Meeting of the Board of Health for the Porcupine Health Unit
Held on October 29, 2020, Timmins Office, Online via Microsoft Teams (MS Teams)
Present:
- Sue Perras, Town of Smooth Rock Falls
- Drago Stefanic, Vice-Chair, Township of Hornepayne
- Cleo Charlebois, Township of Black River-Matheson
- Denis Clement, Town of Cochrane, Town of Moosonee
- Marc Dupuis, Township of Mattice Val-Cote, Opasatika and Val-Rita-Harty
- Marc Ringuette, Town of Hearst
- Pat Britton, Town of Iroquois Falls
- Sebastien Lessard, Town of Kapuskasing,Townships of Moonbeam, Fauquier and Stickland
- John Curley, City of Timmins
- Kristin Murray, City of Timmins
- Mickey Auger, City of Timmins
- Rock Whissell, City of Timmins
Staff:
- Lianne Catton, Medical Officer of Health (MOH)/Chief Executive Officer (CEO)
Recorder:
- Carla Pecjak, Executive Assistant to the MOH/CEO, Secretary to the Board of Health
Attending by Invitation:
- Mary-Lou Pollon, Manager Corporate Services
1. Call to Order
Sue Perras, Board of Health Chair, called the Board of Health meeting to order at 5:00 p.m.
The Board of Health (BOH) for the Porcupine Health Unit received notice effective October 27th. (City of Timmins (COT) Resolution, 20-178), that John Curley, Councillor, COT Timmins was appointed as the replacement for Mayor George Pirie for the remainder of the 2019-2022 term.
Sue Perras welcomed John Curley to the BOH for the PHU and noted he would assume George Pirie’s position as a member of the Resource Committee for the remainder of 2020.
2. Approval of Agenda
The agenda for the October 29, 2020 Board of Health meeting was reviewed. The following motion was read:
MOVED BY: Drago Stefanic
SECONDED BY: John Curley
Board of Health Resolution #BOH-2020-10-58
Be It Resolved, that the Board of Health Agenda, dated October 29, 2020, be approved.
Carried
3. Conflict of Interest Declaration
There were no conflicts of interest declared.
4. Approval of Previous Minutes
The minutes from the Board of Health Meeting held on September 10, 2020, were reviewed and the following motion was read:
MOVED BY: Pat Britton
SECONDED BY: Cleo Charlebois
Board of Health Resolution #BOH-2020-10-59
Be It Resolved, that the minutes from the Board of Health meeting held on September 10, 2020, be approved as presented.
Carried
5. Business Arising from Minutes
There was nothing under Business Arising.
6. Report of the Medical Officer of Health
Porcupine Health Unit COVID Response
General COVID Updates
Increasing cases across province, with several regions well into second wave. Outbreaks in schools, gyms, workplaces across Province, risks learned from investigations and any added recommendations continue to be shared widely. Continue to see cases across the North East and the Porcupine Health Unit region (PHU), at 97 cases currently, with one current workplace outbreak. Halloween messaging has been provided and ongoing communications around the COVID-safe recommendations for Halloween continue to be shared. There have been significant changes to the overall public health recommendations at a provincial level. This includes the recommendation to have close contact with household members only, the abandonment of social circles, provincial mask mandate for indoor public spaces, now with enforcement ability.
Communications
Daily updates continue to be shared on the PHU website, social media, and via email with BOH, municipalities, Indigenous community leadership and partners, community social service, health, and education partners. These updates are shared in both French and English. These daily updates include pertinent local COVID updates, as well as information on local resources and services, such as assessment centres, latest guidance documents, evidence and recommendations from the Province, Ministry of Health, and other Ministries as appropriate.
Media teleconferences are booked to provide information regarding significant events and updates, for instance the mask mandate for indoor public spaces, and the reopening of schools. Another video was shared prior to thanksgiving around recommendations for COVID-safe thanksgiving; and a media teleconference was held to discuss school protocols, reporting of cases and other pertinent updates.
Another key area of communication with the opening of schools, and recognition of trends elsewhere in the Province, is the need to continue to focus on screening for symptoms, staying home if any, isolating, and getting tested. Radio advertisements in French and English were arranged this month to expand reach of this important message to as many community members as possible.
Case Bulletin Updates
With ongoing concerns regarding privacy, confidentiality, and the duty of a Medical Officer of Health to protect personal health information under the Health Protection and Promotion Act (HPPA), the PHU has changed the reporting of individual cases. There have been some recent challenges regarding information and the impact on cases, their families; and the potential impact on others coming forward to get testing is extremely concerning. This goes beyond someone’s name and address, and details around a particular case often also constitutes personal health information, which the PHU must protect.
Case investigation is done in a timely manner to identify contacts who are then called by the PHU for a further risk assessment and provided further guidance as appropriate. If there are public health risks that a community or the public needs to know, then public health communicates this more broadly as appropriate.
Similarly, there are concerns with the ongoing commentary that if there is a confirmed case in a particular community then precautions can be followed. COVID-19 is circulating, and while the region has done well, and the PHU is grateful for the ongoing commitment to the precautions, the North is not immune to this pandemic nor a second wave. As said throughout the pandemic all community partners and members need to act as though exposure is probable and possible every day in every community regardless of case announcements. The false sense of security with not having cases announced is exceedingly concerning and can greatly impact the magnitude of a second wave in the PHU area. The shared responsibility of reducing the risk of spread and protecting individuals from COVID, as well as the health care resources across the region will be for some time to come yet and needs to become the new norm.
As shared last week the PHU will continue with the ‘areas’ used to announce cases and will only provide any confirmation of a specific community if there is a particular risk to public health of the community in a broader sense. In addition, the age ranges for individual case bulletins/announcements are no longer included. This information will continue to be collected, analyzed, and reported on an aggregate level in the weekly epidemiology summaries which are available online. If there are concerning trends noted they will also share that more broadly.
Contact Tracing
Contacts of cases are all identified through the case investigation and follow up and they are all called within the targeted timeframe goals from the Ministry to conduct a risk assessment with them and provide further guidance. The PHU continues to meet targets for reaching cases and contacts as set by the Ministry and reported by Public Health Ontario (PHO). The PHU has been training more staff and planning for increased capacity in order to respond to a second wave. The team then follows cases and contacts regularly as per the guidance, facilitates testing when appropriate, monitors symptoms, need for further health care, and assesses need for further support to remain in isolation and follow public health guidance.
Risks of exposure for the general public or specific settings are assessed and shared more broadly as appropriate. Again, emphasis remains on the proven measures to reduce the risk and the need for all community members to assume exposure is possible and probable every day, regardless of case announcements.
Expanding this team has included training more nurses in the branch offices, as well as hiring some temporary positions which are assisting with both COVID response as well as influenza clinics.
Assistance with other Health Unit’s Contact Tracing
Last week Dr David Williams reached out to health units with fewer cases to request support for one of the health units who has been responding to a significant number of new cases on a daily basis requiring follow up calls for case investigation and contact tracing – which is so critical to the response and control of the pandemic in a region. The PHU is very pleased to have stepped up and agreed to assist with this critical public health role and has shifted some work around to create capacity for a team to conduct the case follow up for this health unit. The provincial Case and Contact Management Tool (CCMT), the database used for tracking and reporting cases, and conducting investigations facilitates this type of support across the province from a distance. At this time, the team continues to take new cases daily. This is an important opportunity to demonstrate the strength of the public health system in Ontario supporting one another, and the public health response to and management of the pandemic. Several health units have stepped up and this demonstrates how nimble and responsive we are as a system, despite being separate local entities.
Schools
Ministry funding for six school Public Health Nurse (PHN) positions have been filled with current complement of public health nurses and includes bilingual nurses and a francophone school manager. These school positions have all been backfilled. School team also includes health promoters – two summer students were hired, one temporary and one full-time positions; as well as a public health inspector, and a registered dietitian. There will be a school PHN assigned to support each school, and with so many schools and such a large region, each nurse will be the main connection for several schools. In smaller branch offices, the community PHN will be the main contact to support local schools. The role of these nurses will be supporting the schools with education, communications, and to provide guidance on infection prevention and control and the implementation of public health measures.
Dr. Catton continues to host weekly calls with Directors of Education (DOE) from all boards of education in the region since the beginning of August, and it has been extremely well received as an opportunity to answer questions, share the latest guidance and support COVID-safe reopening of schools. The group has agreed to continue this important engagement into the Fall. Timiskaming Health Unit (PHU) also participates and the health unit school teams continue to work together to support shared Boards.
There were virtual presentation sessions for all principals in September, from all Boards of Education, one in French, and one in English, to review COVID 19 in general, screening procedures, and the school case response. They were both well attended and well-received.
School Case Protocol
As with any case the initial call is always to the individual with the positive test result to inform them and begin the detailed case investigation and contact tracing process. This includes determining if they attended school during their period of infectiousness, which begins 2 days before symptom onset. If so, then the DOE is informed by the Medical Officer of Health, and the Case and Contact management team contacts the principal to obtain the cohort list of teachers, staff, and students. In general, the cohort of classmates are sent home, to be tested and remain in isolation for 14 days from last date of potential exposure. Teachers and staff are assessed further to identify level of exposure and are provided recommendations accordingly. At this time, the school sends a letter, from the PHU advising the student cohort and staff contacts to stay home and isolate and that the PHU will call them within 24 hours. The rest of the school is provided information from the school – key messages around contact tracing and the ongoing recommendations for self-monitoring. A walk through is done with the public health inspector and school public health nurse to review the infection prevention and control (IPAC) checklist.
Collaboration Across the North
The PHU school team has been working closely with the school team from Timiskaming Health Unit (THU) as several large school boards are shared. This collaboration demonstrates the opportunities in efficiencies and capacities when working together, and the natural synergies between the health units. THU leadership also actively participates in the weekly calls with the DOE. There are many resources, communications, and protocols under development for the ongoing support to schools, school staff, parents, and students.
The Northern Medical Officers of Health continue to meet regularly to assess and address the northern context of the pandemic.
Testing
PHU continues to work with Ontario Health (OH), who is responsible for the testing, and assessment centres (AC) across the region, to discuss testing capacity, planning for increased demand related to back to schools and fall flu season. There will be continued engagement to share and review priorities, including the need to have testing availability for all those with symptoms, as well as those potentially exposed, identified in case investigation – across the region. This planning with OH and AC includes transportation to the lab in Timmins in a timely manner as transportation to the lab also impacts turnaround times. The PHU will also continue to facilitate the timely testing of close contacts and those identified in case investigation or as part of an outbreak investigation, and will work with AC, OH and the lab to coordinate this.
There are many other settings and community partners that public health continues to support for guidance on implementation of the public health measures, communications, and resources, and to provide IPAC guidance and expertise. This includes post-secondary institutions, daycares and childcare centres, personal service settings, food premise operators, restaurants, workplaces, businesses, as well as sports and recreational facilities and organizations and event planners. The workplace committee has not only provided virtual sessions supporting the Timmins Chamber of Commerce, but produces resources to support workplaces and businesses across the region, sends weekly emails, and regularly updates a website page with important updates and resources to support the great work done by businesses and workplaces across the PHU to reduce the risk of COVID.
Ongoing support and leadership for the COVID -19 response:
The PHU both actively participates in and hosts regular meetings to answer questions, provide ongoing updates, recommendations, and latest evidence-based guidance, as well as IPAC expertise and guidance.
Meetings hosted by the PHU: weekly teleconferences for acute and primary care partners across the region; weekly teleconferences for long term care homes (LTCH) and retirement homes (RH). Have also hosted teleconferences for industries such as mining and lumber; childcare and day care centres; and others.
Meetings attended: Emergency control group meetings for municipalities across the region, Taykwa Tagamou First Nation, Ontario Health North and assessment centre teleconferences, LTCH/RH outbreak prevention and management meetings.
Ongoing COVID line phone support for the general public, and community partners remains open, Monday to Friday during business hours, and weekends 11-3.
The Northern Medical Officers of Health continue to meet weekly to review current local context and response across the north. Collaboration and sharing of resources and approaches as well as work to enhance consistency remains a focus of the discussions. This has been important to review the northern context and provide guidance specific to our unique context. Dr Catton remains involved in provincial Ministry of Health and public health unit calls twice a week. These are all important opportunities to share and learn together, advocate for the unique northern context, and demonstrate the strength of the public health system to work together while recognizing potential local and regional differences that may require consideration.
Dr Catton also participates in a few provincial committees and panels, this include Council of Directors of Education-Council of Ontario Medical Officers of Health (CODE-COMOH); a COMOH school working group; Provincial Testing Strategy panel, and in a provincial surveillance working group. Again, providing the northern context to discussions and planning.
INFECTION PREVENTION AND CONTROL (IPAC) NORTH FUNDING AND PLANS
There are some recent developments to support enhanced IPAC expertise and capacity for LTCH, RH and other congregate living settings, and in the north, public health will lead these local planning tables. There is funding expected and more details to come, but an important opportunity that acknowledges the public health role and expertise in IPAC.
COVID RESPONSE WITHIN THE PHU
Current Incident Management System (IMS) remains ongoing and is under current revision to reflect the needs at this time and evolving response to the pandemic. There is a plan underway to increase training of several staff to support COVID work and prepare for potential surges or the second wave. With the recognition of the need to expand management capacity, two temporary program managers have been added to the team. In addition, temporary/part time and casual positions to support both the COVID response and ensure other important public health work continues. This staff will also support the flu clinics and the clinics offered for grade 7 student immunization program.
COVID PHU STAFF
The PHU has implemented the public health measures in all offices. This includes distancing, mask policy (when up from desk, when distancing is a challenge and always in public spaces), personal protective equipment (PPE) training, limits in rooms, enhanced cleaning, daily staff screening survey via email, handwashing, and increased work from home. Signs and stickers are used to remind staff and help outline distancing and limits. There is a focus on virtual platforms for meetings. IPAC walk through, by the public health inspectors, in each office has been planned, similar to what is done in other workplaces and settings.
Weekly updates for staff via videoconferencing with updates on recommendations and guidance, updates, and reminders for measures for staff, as well as thanking the team for support and hard work, providing workplace updates. Recently addition of two temporary managers has led to a shift in teams and sharing this with the organization has been key.
Supporting mental health and wellness remain important for the PHU team. They are establishing a committee to address this and support staff as well, there is a student working on a project to support staff; Employee Assistant Program (EAP) services continue to be promoted.
Workplace outbreak in the Hearst office has been investigated and managed following the same Ministry guidance as every other workplace outbreak.
OTHER IMPORTANT NON COVID-19 PUBLIC HEALTH WORK
Some key public health programs are ongoing, and at times increased due to local context and demand. This includes outreach, harm reduction and the opioid response. The region continues to see increases in suspected opioid related overdoses. The PHU has worked with the opioid emergency task force to monitor and respond to these increases and any alerts related to particular substances to reduce the risk of overdose events. As outlined in the presentation to the program committee, this response has included media alerts, social media and website posts and alerts regularly, and shared with partners, notices to all community partners, including hospital emergency departments and pharmacies to increase access to naloxone, and addiction, mental health services, and enforcement partners. The PHU has increased outreach, increased training of organizations to distribute naloxone, and has maintained access to the harm reduction clinic. The PHU remains involved with many community tables and is committed to working with partners to address the opioid crisis.
Other public health work continues such as:
Healthy Babies Healthy Children (HBHC); infant feeding; Canadian Prenatal Nutrition Program (CPNP)
Working to increase access to the programs and services, recognizing greater need during the pandemic.
Sexual health clinic provided ongoing follow up of infections and support and increasing in person clinics and supports.
Speech has been providing virtual support for clients requiring speech language services and started in-person with COVID measures for those who need it.
Over the summer the PHU offered catch up on school immunizations that were missed last year after school closures. Finalizing plans for mass flu immunization clinics across the PHU, as well as immunization clinics to be offered to grade 7 students who would have received their immunizations in school this year. All with COVID-precautions in place.
ONGOING HEALTH PROTECTION WORK
Health protection services continue and in some areas the demand for support has increased during COVID, for example.
- Follow up of all reportable diseases - includes Tuberculosis (TB), iGAS, Salmonella, E.coli
- Inspections of settings as required by OPHS and ministry protocols – PSS, restaurants, pools, beaches, water systems, etc.
- Support for emergencies and evacuations – Kapuskasing and Timmins this year
- Investigation of complaints in inspected settings
- Ongoing opioid crisis
PORCUPINE HEALTH UNIT STAFFING
The following temporary full-time positions were recently filled. These vacancies were created because of retirements, resignations, internal transfers and new funding for COVID positions:
- COVID Response Assistant, effective September 28, 2020
- Dental Hygienist, effective November 9, 2020
- Graduate Practical Nurse, effective October 26, 2020
- Health Promoter, effective September 28, 2020
- Health Promoter, effective October 26, 2020
- Public Health Nurse, effective September 28, 2020
- Public Health Nurse, effective September 30, 2020
- Public Health Nurse, effective September 30, 2020
- Public Health Nurse, effective October 19, 2020
- Public Health Nurse, effective November 2, 2020
- Speech Language Pathologist, effective October 5, 2020
The following temporary casual positions were recently filled. These vacancies were created as a result of new school nurse COVID-19 funding. These positions are effective until January 15, 2021.
- Community Health Nurse
- Public Health Nurse
- Registered Nurse
- Six Registered Practical Nurses
The following permanent full-time and part-time positions were recently filled. These vacancies were created because of retirements, resignations, and internal transfers.
- Public Health Nurse, full-time effective October 5, 2020
- Two Administrative Assistants, full-time, effective October 13, 2020
- Speech Language Assistant, part-time effective October 19, 2020
- Harm Reduction Worker, full-time effective November 19, 2020
- Program Coordinator, internal transfer, effective October 19, 2020
- Program Coordinator, internal transfer, effective September 29, 2020
- Public Health Nurse, internal transfer, effective September 21, 2020
- Public Health Nurse, internal transfer, effective September 30, 2020
- Program Coordinator, internal, temporary full-time, effective October 26, 2020
7. Board of Health Committee Minutes and Reports
Program Committee
Program Committee Minutes – September 10, 2020
A Program Committee meeting was held prior to the Board of Health meeting; the minutes were received for information; the following motion was read:
MOVED BY: Mickey Auger
SECONDED BY: Cleo Charlebois
Board of Health Resolution #BOH-2020-10-60
Be It Resolved, that the minutes from the Board of Health Program Committee meeting held on September 10, 2020, be received for information.
Carried
Program Committee Reports
PHU Response to the Opioid Crisis – Dr. Lianne Catton
Mickey Auger, on behalf of the Program Committee, thanked Dr. Catton for the informative presentation regarding the opioid crisis in the PHU area.
8. Resource Committee
Resource Committee Minutes – September 10, 2020
A Resource Committee meeting was held prior to the Board of Health meeting; the minutes were received for information; the following motion was read:
MOVED BY: Pat Britton
SECONDED BY: Marc Ringuette
Board of Health Resolution #BOH-2020-10-61
Be It Resolved, that the minutes from the Board of Health Resource Committee meeting held on September 10, 2020, be received for information.
Carried
Resource Committee Reports
Medical Officer of Health Coverage – Amendment to BOH Resolution #BOH-2000-12
The Medical Officer of Health Coverage - Amendment to BOH Resolution #BOH-2000-12 was reviewed. The following motion was read:
MOVED BY: Drago Stefanic
SECONDED BY: Pat Britton
Board of Health Resolution #BOH-2020-10-62
Be It Resolved, that the Medical Officer of Health Coverage – Amendment to BOH Resolution #BOH-2000-12, be approved.
Carried
Ministry of Health Public Health Funding and Accountability Agreement 2020-21
The PHU Funding Letter Report 2020-21 was reviewed. The following motion was read:
MOVED BY: John Curley
SECONDED BY: Rock Whissell
Board of Health Resolution #BOH-2020-10-63
Be It Resolved, that the PHU Funding Letter Report 2020-21 Report for the Board for the Board of Health for the Porcupine Health Unit be approved.
Carried
8. Correspondence
Board of Health correspondence was provided to Board members for review. There were no questions related to BOH correspondence and no further discussion required.
9. New Business
No new business.
10. In Camera
No in-camera business.
11. Date of Next Meeting and Adjournment
The following motion was read:
MOVED BY: Mickey Auger
SECONDED BY: John Curley
Board of Health Resolution #BOH-2020-10-64
Whereas, the next meeting of the Board of Health for the Porcupine Health Unit be held on November 26, 2020 at 5:00 p.m. and that this meeting adjourns.
Carried
Approved by: Board of Health, November 26, 2020
Original Signed by: Sue Perras, Chair, Board of Health