December 2020 Board Meeting - Minutes

Introduction:  Dr. Felicia Lawal, Acting Director, Health Protection

Moved by:  Judy Lund 
Seconded by: Rino Bortolin
That the agenda be approved.
CARRIED

1. COVID-19 Update

       Dr. W. Ahmed provided an update on the status of COVID-19 cases in our region and some context on the situation globally. Many countries are experiencing a second wave of the virus, worse than the first, and are implementing more restrictions.  France has had a huge surge and went into complete lockdown in October and numbers reduced.  Case counts in the USA continue to rise and the USA leads in the number of deaths worldwide.  Sweden did not implement many restrictions during the first wave and had the mindset that everyone would contract the virus and that they would then all recover.  That strategy failed and now they are calling for more restrictions as conditions worsen.  Germany stayed strong in the first wave, but continue to see more cases during the second.  Canada is on a steady pathway to see more cases with the second wave than the first, and in Ontario cases continue to climb, including Windsor-Essex. 

   September and October showed a slight decline in our region, but in November and December there was a significant increase.  The Epi curve is steep, with 1,000 cases in the last 10 days.  We may see our case doubling rates happen very quickly.

   When looking at our municipalities from November 1 to today, Leamington has led the way based on their population. In the last 30 days, Windsor leads with 71% of positive cases.

   We have seen a shift in ages with a rise in cases from 0-20 years, which are linked to school cases.  More community transmission is happening with cases coming from every direction.

   The Effective Reproduction Rate is high at 1.36, meaning each case can make 1.36 other cases.  This is of significant concern as Windsor-Essex cases are increasing higher than the provincial rate, putting us just behind the Region of Peel.   We will likely continue to see significantly more cases in Windsor-Essex moving forward.

   R. Bortolin asked with case numbers trending in a negative way how likely are we to see a change in plans other than Grey (Lockdown) for more stringent measures if numbers continue to rise.  Closing schools in our region before Christmas was a local decision, but as Medical Officer of Health (MOH) do you foresee more restrictions coming from the province. Also, are there discussions around travel and restricting movement around the province. 

   Dr. Ahmed said that we are in discussions with other MOH’s whose health units are either in Lockdown or in Red category for a little more consistency across the province instead of being fragmented.  The province share their mobility data from Blue Dot which tracks cell signals.  These signals show that in the GTA area, which is in Lockdown, people are still out.  We are attempting to obtain data around our Canada/USA border but it’s hard to say who is going where and travel is still happening, which is contributing to higher number of cases in the second wave. 

   J. Bachetti said that we often hear in the media about the number of cases under investigation and asked for clarity on what that means.  Dr. Ahmed said that anything we are reporting is a confirmed case even when it is reported as under investigation. A case reported as under investigation, means we do not yet know the source of the exposure.  It could be via close contact, from an outbreak or part of community transmission.  It takes time to conduct interviews by trained nurses to identify the source of exposure based on behaviour and activity over the last 14 days.  

   J. Lund asked about community transmission.  As many people have to attend their place of work, do we have a sense of how much of the population at work are wearing masks and staying socially distant.  Is this part of community transmission or is it individuals who are not masking or following public health guidelines.  

   Dr. Ahmed said that an individual has to have the virus to pass it on.  When we establish the link then we can identify close contacts through investigation which can be linked to wearing or not wearing masks.

   E. Sleiman inquired around the number of cases and capacity at our hospitals. Dr. Ahmed said that the hospitals are stretched and are scaling back elective procedures because of that.  We work with our hospital partners on various issues, but we are not directly involved in operations or their pressures and challenges. R. Bortolin asked about capacity and staffing within the health unit.   Where are the gaps and are we falling behind due to the sheer volume of work. 

   T. Marentette said that pressures are keeping staff very busy and we are stretched to capacity. Case interviews alone include case management and initial calls, discussing signs and symptoms, providing education around the virus, medical follow, lists of contact as well as isolation requirements. Contract tracing is the next piece.  All of this takes a significant amount of time and with the number of positive cases coming in daily, our current resources are not enough.  The City of Windsor has offered to deploy some of their staff to the health unit to assist, but intensive training is required, and interviews and documentation for contact tracing is usually done by medical professionals. We will be discussing this further in Committee of the Whole.

   G. Kaschak asked about further Canada/USA border restrictions and does WECHU know if there has been any more discussions on that.  There seems to be more individuals crossing the international border, not just essential workers.  Dr. Ahmed said he will answer G. Kaschak’s question once he returns to the meeting.  Dr. Ahmed excused himself from the meeting for a brief call.

   4:25 pm – Dr. W. Ahmed left the meeting for a call with the Ministry of Health

   G. McNamara said with 51 nurses, an average of 200 new cases per day, and the complexity to do a proper investigation can easily take up a significant amount of time and would like further discussion around the additional resources required.  Given recent trends, cases are just going to increase.  Dr. D. Kane said there were five retired colleagues that offered to assist, RNs from the Ministry, but the commitment needs to be full time, given the amount of training and time intensive work involved. 

   5:00 pm – Dr. W. Ahmed returns to the meeting 

   In response to G. Kaschaks’ question above, Dr. Ahmed said that we have raised this issue with the Chief Medical Officer of Health for the province, Dr. David Williams, to ask the Federal government to put more restrictions in place around who is crossing border for reasons other than essential workers, namely not health care, and if they are crossing that they consider putting them in a 14-day quarantine.  We have not heard back from the province or anyone else on this issue.  The Federal government controls the Canada/US border so there is not much we can do locally.  Other than that, we have no other updates.  

   Moved by:    Rino Bortolin
   Seconded by:  Judy Lund
   That the information be received.
   CARRIED

1. Regular Board Meeting: November 19, 2020

   Moved by:  Rino Bortolin
   Seconded by:  Fabio Costante 
   That the minutes be approved.
   CARRIED

1. INFORMATION REPORTS

   Moved by:  John Scott
   Seconded by:  Debbie Kane 
   That the information reports be received.
   CARRIED

   1. Healthy Families Department and Healthy Babies, Healthy Children Program Updates (N. Dupuis)
      Brought to the Board for information.
   2. Oral Health Program Update (N. Dupuis)
      Brought to the Board for information.
   3. Influenza Vaccine Update (K. McBeth)
      Brought to the Board for information.
   4. Q2 Financial Report (L. Gregg)
      Brought to the Board for information.
   5. November Communications Recap (L. Gregg)
      Brought to the Board for information.
2. RECOMMENDATION REPORTS

   1. Bill 216 – An Act to Amend the Education Act – Food Literacy (N. Dupuis)
      The WECHU is requesting a recommendation from the Board.  If implemented this brings food literacy throughout the curriculum from grade 1 to grade 12.  Food skills are connected to healthy eating and will help to curb disease in future.
          
      Moved by:  Rino Bortolin 
      Seconded by:  Joe Bachetti 
      That the recommendation report be received and that the Recommendation be approved.
      CARRIED

1. Long Term Service Awards (T. Marentette)
   T. Marentette announced the names of WECHU staff that have more than 20 years of service at the health unit.  G. McNamara and the Board extend their best wishes with heartfelt congratulations.  WECHU staff eligible for long-term service awards are recognized and acknowledged for their years of service annually at December Board of Health meetings.

2. Records Management (L. Gregg) 
   L. Gregg and N. Dupuis have been looking into an electronic medical records software tool to promote efficient and effective interaction with clients.  The software has several tools that help with client interaction that we can use in several of our departments, oral health, healthy families, IDP, via video.  The software has a referral process imbedded into it and is being utilized by a number of organizations in W-E.  We are bringing this to the Board for approval, and are looking to do this in accordance with our procurement policy.   This software would increase our licensing costs to $15,000 per year for a 100-user model, and in the first year we would incur a one-time cost up front of approximately $10,000. Training would take place virtually.  G. McNamara believes that this is a good investment and use of public health funds, and requested a motion be brought to the Board for approval. 

   Moved by:  Rino Bortolin 
   Seconded by:  Joe Bachetti
   That the Board approve the purchase of an electronic records management system
   CARRIED

   4:54 pm – Chair, G. McNamara, left the meeting – Vice-Chair, J. Scott, assumes the Role of Chair

1. WECHU Letter to The Right Honourable Justin Trudeau – Federal Government Supervision of Self-Isolation Period for Arriving Migrant Workers
2. Grey-Bruce Public Health Unit – Letter from Board Chair Mitch Twolan – Public Health Regionalization  
3. Timiskaming Health Unit – Letter to The Honourable Stephen Lecce, The Honourable Christine Elliott, The Honourable Ernie Hardeman – Bill 216 Food Literacy for Students Act 2020

Moved by: Ed Sleiman
Seconded by: Judy Lund
That the information be received.
CARRIED

The Board moved into Committee of the Whole at 5:03 pm
The Board moved out of Committee of the Whole at 6:02 pm

Moved by:  Rino Bortolin
Seconded by:  Judy Lund
That the meeting be adjourned.
CARRIED

The meeting adjourned at 6:17 pm.