Chair’s Speaking Notes
September 20, 2021 Board of Health Meeting
Good evening, Kwey (pronounced k-way), Aingai (pronounced
i-ng-nye), Taanishi (pronounced tawn-shai), Bonsoir,
I would like to begin by honoring the Algonquin
Anishinaabe Nation, land and people.
Ottawa is located on unceded territory of the Algonquin
Anishinaabe Nation and is a gathering place for many Indigenous peoples.
On behalf of the Board of Health, I would like to honour
the land and peoples of the Algonquin Anishinaabe Nation, whose ancestors have
lived on this territory for millennia, and whose culture and presence have
nurtured and continues to nurture this land.
I would like to extend that honour to all First Nations,
Inuit and Métis peoples, their elders, their ancestors and their valuable past
and present contributions to this land.
Next week, on September 30th, we will be
observing the first National Day for Truth and Reconciliation. This is an opportunity
to bring awareness to the painful legacy and impacts of the residential school
system, which is especially important in light of the discoveries of unmarked
grave sites at former residential school locations this year. It's also a time
to advance our reconciliation efforts to build a better future for everyone in
our community.
August 2021 Pride Activities
For
the past 19 years, Ottawa Public Health has actively been involved in the
Ottawa Pride Festival. OPH continues to work alongside 2SLGBTQQIA+ communities to ensure
access to welcoming, safe, supportive, diverse, and inclusive environments -
free of stigma and discrimination.
Again, this year, OPH partnered with
Community and Social Services to honor Pride Week in Ottawa with the Pride Flag
raising ceremony at the Mary Pitt Centre. The event was livestreamed
on YouTube
allowing the community and employees to participate virtually. As Chair of the
Ottawa Board of Health, I was proud to be there to take part in that ceremony.
Of course, no pride festival is
complete without a fun and colourful Parade. Once more we were able to
participate virtually by submitting a short video highlighting our support
to the community. I want to thank OPH staff and Board Members who were able to
be part of that fun activity.
Overdose Awareness Day, Getting to Tomorrow, and Recovery
Day Ottawa
On August 31st, Ottawa Public Health attended an event,
held at the Human Rights Monument outside City Hall, to recognize International
Overdose Awareness Day alongside people with lived and living experience, their
family and friends, service providers, allies, community partners and City
partners, including Ottawa Paramedic Services and Mayor Jim Watson.
Overdose Awareness Day is globally recognized in efforts
to reduce stigma and harms related to drug and substance use. Time and time was
taken during this event to acknowledge the grief felt by families, friends and
the harm reduction community of those lost.
Locally, nationally and globally, we remain in a
worsening overdose crisis that has been exacerbated by the COVID pandemic.
Sadly, the opioid crisis continues to take lives across Canada. The presence of
a toxic drug supply persists, and stigma remains a significant barrier to
accessing much needed services and supports. OPH and its partners are dedicated
to learning, adapting, creating and providing barrier-free services. OPH’s work
regarding substance use and mental health has been ongoing and remains a top
priority. OPH continues to advocate for systematic changes to be made at all
levels of government and supports efforts to amend government policies to make
all necessary resources available.
OPH continuously strives to learn more and do more to
advocate for the needs of people with lived or living drug using experience,
reduce stigma, remove barriers to accessing services, and promote harm reduction
philosophies and principles. This knowledge is used to work towards a society
where no one is forgotten or denied the care they need.
Last week Dr. Etches and I were honoured to participate
in a two-day dialogue about drug policy in Ottawa. The event was a part of Getting
to Tomorrow: Ending the Overdose Crisis, a national, Health Canada funded
public health initiative aimed at surfacing solutions to the overdose crisis by
bringing communities together to build consensus and a shared understanding for
change. The local event was led by the Drug Users Advocacy League and
Sandy Hill Community Health Centre and included many community leaders and
stakeholders from a diverse range of sectors, including people who use drugs
and people in recovery, youth, families, health professionals, representatives
from all levels of government, police, First Nations, Inuit and Metis
organizations, faith leaders, media, political leaders and more. It
provided an opportunity to come together, as a community, to talk about the
impacts of the unprecedented overdose crisis here in Ottawa and across the
country and to discuss how we can advance a public health and human rights
framework to respond. We look forward to continuing this conversation and
moving forward with the actions we heard were a priority for improving the
substance use health and wellness of Ottawa residents.
This past Friday, September 17th, Ottawa Public
Health took part in Recovery Day Ottawa, which is an annual community
event organized by the Community Addictions Peer
Support Association (CAPSA). The purpose is to help reduce stigma
surrounding people living with substance use disorders and to raise awareness
about substance use health, wellness, and recovery in the Ottawa community.
OPH works alongside CAPSA, partners and community members to
help support individuals and those around them in all aspects of recovery and
wellbeing. The pandemic has exacerbated many challenges in our community, in
particular the harms related to substance use. In Ottawa, we continue to face
barriers caused by stigma that surrounds substance use health. To address these
barriers, OPH is proud to be partnering with CAPSA and other partners, such as
the Royal, CHEO, The Ottawa Hospital and many more, to continue to take action
on reducing stigma through the Ottawa Community Action Plan.
Recovery Day Ottawa endeavours to engage the broader community
by building partnerships with local, provincial and national organizations and
to raise awareness through the #StigmaEndsWithMe campaign. OPH is
committed to continuing this work alongside CAPSA, those with lived and living
experience and the many community partners.
Vaccine Policy
As many of you know, on September 2nd, Dr. Etches
informed all Ottawa Public Health staff that OPH’s Employee Immunization Policy
had been updated to include a requirement for all employees, volunteers,
contractors and students to be fully immunized against COVID-19.
Similarly, on September 3, 2021, the City’s General
Manager, Steve Kanellakos, informed all City employees that the City of Ottawa
would be implementing a Mandatory Vaccine Policy requiring all employees,
contractors, students and volunteers to be fully vaccinated against COVID-19 by
November 1, 2021.
OPH has consistently expressed support for policies that
increase immunization coverage in our City and has been supporting employers in
developing and implementing their own workplace vaccination policies as part of
their COVID-19 safety planning.
We have consistently said that vaccination is our best
way out of this pandemic and that we must do all that we can to encourage
uptake.
I asked for and received a legal opinion that, because
OPH’s and the City’s vaccine policies are administrative, they do not apply to
elected officials or appointees. However, I feel very strongly that as the
governing body responsible for public health in Ottawa, our Board should lead
by example.
At the September 8th meeting of City Council I
was happy to second 2 motions put forward by Mayor Watson – the first to direct
that the City’s Mandatory Vaccine Policy apply to Members of Council and the
second to ask Council to approve that citizen volunteers appointed by Council to its various
governance bodies, including Advisory Committees, the Built Heritage
Sub-committee, the Transit Commission, the Boards for the Public Library,
Ottawa Public Health and Ottawa Police Services, and the Committee of
Adjustment, be notified that those volunteers must provide proof of full
vaccination or medical exemption prior to the resumption of in-person meetings
in order to take their seats at those meetings.
I am also pleased to share that every Member of our Board
of Health has agreed to publicly disclose their
vaccination status as an example of leadership befitting our collective role in
overseeing the provision of public health services in the City of Ottawa and
that all Members of the Board of Health have been fully vaccinated for
COVID-19.
I feel it is important, not only that we lead by example,
but that we be seen to lead by example.
I want to thank my Board colleagues for demonstrating
leadership on this. I also want to thank OPH staff and our many partners for
their continued efforts to increase COVID-19 vaccination coverage in our
community.
Holidays and Observances
With various
holidays and observances coming up in the next several weeks, many may be
thinking about how to celebrate this year.
We know that
COVID-19 rates have been increasing in recent weeks and that the Delta variant
presents an increased risk.
We also know
that being fully vaccinated significantly lowers your risks of serious illness
from COVID-19 but it does not mean you’re immune. Moreover, children under the
age of 12 are not yet eligible for the COVID-19 vaccine which means that they
continue to be at greater risk of infection. Therefore, notwithstanding our
vaccination status, we must all continue to do everything we can to keep
COVID-19 levels in our community as low as possible.
If you’re
going to get together with a small group of friends or family over the coming
days or weeks, remember that outdoors is much safer than indoors. Keep
physically distancing and wearing a mask in situations where you can’t maintain
physical distancing, keep up with your hand hygiene and stay home if you’re not
feeling well.
This is
important so that our children and youth can continue in-person learning and so
that businesses can stay open and operate as safely as possible.
I want to
thank every Ottawa resident who has gotten vaccinated and everyone who
continues to adhere to public health measures to protect themselves, their
friends and family and our community.
That concludes my Verbal
Report. I would be happy to take any questions.
Board of Health Meeting
Dr. Vera Etches – Verbal report
September 20, 2021
Good afternoon, Kwey, Ulaakut, Taanishi, Bonjour,
I would also like to begin by honouring the Algonquin
Anishinabe people, on whose unceded traditional territory the City of Ottawa is
located.
In tonight’s Verbal Report, I will provide a brief update
on Ontario Health Teams, highlight Environmental Health Week, talk about OPH’s
Employee Immunization Policy and provide an update on the local COVID-19
situation and vaccine rollout in Ottawa, including an update on OPH’s
initiatives aimed at keeping COVID-19 levels manageable this fall.
Ontario Health Teams
On Friday, the province announced eight new
Ontario Health Teams (OHTs), including Four Rivers, which covers West Ottawa,
Arnprior, North Grenville, Carleton Place, and Almonte. Ottawa Public Health is
pleased to be one of over 60 health system partners contributing to this OHT.
In its first year, Four Rivers will focus on improving mental health and
addictions services, which is very much aligned with OPH’s strategic plan and
recovery goals going forward.
Environmental Health Week
This week is Environmental Health Week – a
time to celebrate and recognize Public Health Inspectors and other
environmental public health professionals (EPHPs) for their outstanding
contributions in communities every day. These professionals ensure
they remain at the forefront of protecting public health by expanding their
education and collaborating with partners and colleagues. // Ces professionnels
veillent à rester à l'avant-garde de la protection de la santé publique en
élargissant leur formation et en collaborant avec des partenaires et des
collègues
During these unprecedented times,
environmental public health professionals have demonstrated their commitment to
the health and safety of people in Ottawa through their commitment,
flexibility, and ability to leverage partners and other stakeholders to ensure
effective and timely support. While some environmental health staff were
assigned to the pandemic response supporting infection prevention and control
and outbreak management, others continued to manage a wide range of essential
core services including food safety, safe water, and health hazards arising
from environmental contaminants, extreme summer heat, and
infectious diseases such as rabies, West Nile virus and Lyme disease.
Environmental health is also a key aspect of Ottawa Public Health’s collaboration
with the City to build healthy communities via the refresh to the City’s
Official Plan and a climate resiliency strategy.
As public health evolves, these professionals
ensure the public is informed of risks, while promoting interventions and solutions
to improve the health and safety of the community. I thank them for their work
and leadership.
Immunization Policy
Ottawa Public Health is supportive of many
policies that increase immunization coverage in our city. That’s why we were
supportive of the Province’s announcement to require proof of vaccination for
patrons and clients to access certain businesses and settings. // Santé
publique Ottawa appuie les politiques visant à accroître la couverture
vaccinale dans notre ville. C'est pourquoi nous étions d'accord avec l'annonce de la province
d'exiger une preuve de vaccination pour les clients qui veulent accéder à
certains commerces et établissements.
When it comes to businesses and workplaces,
OPH has been and continues to strongly recommend that all Ottawa employers
implement workplace vaccination policies for staff. These policies help protect
employees by reducing the risk of COVID-19 transmission. They also help prevent
outbreaks and build confidence in the workplace. To support this recommendation,
OPH released guidance, available on our
website, to assist employers in the development and implementation of
their workplace vaccination policies as part of their COVID-19 safety planning.
Employers have a responsibility to maintain a
safe work environment for their employees and to support employees to get fully
vaccinated. Of course, this also applies to OPH and on September 2nd, details were shared
with all OPH staff about our own updated Employee Immunization Policy.
In updating OPH’s Employee Immunization Policy, the following
were considered: the vulnerability of many of our clients to whom we provide
direct services; the need to maintain our operations throughout a resurgence;
the effectiveness of vaccination compared to relying on testing; and an ethical
analysis.
The updated policy requires
all employees, volunteers,
contractors, and students to have received a first dose of the COVID-19 vaccine
by September 15, and a second dose by October 15 in order to be fully
vaccinated by November 1.
They will also be required to provide proof of full
vaccination against COVID-19 using the same system as other City of Ottawa
employees.
Employees,
volunteers, contractors, and students are being supported to
access COVID-19 vaccines. People who are unable to be vaccinated will have to
provide written proof of a medical exemption from a physician or nurse
practitioner. Employees without a medical exemption and who
are not fully vaccinated against COVID-19 will be provided with
information and required to attend an education session. Personal
and/or philosophical objections to the COVID-19 vaccine will not be
accepted for granting an exemption.
Current COVID-19 Situation and Immunization in Ottawa
Moving on to the current COVID-19 situation in Ottawa –
In recent weeks we have seen increases in the
number of people testing positive for COVID-19 and an increase in people in the
Intensive Care Units with COVID-19, though overall hospitalizations are holding
steady. // Ces dernières semaines, nous avons vu une augmentation du nombre de
personnes testées positives pour COVID-19 ainsi qu’une augmentation dans le
nombre de personnes aux soins intensif, bien que le nombre total
d'hospitalisations reste stable
The level of the virus in wastewater has also
increased slightly, as have the number of outbreaks. We are aiming to maintain
a manageable level of COVID-19 in the community this fall and through the
winter. I am very hopeful that, with the high level of immunization protection
of older adults and more vulnerable populations in our community, that we will
not see the same level of serious illness as previously, even with the delta
variant circulating.
While modeling has predicted a significant
resurgence this fall, the people of Ottawa are keeping transmission manageable
for the hospitals at this point. Hospitals are working hard to catch up on
needed surgeries and procedures and avoiding further cancellations through the
fall and winter when respiratory viruses typically increase in hospitalizations
is important for the health of the population.
On September 1st, the OPH epidemiology team
began adding information to the COVID-19 Daily Dashboard to provide the
breakdown of people testing positive for COVID and hospitalizations for
COVID-19 by vaccine status. The rate of new people testing positive among the
unvaccinated population who are eligible for the COVID-19 vaccine is 73.3 per
100,000 while the rate of new cases among people fully vaccinated is 6.5 per
100,000. This means that the risk of COVID-19 infection among the unvaccinated
population who are eligible for a vaccine is 11 times higher than it is for the
fully vaccinated population.
Ottawa continues to make progress with
vaccination coverage. To date, 82 per cent of people born in 2009 or earlier
are fully vaccinated. This represents 72 per cent of the total population in
Ottawa. 88 per cent of eligible Ottawans have their first dose of a COVID-19
vaccine.
As of Thursday, August 19, 2021, daily
operations for Ottawa’s COVID-19 vaccination program transitioned from the
City’s Emergency Operations Centre (EOC) to the OPH Command Centre, led by
Marie-Claude Turcotte.
Considering the tremendous leadership and
contributions of Mr DiMonte and the EOC with Ryan Perrault as Incident
Commander, I would like to pause for a moment to take the opportunity to thank
our City partners for their role in supporting Ottawa’s COVID-19 vaccine
program. From November 2020 through to August 2021, we worked very closely with
the City’s Emergency Operations Centre on the coordination and delivery of the COVID-19
vaccination program and the operation of COVID-19 vaccine clinics. It was a
huge undertaking with daily challenges and frequent changes in strategy and
provincial direction and I am very grateful for everyone who contributed to
this work. I especially want to recognize and thank Mr Anthony DiMonte and Ryan
Perrault for their leadership and their dedication to this effort and am
pleased to have Mr DiMonte join us here this afternoon.
Mr. Di Monte, both you and Ryan have shown tremendous
leadership as we navigated these unprecedented times and provided critical
emergency management experience to assist with the rapid vaccination rollout,
resulting in the City of Ottawa being seen as a leader in vaccination. Your
leadership led to us administering an impressive number of vaccines every day,
with over 11 clinics running at the same time, to serve residents. The support
of emergency management and other City departments was seen throughout the
process and included ensuring those in most at-risk settings such as Long-Term
Care and Retirement Homes received vaccinations as soon as possible. I will now
welcome Mr. Dimonte to say a few words.
The COVID vaccination
roll-out and increasing overall vaccination rates to meet
or exceed 90% continues to be a top priority for OPH. Work continues
to reduce barriers to accessing the vaccine and to bring the vaccine to where
people work, live, pray and play. This includes supporting
uptake in individuals aged 18-39 and in neighbourhoods with lower
vaccination coverage. // Le déploiement de la vaccination COVID et
l'augmentation des taux de vaccination globaux pour atteindre ou dépasser 90 %
restent une priorité absolue pour SPO. Le travail se poursuit pour réduire les
obstacles à l'accès au vaccin et pour amener le vaccin là où les gens
travaillent, vivent, prient et jouent. Il s'agit notamment de favoriser
l'adoption du vaccin chez les personnes âgées de 18 à 39 ans et dans les
quartiers où la couverture vaccinale est plus faible.
Residents have a number of options for
accessing the COVID-19 vaccine. No appointment is necessary and walk-ins are
welcome at all of our 4 community clinics, 11 Vaccine Hubs including 10
neighbourhood and 1 African Caribbean Black (ACB) vaccine hub, and pop-up
clinics. Pharmacies are also still providing vaccinations. Further, workplaces,
community organizations, places of worship and other groups can request a
mobile vaccination team to administer doses of the COVID-19 vaccine on-site, at
their own location. This can be done by completing a form found on our website. We are
seeing vaccine uptake continue to grow, with first doses making up 40% of the
doses given in mobile locations.
I would like to thank all our partners
hosting vaccine clinics, supporting employees to get vaccinated and supporting community
outreach through the neighbourhood hubs, which have proven to be an effective
way of reaching people who were previously unvaccinated. To date, the
neighbourhood hubs have administered just under 3000 doses, 43% of which were
first doses.
OPH also continues to support vaccination efforts in
Long-term Care and Retirement Homes. OPH has worked with homes to increase
their capacity to administer COVID-19 vaccines on-site and to increase
employees’ vaccine coverage. OPH is now supporting third dose immunization for
residents within the 28 Long-Term Care Homes and 37 eligible high-risk
Retirement Homes in Ottawa. As of September 15, 25% of long-term care and 17%
of eligible retirement home residents have received their 3rd dose.
By October 1, OPH expects the majority of long-term care homes and high-risk
retirement homes will have residents protected with third doses and the
Ministry of Long-Term Care has set a deadline of October 8 for homes to ensure
this is the case.
Last Wednesday, the province announced that
eligibility for third doses of the COVID-19 vaccine will be expanded to include
additional groups, such as individuals with moderate or severe primary
immunodeficiency, individuals receiving active treatment for significantly
immunosuppressive conditions and those with acquired immunodeficiency syndrome.
This will help to further
protect those who face the highest risk from COVID-19 and have weakened immune
system. Details about which specific conditions are covered can be found on
www.ottawapublichealth.ca/covid19vaccine.
As the National Advisory Committee on Immunization (NACI)
reviews the evolving science about COVID-19 immunity following immunization,
OPH will adapt the COVID-19 immunization program based on provincial decisions
about strategy informed by NACI’s recommendations. OPH is also preparing plans
to immunize children ages 5-11 should approvals be achieved for a COVID-19
vaccine this fall or winter. The COVID-19 vaccination program will continue as
the OPH team also begins to distribute Influenza vaccines in October, with both
vaccines expected to be available in our clinics.
Other OPH initiatives to keep COVID-19 manageable this
fall
OPH recognizes that the best way to keep
businesses and schools open, and students in class for their health and
development, is to minimize the introduction of COVID-19 into the school
setting by keeping transmission low in the community. In addition to promoting
immunization, many teams are involved in the work that decreases COVID-19
transmission in the community.
OPH continues to communicate with every
resident who receives a positive COVID-19 test to identify locations they may
have visited while contagious, obtain a list of close contacts, and provide
information on measures needed to prevent any further spread of infection. OPH
then notifies residents who are deemed to be a high-risk close contact of
someone who has tested positive to provide them with information based on their
individual level of risk. The Case and Contact Management team is working to
grow capacity again, following redeployment of employees to the immunization
program and other core public health work over the summer. We are able to
follow up with approximately 90% of cases and contacts within 24 hours, which
is the expectation from the Province, and we are using automated notifications,
as well as provincial and federal workforces to continuously expand capacity.
The prevention of outbreaks in healthcare and congregate
settings has been a focus during the summer months.
OPH worked in collaboration with the Regional Infection Prevention and Control
(IPAC) team to implement strategies like outbreak preparedness site visits,
additional education and training, and ongoing engagement with stakeholders.
OPH’s IPAC team continues to meet with agencies like
Ontario Health, the Ministry of Long-Term Care, Home Community Care Support
Services, and the Regional IPAC Team to provide coordinated support to
long-term care, retirement home, and congregate settings. In line with the
recommendations from the LTC COVID-19 Commission, OPH has enhanced engagement
strategies with partners/stakeholders, strengthened prevention strategies, and
improved response and we are thankful for the partnerships.
OPH is currently investigating 9 COVID-19 outbreaks and
managing the resurgence of non-COVID respiratory and enteric outbreaks.
Although the current number of non-COVID outbreaks remains lower (7 to date),
the team is preparing to address more outbreaks of all types this fall.
In collaboration with City partners and Ottawa Inner City
Health, OPH is providing ongoing support to people who are homeless and
marginally housed by assisting agencies with the re-opening of rooms and
communal spaces, as well as starting up of services – including, mental health
and addictions services – by providing infection prevention and control
recommendations.
The COVID-19 School Support Team has also
been growing its capacity to support schools to prevent and limit COVID-19
transmission, as further described in the Schools report on the agenda this
evening.
With students returning to classrooms, more people are
completing daily screening for COVID-19 symptoms and seeking testing when
symptomatic. The Ottawa COVID-19 Testing Taskforce is closely monitoring demand
for testing, to adjust assessment centre capacity to meet the community’s
testing needs. Ottawa’s labs and testing locations have also increased staffing
levels in anticipation of kids returning to school. Our hospital partners and the
Testing Taskforce continue to work with Ontario Health to increase testing
capacity and streamline the testing space. The types of approaches hospital
partners are implementing and exploring include: increasing staffing and hours
to accommodate more testing appointments daily, ongoing pop-up testing by a
third-party provider, self-serve kits being trialed this week with the hope of
launching to the broader community, exploring testing through community
providers by engaging with primary care and community pediatricians, and
extending weekend hours. I am hearing that over the weekend, there were many no
shows for testing appointments, which limits testing capacity. If an individual
that has booked an appointment no longer needs it, please cancel it so someone
else can use it. I expect further communications from the Testing Taskforce
about increased capacity into the future.
I continue to receive questions about why
there are limits to the mixing of different cohorts in school environments.
Reducing interactions between cohorts is expected to minimize the risk of
COVID-19 spread between cohorts and reduce the number of individuals who must
self-isolate at home as high-risk contacts. A recent estimate was that there
were about 43 people being named as high risk contacts for each person testing
positive in school. In addition, masking and physical distancing between
individuals continue to play important roles in reducing the risk of
transmission. OPH is monitoring the local situation regarding COVID-19 on an
ongoing basis and may recommend the implementation of additional measures in
the school-setting if the risk of COVID-19 infection and/or disruption to
students’ learning from larger numbers of students being named as high risk
contacts grows.
Moving into the fall with caution is key. In
addition to getting fully vaccinated, choosing safer activities will be
required to get through until a time when more of the population is immune.
This means OPH’s communications team will be continuing to encourage people to
choose to:
·
Gather
in well-ventilated areas, especially outdoors
·
Keep
gatherings small, and
·
Avoid
large crowds where masking and distancing can’t be maintained
Recognizing that maintaining these measures
can feel hard, I would like to encourage everyone in Ottawa to keep reaching
out to friends and family, to get outside and keep active and to recognize the
lives that are being saved by the collective work people are doing to keep each
other well. // Sachant que le maintien de ces mesures peut sembler difficile,
j'aimerais encourager tous les citoyens d'Ottawa à continuer de tendre la main
à leurs amis et à leur famille, à sortir et à rester actifs et à reconnaître
les vies qui sont sauvées grâce au travail collectif que les gens accomplissent
pour se maintenir en bonne santé.
Knowing the OPH team is working hard to keep
COVID-19 manageable for a second fall, while increasing the essential services
that OPH normally provides, the OPH senior leadership team is also focusing on
employee well-being and our Wellness@Work team has launched a 4-week self-care
challenge. You can join us by posting photos on social media about how you are
promoting your own well-being during this time.
While the latest COVID-19 numbers and
modelling are concerning, I am hopeful because we’ve seen Ottawa beat the odds
before. We’ve seen Ottawa residents persevere and come together as a community,
while staying two metres apart, to support one another. The Delta variant is
presenting challenges, but we have learned a lot in the last 18 months. We have
the tools, knowledge and resilience to get through this next phase.
That concludes my verbal report. I would be happy to take
any questions. / Cela conclut mon rapport verbal. Il me fera plaisir de répondre à vos
questions.