVID-19 emergency response and that, in the
interim, we authorize OPH’s senior management to work with Renfrew County and
District Health Unit’s senior staff to enhance collaboration where feasible.
I would now ask Member Menard to introduce a motion to
that effect, after which I would welcome any questions or comments from Board
Members before proceeding to a vote on the motion.
Board of Health Meeting
Dr. Vera Etches – Verbal report
April 20, 2020
Good evening, Bonsoir, Kwe,
This evening I will be providing updates on a variety of
topics relating to COIVD-19. I will discuss our approach to controlling the
disease, non-pharmaceutical interventions, how Ottawa Public Health and
partners are working together to support the community, operational aspects of
our response, and a look ahead in terms of when we may be able to start easing
restrictions.
Ce soir, je ferai le point sur divers sujets relatifs à
la COIVD-19. Je parlerai de notre approche pour contrôler la maladie, des interventions
non pharmaceutiques, de la façon dont Santé publique Ottawa et ses partenaires
travaillent ensemble pour soutenir la communauté, des aspects opérationnels de
notre réponse et d'un regard vers l'avenir pour savoir quand nous pourrons
commencer à assouplir les restrictions.
Symptoms
It’s important to remind the public of the full range of
symptoms and that symptoms can be much broader than traditional respiratory
symptoms.
Initially the typical symptoms of COVID-19 captured in the case
definitions included fever, cough, or difficulty breathing and symptoms of new
or worsening acute respiratory illness.
Recently, the signs and symptoms have expanded to include consideration of atypical
symptoms of COVID19, particularly for young or older people with unexplained
fatigue/malaise, delirium, falls, sudden functional decline, worsening of
chronic conditions, digestive symptoms (including nausea, vomiting, diarrhea,
abdominal pain), chills, headaches, croup, loss of taste/smell, unexplained
rapid heart rate (including in children), decrease in blood pressure,
unexplained drop in oxygen levels, lethargy, or difficult feeding in infants.
Expanded Testing
Local testing
capacity has increased to 800 tests per day and there
are a number of COVID-19 assessment centres across eastern Ontario where
testing is being done.
Specific to Ottawa,
since opening on March 13th, the Brewer Park Assessment Center
(Swabbing) has had over 9,700 patients registered and assessed with over 8,900 receiving
testing. This volume would have otherwise been managed in regional Emergency
Departments.
An increase in
testing across the region has been noticed as a result of the expansion of
guidelines to include atypical symptoms and increased
the list of people who should be prioritized for testing.
Une augmentation du
nombre de tests de dépistage dans la région a été constatée suite à
l'élargissement des lignes directrices pour inclure les symptômes atypiques et
à l'augmentation de la liste des personnes à être testées en priorité.
The highest priority
groups now include:
- Healthcare
workers and health care facilities staff
- Household
members (or similar close regular contact) of HCWs or staff who work in health
care facilities
- Residents
and staff in LTCH, RH, and other institutional settings such as correctional
facilities, homeless shelters, mental health and substance use treatment
facilities, hospice, and other congregate living settings.
- Hospital
inpatients and those requiring/likely requiring admission
- Members
or remote, isolated, rural and/or Indigenous communities
- Caregivers
and care providers
- First
responders such as fire fighters, police and paramedic, and other essential
workers; and
- Vulnerable
healthcare priority population with frequent healthcare contact (i.e., patients
with cancer/chemotherapy, dialysis therapy, pre-/post-transplant, pregnancy,
and neonates)
Case and Contact
Management - Digital Solutions
Case Management and provincial reporting of COVID-19
case data are essential for controlling spread of COVID19 in the community.
Each laboratory report of a confirmed COVID19 case represents a person that OPH
team members interview and support over their period of infectiousness. OPH has
ramped up its resource capacity to keep pace with the projected increases in
case numbers. In order to make efficient use of these resources, it has also
been necessary to develop a local case management database to replace existing
manual paper-based processes and augment available functionality of the
existing Integrated Public Health Information System (also known as iPHIS).
OPH has collaborated with the Ontario Ministry of Health
and Public Health Ontario to temporarily automate the daily reporting process,
for COVID19 cases only, directly from our new local case management system to
the provincial reporting tool. Automating existing manual/paper-based processes
will not only increase our case management capacity and support provincial
reporting requirements, it will also enable our case management team to work
remotely and achieve the objective of physical distancing. Pending
approval from Ontario’s Chief Medical Officer of Health, OPH will begin
using this new case management system.
Contact Tracing follows from case management and
contributes to containing the spread of COVID-19. The manual process of
identifying close contacts of infected individuals and of contacting and
following them is labour intensive. During the time it takes to identify and reach
close contacts, people may unknowingly be exposing others to the virus.
As the number of cases of COVID-19 continues to increase,
so does the possibility of community spread in close contacts of infected
individuals (increased physical distancing has resulted in reduced average
number of contacts in community cases).
Automating some aspects of this process could greatly
reduce the time to trace contacts, thereby optimizing efforts to contain the
spread of the virus.
OPH has identified a need to automate aspects of its
contact tracing functions. Specifically:
·
Identification of locations visited by
infected individuals while contagious
·
Notification of close contacts (known and unknown)
of infected individuals
·
Provision of information to close contacts
about measures to take
·
Daily monitoring of symptoms
·
Support for isolation and protective measures
There are several solutions currently in development in
Canada. However, while other jurisdictions in the world have made use of such
solutions, to date no jurisdiction in Canada has done so.
OPH has been in regular contact with the Ontario Ministry
of Health about our needs to automate aspects of contact tracing. We are not
aware of any plans by the province to develop or adopt a contact tracing
application. Similarly, we are not aware that the federal government has any
such plans. Should either the provincial or federal governments proceed with
making a contact tracing application available, we will consider aligning with
this solution or ensuring our application will be able to communicate with
others.
Developers of such solutions need to partner with a
recognized public health agency or government to make these applications useful
and available to the public.
OPH is looking to partner with a developer to finalize
the customization of a contact tracing application and to make it available to
the public.
The use of the contact tracing application would be on an
opt-in basis (i.e. voluntary) and safeguards would be put in place to protect
personal information, which would only be used by OPH to identify close
contacts of infected individuals and notify them of appropriate actions to
take. Further, OPH would only access this information with the explicit consent
of the infected individual.
Given that this is new technology not yet being used by
other Canadian jurisdictions, there is a motion for the Board of Health to
consider lending its support to this direction.
Étant donné qu'il s'agit d'une nouvelle technologie qui
n'est pas encore utilisée par d'autres juridictions canadiennes, il y a une
motion pour que le Conseil de la santé envisage d'apporter son soutien à cette
orientation.
Hospitalizations & ICU Trends
Because the number of laboratory-confirmed cases will
likely keep going up with increased testing, I prefer to look at
hospitalizations to get a picture about the overall trends in infection in our
community. While there is a lag between time of being infected and developing
severe enough infection to be hospitalize, it is less likely that these severe
infections are not counted, compared to the mild infections in the community
that people manage at home.
As of 4 p.m. yesterday, April 19th, there are
currently 37 individuals in the hospital (4%), (106 cumulative, 12%), of which
10 are in Intensive Care (1%), (32 cumulative, 4%).
The graph of hospitalizations shows that the number of
hospitalizations has been stable over the last week and a decline in the
hospitalizations would likely reflect a decline in infections in the community
the week before.
Health Care Capacity and Supports
Healthcare sector surge capacity is an important factor
in managing this illness.
La capacité de pointe du secteur des soins de santé est
un facteur important dans la gestion de cette maladie.
OPH has been involved in supporting the establishment of
many health-care related services
to increase healthcare and hospital capacity. The Brewer Assessment Centre,
which I mentioned earlier, was one example. Another is the establishment of
COVID-19 Care Clinics.
Currently there are two (2) COVID-19 care clinics
currently providing direct care to residents in Ottawa, one on Moodie Drive,
supported by the Queensway Carleton Hospital and one on Heron Road, supported
by l’Hôpital Montfort, with over 90 patients treated to date. The Heron Road
clinic saw 260 patients in its first 6 days of operation and the Moodie Drive
Clinic has seen over 650 patients since opening on April 6th.
These care clinics help deflect patients away from
emergency departments and primary care settings. The clinics follow an urgent
care clinic model, with diagnostics on site, and have integrated with hospital
health records for continuity of care.
Ces cliniques de soins contribuent à détourner les
patients des services d'urgence et des établissements de soins primaires. Les
cliniques suivent un modèle de clinique de soins urgents, avec des diagnostics
sur place, et ont intégré les dossiers médicaux des hôpitaux pour assurer la
continuité des soins.
The Community Paramedicine Program is active providing
outreach to LTC. Have leverage
regional General Practitioner labour pool to create a ‘home visit’ model to
enhance Community Paramedicine activities and care for people at home.
Ramping up activity through mobile outreach teams by expanding
outreach to
include retirement homes and vulnerable populations outreach (i.e. homeless,
First Nations/Inuit/Metis, women’s/family shelters, etc). The leveraged General Practitioner
labour pool supports Community Paramedics in testing, and to provide primary
care outreach to vulnerable populations. IPAC support for institutions and
there is a formal integration with Public Health to provide coordained support.
Personal Protective Equipment (PPE) is being collected,
stored and distributed regionally. Gloves, face shields and gowns are the items
most needed, regionally, for those who have supplies to donate We are working
closely with our partners to secure further supplies from the province. Work
continues to ensure that Long Term Care homes and retirement homes have enough
PPE to address their need. Donations can be made by going to
613ppedonations.ca.
Long-Term Care / Retirement Homes
Since March 1st, 24 COVID19 outbreaks have
been reported in institutions with 204 lab-confirmed cases (165 in residents, 39 in
HCWs) and 16 associated deaths. 5 institutional outbreaks have been resolved,
19 are ongoing.
All long-term care facilities and
seniors’ residences operating in the City of Ottawa receive regular
communications and guidance from OPH’s Infection Prevention and Control (IPAC)
team and are familiar with outbreak management protocols and
COVID19-testing guidelines.
Tous les établissements de soins de
longue durée et les résidences pour personnes âgées dans la ville d'Ottawa
reçoivent régulièrement des communications et des conseils de l'équipe de
prévention et de contrôle des infections (IPAC) de SPO et connaissent les protocoles
de gestion des épidémies et les directives relatives aux tests COVID19.
New provincial testing
guidelines mean that homes are now expanding COVID-19 testing in these homes to
include specified asymptomatic residents and healthcare workers during outbreaks.
Residents are now tested even if they do not have a fever and a cough if there
are other signs of a change in the person’s health that could be related to a
COVID19 infection. And, everyone being admitted to a home will be tested, even
if they do not have symptoms of infection.
It is important to remember that testing in itself is not
the solution to decreasing COVID-19 transmission in institutions that have
outbreaks. A negative test does not rule out that an individual is infected
since they could be incubating an infection, and therefore the result could be
falsely reassuring. Tests early in an infection may also be falsely negative if
the viral load is low. A reliance on testing results with ongoing testing of
people initially negative is a challenge, raising concerns of sustainability
and potential distraction from the primary importance of infection prevention
and control efforts. Personal Protective Equipment and sound Infection
Prevention and Control practices are what makes a difference in reducing
transmission. Universal masking, in particular, plays an important role in
reducing transmission from a person who is infected but does not have or does
not yet have any symptoms. Other PPE includes equipment that is principally
designed to protect the wearer: this still includes face masks but also
encompasses eye protection, gloves, and a gown.
Other supports to LTCH/RHs
are being increased through partnership with other healthcare providers – like
faster access to personal protective equipment, assistance with testing
options, and also getting access to more staff through regional staffing
plans. OPH is designating specific employees to be “brokers” between each
LTCH/RH and the “support teams” being created within the healthcare system.
To support priority
populations in congregate living, OPH has provided COVID-19 related guidance
and precautions for homeless shelters, violence against women shelters, youth
group homes through the Children’s Aid Society, rooming shelters, domestic
hostels and hospices. In congregate living settings, when there is a positive
case, our IPAC staff respond with the high level of rigor used for an
institutional outbreak situation. This includes investigations undertaken,
onsite education and recommendations based on the investigation to ensure that
appropriate prevention and control measures are taken. This may include working
with the City’s housing staff to transfer residents to other settings to reduce
the risk of further transmission. Supports are provided for needs such as food
services, through the Human Needs Task Force. We are also working with
community health centers to support these priority populations with health
literacy and education, and symptom monitoring support. Healthcare partners
have been instrumental in assisting with testing of residents in particular
settings.
Non-Pharmaceutical Interventions
Current models support that physical distancing—by which
we mean the 2 m rule as well as closures and stay-home restrictions—is the most
effective strategy
we have to decrease transmission of COVID19 in the community. However, a word
of caution about assuming that physical distancing is the most effective
strategy (implying that physical distancing cannot be improved upon) because a
potential adjunct that is likely just as useful—that which is, the use of masks
when outside the home, close to others in indoor settings—has not been as
extensively modelled. Masking can play an important role in reducing the
transmission of the COVID-19 virus. Therefore, the most effective strategy is
likely the combination of physical distancing and mask use. Nevertheless,
it has been shown that physical
distancing protects ICU capacity and hospitals’ ability to care for the sickest
patients. Physical distancing also decreases the likelihood that older adults
and more vulnerable populations will be infected. The more effective we are at
physical distancing, the flatter the curve and lower the number of infections
in the community we will have all at once, giving hospitals time to expand ICU
capacity, fine tune public health measures, and develop a vaccine. Yet, these
practices are hard to sustain. Everyone wants to know when we will be able to
relax some restrictions and I will speak about this more in a moment.
In the meantime, OPH has facilitated significant public
engagement campaigns to support physical distancing and other
non-pharmaceutical or public health measures. People continue to have
questions about how to best protect themselves and others with public health
measures and we are continuously adapting our messages to different audiences
and targeted needs.
We continue to ask people to
limit trips outside their home to essential needs such as for groceries,
medicine or daily physical activity, to limit close contacts to members of
their household, and to practice proper hand hygiene and coughing and sneezing
etiquette. These continue to be the best non-pharmaceutical interventions for
preventing the spread of illness in our community.
Home-made masks or face coverings are
one non-pharmaceutical intervention I would like to spend more time talking
about this evening.
We know that there is
asymptomatic or pre-symptomatic transmission of COVID19 in the 48 hours before
people feel unwell and would know to self-isolate. These are two different
concepts: an asymptomatic person can transmit the infection and never become
ill. A pre-symptomatic person will become ill but won’t know to self-isolate
until feeling ill and therefore may transmit in the 2 days or so before self-isolating.
Studies and modelling have now shown that asymptomatic and pre-symptomatic
transmission are very important drivers of the COVID-19 pandemic. Until a
vaccine becomes available to control the spread of illness, we recognize that
masks can play a role in slowing the spread of infection. If you are ill or if
you are asymptomatic or pre-symptomatic, wearing a home-made mask or face
covering protects others from your respiratory secretions, thereby preventing
the potential spread of infection.
Given the world-wide challenge with securing enough
medical masks for healthcare workers and first responders, OPH is avoiding
promotion of medical masks for the general public. The healthcare sector,
supported by the provincial Ministry of Health, has been working hard to
increase supplies of medical masks for healthcare workers. OPH is recommending
non-medical or home-made masks or face coverings for use when physical
distancing is not possible, such as in grocery stores or on public transit.
OPH has been hearing that access to non-medical masks is a challenge for people
in Ottawa and so there is a motion before you for the Board to support the
direction of pursuing options for increasing the production and supply of
home-made mask or face coverings to enable everyone in Ottawa to wear a
non-medical mask if they wish to follow OPH’s recommendation to add this layer
of protection against the transmission of COVID19 in our community.
Community Supports
Targeted messaging & Priority
Populations
OPH’s website contains a significant amount of
information and resources regarding COVID-19. Our website now has critical
information in over 30 languages and targeted messaging for seniors, parents,
youth and other key demographics.
OPH has a Priority Population Engagement Strategy under
development in order to address the unique communication needs of a variety of communities in
Ottawa.
The OPH Mental Health Team is working closely with
partners to support the community. For example, the Team has developed
guidance for coping with the current situation and speaking to children and
youth about the pandemic, a guide for employers on how to best support
employees’ mental health, and a series of tools and resources on “protecting
your mental health”. They have also partnered with OPH’s Indigenous Health
Liaison and the Ottawa Newcomer Health Centre to adapt messages on mental
health and coping with COVID-19 as well as general COVID-19 messaging for
newcomer and diverse communities. Since the onset of the pandemic, the OPH
Indigenous Health Liaison has been responding to a variety of public health
requests and working with Indigenous community partners to find solutions. S.
These efforts are in addition to OPH’s work with the City’s Human Needs Task Force
(HNTF) and the healthcare response. The Ottawa Aboriginal Coalition and other
local Indigenous partners have identified COVID-19 specific needs and barriers
for First Nations, Inuit, and Metis peoples in Ottawa. For example, the need
for collaborative case-management and access to testing with Indigenous primary
care partners. OPH is listening to Indigenous partners to understand the
communities’ COVID-19-related information needs as well as the most effective
ways to reach community members by leveraging existing communication channels
and networks. OPH has been working with partners to gather and share First
Nations, Inuit and Métis-specific COVID-19-related information and resources
including available mental health supports. There is funding available for
Indigenous-led COVID-19 initiatives and we are offering to partner and support
proposal applications as needed.
OPH has providing support to African, Caribbean, and
Black (ACB) populations as well as immigrants, refugees, and minority
populations. OPH has partnered with Somerset West CHC, Refugee613, Ottawa
Local Immigration Partnership (OLIP), and staff from Councilor King’s office in
order to assist with a series of Facebook Live events related to COVID-19,
mental health, enforcement, and violence against women. A Facebook Live event
for Arabic communities is also being planned on Mental Health and COVID-19, and
collaboration with the Somali Centre for Family Services is currently being
scoped to provide COVID-19 messages. A variety of communications are being
leveraged, such as the CHIN radio campaign and the development of videos in
Arabic, Somali and Mandarin on physical distancing, physical isolation, masks
etc. Furthermore, OPH is developing PSA’s around Multigenerational households
and self-isolation.
OPH is serving individuals with developmental
disabilities by providing assistance to members of the Ottawa Development
Services Network (ODSN). OPH is providing guidance on health questions,
resources for staff, access
to PPE supplies, as well as access to testing support for individuals within
their networks who may have difficulty getting to the testing centre and
obtaining timely results.
OPH is supporting the City’s Human Needs Task Force in
their rural outreach,
including a rural mailout being sent to residents this week and developing a
comprehensive list of residents who are isolated and vulnerable. The Human
Needs Task Force has facilitated consultations with rural ward Councillors in
order to determine what needs are being seen in each ward and to identify gaps
in messaging and services provided to this population.
OPH has been assisting older adults by providing and
promoting specific older adult content on the OPH website and will be reaching
out to organizations that support older adults to determine their information
needs. Resources and delivery methods will be adapted based on the feedback
received.
L'OPH aide les personnes âgées en fournissant et en
promouvant un contenu spécifique pour les personnes âgées sur notre site Web et
travaillera avec les organisations qui soutiennent les personnes âgées afin de
déterminer leurs besoins en matière d'information. Les ressources et les
méthodes de diffusion seront adaptées en fonction des commentaires reçus.
Mental Health
We are hearing from the
community and our partners that this situation is taking a toll on people’s
mental health.
OPH continues to add various resources on the
Ottawa Public Health website, including a video on maintaining your mental
health and a list of telephone, text or chat services. We are partnering with
the leading experts in mental health from the Royal, CHEO, YSB, the Ottawa
Health Team and the Ottawa Distress Centre and more, to develop tools and
resources to support residents mental health and wellness, and to ensure that
residents know how and where to access services for mental health and substance
use.
These resources and information on supports
and services have been grouped together and are now easy to find under the
“Mental Health and COVID-19” banner on our main Coronavirus page at
OttawaPublicHealth.ca/coronavirus.
Violence Against Women
We also
know that for some, home is not a safe place. For this reason, violence against
women and domestic violence, including child abuse and elder abuse, are a
growing concern.
Crime Prevention Ottawa (CPO), the
Ottawa Coalition to End Violence Against Women (OCTEVAW), Interval House of
Ottawa and the Eastern Ottawa Resource Centre have teamed up to launch a new
initiative called “Unsafe at Home Ottawa” - a text and online chat tool
that allows victims and survivors of domestic violence and abuse to get help
and support.
The service was created for those who
may find it impossible to reach out by calling a crisis line when trapped at
home with their abuser due to the ongoing COVID-19 pandemic and physical
distancing measures.
Ottawa Public Health has been and will
continue to promote these new resources through our social media platforms and
to raise awareness about this important issue.
Child Protection
OPH is in partnership with CHEO, the
Children’s Aid Society, and Ottawa Police Services in development of daily
child/youth protection meetings to assess complex cases during the current
COVID019 situation. In addition, there is a joint communication working group
developing strategies to promote reporting and communication to families,
children and youth during these difficult times. Finally, working with the four
school boards with whom OPH meets with weekly, we are reaching out to those
families that have not been in contact with teachers, principals, or the school
board. Teachers have a unique window into homes through online education and
are being provided tips and tools to identify concerns that may be arising.
We are OPH is? looking to connect with
these hard to reach families with the efforts through Human Needs Task Force to
do wellness checks in addition to the continued work CAS is undertaking with
their existing clients.
The Canadian Red Cross will be providing
wellness checks? With an initial focus on people isolated in rural areas and in
community housing. OPH is? currently working to ensure they have all the right
precautions and necessary PPE to send volunteers to do quick check-ins and
identify needs and mechanisms to connect with families who are hard to reach so
they can access services that are available.
Together we are working on pathways to support families
facing barrier to support.
Alcohol / Substance Use
Canadians are self-reporting an increase in alcohol use,
particularly people under the age of 54. A poll, recently commissioned by
the Canadian Centre on Substance Use and Addiction, found that 25 per cent of
Canadians aged 35-54 have increased the amount of alcohol they drink while
spending additional time at home [21% - aged 18-34 and 10% - aged 55+] [Poll
conducted between March 30 and April 2].
The three main reasons given for the increase are: change
of schedule, boredom, and stress.
Staying at home is critically important right now to
reduce the transmission of COVID-19. Certainly, people have different ways of
coping with the stress and isolation associated with the pandemic. Moderation,
as always, is key.
OPH is urging people to monitor their substance intake,
including alcohol and cannabis, to know their limits and pace themselves, to
find other means of coping with stress and isolation, and to reach out for
support if needed.
There are many resources available for those who need
assistance with substance use. One of them is Breaking Free Online (an evidence-based,
support program). The OPH Mental Health and COVID webpage has listed many
other resources and services available for substance use and mental health here
in Ottawa.
Community Gardens
Board Members will be aware that on March 30th
the Government of Ontario issued an Emergency Order that effectively ordered
the closure of all outdoor recreational amenities in Ontario. The list of
specific outdoor spaces subject to the closure includes “all outdoor allotment
gardens and community gardens”. This has been flagged as a concern because, in
addition to providing a source of outdoor physical activity, community gardens
also represent an important measure for increasing food security for many
residents. Further, we believe that with proper public health guidelines, such
as physical distancing and scheduling use to avoid crowding, community gardens
could operate safely. For these reasons, OPH is recommending a motion that the
Province consider amending the March 30th Emergency Order to exempt
outdoor allotment gardens and community gardens where food is grown.
Finance
All of the activities mentioned above take financial
resources to carry out. Currently, OPH is exceeding its budget by
approximately $750,000 per month, with most of this added cost due to employee
compensation for additional casual and temporary employees added to the team
and for overtime hours. This figure also includes loss of revenues and savings
as a result of program modifications. Financial figures are actively monitored
and subject to change based on the evolution of the response. Provincial
funding has been announced including one billion dollars for contingency and
emerging needs, as well as 160 million dollars for monitoring, surveillance,
testing, and virtual care. While we have asked for more details from the
Ministry of Health, OPH learned today that the financial support approved
specifically for public health units and Public Health Ontario is $100 million
for extraordinary costs incurred.
OPH Staff
The health and safety of our employees is our top priority.
Ottawa Public Health Senior Leadership Team has implemented
measures to safeguard employees in work areas occupied by OPH employees.
The measures are aligned with the latest guidance from the Ministry of Health
and Long-Term Care, the Ministry of Labour, Training and Skills
Development and the Public Health Agency of Canada and we will continue to
enhance these measures as new guidelines are provided or employees raise ideas.
This slide provides a summary of the measures that have been
implemented and are continually reviewed.
Look Ahead
We are often asked: “How long will the current situation
continue?”, “What needs to be in place before we can begin to relax
restrictions?”, “What data will you use to decide?”
To begin with, it must be clear that the current epidemic
here in Ottawa still has lots of room to grow if strong control measures are
not in place. Because our current tests can only tell if someone is currently
infected and because we have been able to only test a portion of those
infected, we don’t really know how many people in Ottawa have been infected.
The number may be somewhere around 1% or so of the population, leaving about
99% not yet immune to COVID-19 illness. This means that any illness can quickly
multiply if interventions like physical distancing and masking aren’t in place.
This situation will continue until perhaps a vaccine is available because we
are doing our best to not let the virus run totally free and infect two-thirds
to three-quarters or so of the population in one big wave that would completely
overwhelm the healthcare system.
In addition to the testing to detect the virus that is
taking place now, an important addition to the surveillance system will be to
test blood serum for antibodies against the COVID-19 virus, which, if found,
would show that the person had been infected and likely is, for the time being,
immune. Data about lasting immunity is still lacking. The Province is working
on a surveillance system that will include using serology tests that measure
antibodies to COVID19.
I want to take a moment to speak about the different
COVID19 tests that may become available and how they may be used differently.
The goals of testing for COVID19 change over the course of the pandemic. To
begin with, the tests that we first used and will continue to use are for
diagnosing someone with an infection. The test detects the COVID virus.
Initially, we focused on travellers to try to detect early cases and limit
introduction and spread of the virus. We then added focus to identifying the
virus in high risk settings and for workers who need to be back at work. We
rely on self-isolation and physical distancing to keep people who might have
COVID19 infections in the general population from passing them on without the
need for a diagnosis. Ideally, we will keep increasing testing capacity to be
able to find COVID19 cases in the general population so that our case and
contact management is as effective as it can be. Keeping the rate of
transmission as low as possible in the general population may help us let up on
some of the closure and stay-home restrictions (but maintaining the 2 m rule
and likely adding perhaps the wearing of masks when close to others in indoor
settings outside the home). As mentioned, the next type of test to be available
is the serology test and it will be less useful for diagnosis but will help us
understand what proportion of the population has been infected. Serology tests
are not as good for diagnosis because it takes a few days to a week or so for
antibody levels to become detectable; in other words, the virus detection test
will show that someone is infected sooner than serology will show that someone
was infected.
When people speak about “point of care” or “rapid COVID19
tests” they are often referring to serology tests, though point of care tests
that detect the virus are also being developed. None of these tests are
available in Ontario as yet to the point of being as useful intervention tool;
most still need to be validated. In some cases, countries have had to cancel
their rapid testing programs because of false negative rates being too high.
Last week, the World Health Organization shared their
recommendations in terms of six criteria that jurisdictions should have in
place before lifting restrictions:
·
That disease transmission is
under control
·
That health systems are able to
“detect, test, isolate and treat every case and trace every contact”
·
That hot spot risks are
minimized in vulnerable places, such as nursing homes, long term care
facilities, retirement homes and group homes
·
That schools, workplaces and
other essential places have established preventive measures
·
That the risk of importing new
cases “can be managed”
·
That communities are fully
educated, engaged and empowered to live under a new normal
Locally, we will be monitoring data and looking for a
sustained reduction in the number of cases hospitalized and in intensive care
units (over a 14 day period), looking to ensure we have stable hospital
capacity, strong testing and case and contact management capacity, and supports
for those who continue to be disproportionately affected, such as people in
congregate care settings and people who are homeless. The relaxation of
restrictions related to closures and stay-home requirements (but not the 2 m
rule) will need to be gradual and done in conjunction with other levels of
government and neighbouring jurisdictions. The use of masks outside the home
setting will likely also be an important adjunct to the relaxation of
restrictions.
In line with OPH’s commitments in our strategy, community
engagement on the priorities and process for changes is important. OPH is
working with the City of Ottawa on a public engagement plan.
Lastly, I wanted to mention that OPH is also involved in
the City’s flooding response as a liaison member on the Emergency Operations
Centre’s Spring Freshet Incident Management Support and has updated all our
flood-related health protection content and key messages, including a COVID-19
lens. As such, OPH has entered into situational awareness and is prepared for
an enhanced response if needed.
Should such a response be required, OPH’s main role will
be to support communications, provide IPAC consultation and link residents and
partners with resources. Residents are still able to submit well water samples
for testing at locations in rural Ottawa. Information on our website is up to
date for water bottle pick up and drop off locations and hours.
Thank you
I want to thank the Registered Nurses’ Association of
Ontario (RNAO) for their support during this crisis to significantly enhance
our capacity with over 100 nurses for triaging, test results, case management
and contact tracing. I want to thank our City partners. Other city
departments have been supporting our efforts in various way, including the
redeployment of resources to OPH and support of the Human Needs Task Force and
the Business Task Force, among other things. Right now, I want to thank our health
system partners for their continued efforts to increase capacity, share
resources, facilitate patient flow, and so many other aspects of this response.
Lastly, I want to thank the media for their continued work in ensuring
residents have accurate, timely information.