July 2020 Board Meeting - Minutes

1. Call to Order
   Board Chair, Gary McNamara, called the meeting to order at 4:03 p.m.
2. Agenda Approval
   Addition to agenda (Requested by Tracey Bailey):
   New Business, Section 9.2 – Resumption of Water Testing and Utilizing a Third Party Contract

   Addition to agenda (Requested by Tracey Bailey):
   Proposed Amendments to Enhance the Section 22 Class Order – to be discussed in-camera in Committee of the Whole
   Moved by: Tracey Bailey
   Seconded by: Ed Sleiman
   That the agenda be approved.
   CARRIED

3. Announcement of Conflicts of Interest – None
4. Update (Dr. W. Ahmed)
   1. COVID-19 Update

      Dr. W. Ahmed provided an update on the current status of COVID-19 cases in our region. We currently have 1,857 cases with 69 deaths. There are 6 workplace outbreaks, 1 being in manufacturing and 5 in the Agri-sector. There are four farms that have most of the cases amongst those in the Agri-sector with 143 active cases and solutions for isolation and accommodations are being discussed. Community transmission remains low, but it is still important to keep close contacts at a minimum. The messaging will be the same when Windsor-Essex moves to Stage 3.

      There are currently a number of partners (WECHU, OMAFRA, Ministry of Health, Ministry of Labour, Ontario Health, Canadian Red Cross) working together to build a system for testing, isolation and accommodations for the Agri-sector. The Canadian Red Cross is supporting 2 hotels in the region for self-isolation and we are participating in all conversations to provide our public health perspective. We are speaking daily with Dr. David Williams, the Chief Medical Officer of Health at the Ministry of Health, and are hoping to have a good strong system in place, and possibly some new initiatives for Ontario Health testing Agri-farm workers, in the next week.

      Dr. Ahmed noted that Dr. Alex Summers (AMOH, Middlesex-London Health Unit) has joined us in today’s Board of Health meeting and was working with us in Windsor to help support with protocol and assessing the farm situation. As a result of working together, we created an outbreak case and contact management document for our work with the Agri-farm sector and have shared it with the Ministry which they will use as a tool for the rest of the province. On behalf of the Board of Health, G. McNamara thanked Dr. Summers and his team for their assistance with the Agri-sector.

      Moved by: John Scott
      Seconded by: Tracey Bailey
      That the information be received.
      CARRIED

5. Approval of Minutes
   1. Regular Board Meeting: June 18, 2020
      Moved by: John Scott
      Seconded by: Joe Bachetti
      That the minutes be approved as amended.
      CARRIED
6. Business Arising – None
7. Consent Agenda

   That the information reports be received.
   CARRIED

   1. INFORMATION REPORTS
      1. Effects of Climate Change on Invasive Mosquitos, Zika Virus, and Migrant Workers Health in Windsor-Essex (K. McBeth)
         Brought to the Board for information.
      2. June Communications Recap (L. Gregg)
         Brought to the Board for information.

      Moved by: Ed Sleiman
      Seconded by: Judy Lund

   2. RECOMMENDATION REPORTS
      1. 2020 Budget Amendments (T. Marentette/L. Gregg)

         T. Marentette noted that this is an amendment to the 2020 Budget. On March 20, 2020, the WECHU reported its first case of COVID-19, and we now have 1,857 cases and 69 deaths. We continue to have unique challenges in our health unit related to many bunkhouse inspections in farm operations, with 8,000 to 10,000 Temporary Foreign Workers across 176 farms in our region. Our public health inspectors inspect bunkhouses, over 900 so far, in addition to the 44 Long-Term Care Homes and Retirement Homes in our community.

         In May, the Ministry asked health units to follow up with positive cases within 24 hours. At that time, we had 656 cases and were already stretched for resources. We knew that as COVID progressed we did not have enough staff to continue with the requirements that were needed for the pandemic, wherein we made decisions under the Medical Officer of Health to defer or reduce some public health programming. We instituted an IMS Structure to respond to the pandemic. Under the Emergency Management and Civil Protection Act,we were able to redeploy approximately 80 staff across different programs and schedules to devote our resources where needed to protect the public, 2 shifts 7 days a week.

         In the last week of June, we reached out to other health units for assistance. Our HR and IT Departments assisted in onboarding and orientation (approximately 11 full time and 10 casual health unit staff). Dr. Alex Summers (Associate Medical Officer of Health, Middlesex London) attended on-site for two weeks and continues to support us remotely with the Agri-sector. In addition, we received the services of a field epidemiologist for three weeks through the Public Health Agency of Canada (PHAC).

         As we move forward with COVID-19, and with the province slowly reopening, it still remains the priority for 2020. With all of our resources stretched to capacity we are submitting a proposal requesting a full time Associate Medical Officer of Health (AMOH), a Manager for the COVID Response Team, Clerical Support, PHNs, RPNs, Public Health Inspectors and an Epidemiologist, to help meet the needs of the pandemic and allow for some staff to support other programs we need to reintroduce. E. Sleiman asked if the request for an AMOH is permanent or just through the pandemic. T. Marentette advised that the request is for a full time permanent AMOH. The work of COVID will not end after this year, and for a health unit of this size, it is in the best interest for our community.

         L. Gregg said that we have compiled our operating budget from September to fiscal 2020 and the total operating costs for 22 FTE is approximately $857,329. These FTEs would be deployed to work from home, so as to not incur infrastructure costs in office space. If the Ministry of Health does not fund any portion of these FTE’s, the increase in costs would be absorbed by municipalities. Contributions would be $466,726 from the City of Windsor; $390,098 from the County of Essex; and $505 from the Township of Pelee. Should the Ministry of Health come forward with funding for this particular initiative, and we use the funding allocation of 70/30, that would decrease contributions from the municipalities to $257,200 for the remainder of 2020.

         On an annual basis, under the scenario that the municipalities would bear the complete burden of the FTEs, the impact would be $2,208,953 resulting in an impact to the City of Windsor of $1,200,000 and $1,000,000 to the County of Essex and $1,300 to the Township of Pelee. Should the Ministry provide funding on the 70/30 basis those costs would decrease to $662,686 broken down to $360,000 to the City of Windsor, $301,000 to the County of Essex, and $390 to the Township of Pelee. In May of 2020, the WECHU submitted a business case to the Ministry similar to the 2020 Budget Amendment.

         T. Bailey said it is her understanding then that there is some surplus available for re-allocation and does the health unit have some sense there will be resources coming their way to take the pressure off municipal funding needed.

         L. Gregg noted there was a letter from the Ministry based on extraordinary costs related to the pandemic, and at some point in the year we would be asked to accumulate and submit those costs. At this time, we are not exactly sure what the Ministry would define as extraordinary costs.

         T. Bailey noted that the health unit has her support.

         R. Bortolin said that under these scenarios has there been any conversation with the Ministry where this shortfall could be made up by support from either the provincial or the federal governments through relief programs. G. McNamara noted that on talks yesterday with the province and other mayors the response was clear from all other jurisdictions around the province, i.e. that municipalities finance public health and other COVID affected areas and if the province wants to soften the burden to municipalities, they need to come through with more funding for health units.

         R. Bortolin asked if the $857,329 is a total surplus or just to cover costs for the new FTEs. Also, what is the overall deficit expected to be by the end of December.

         L. Gregg advised that we are currently working on that estimate and believe it was around mid-May timeframe that we anticipated approximately $1M in deficit factoring in a team such as this. The WECHU is looking to bring a report to the Board at a later date indicating the anticipated deficit.

         R. Bortolin noted to the Chair that he would like to put forward a friendly amendment to the motion included in the 2020 Budget Amendment Recommendation Report, indicating that final deficit numbers be forwarded to the Obligated Municipalities as soon as possible. In addition, a request to the Obligated Municipalities to write a letter to the Province of Ontario and the Ministry of Health for financial support to fund the shortfall.

         Chair, G. McNamara believes that this is a reasonable ask. There is no doubt that the municipalities need to push the provincial and federal governments for assistance and this was an ask by the majority of the municipal sectors, i.e. the Municipal Finance Officers Association (MFOA), the Federation of Canadian Municipalities (FCM) and the Association of Municipalities of Ontario (AMO).

         Moved by: Tracey Bailey
         Seconded by: Rino Bortolin
         That the 2020 Budget Amendment be approved to support the recruitment of 22 FTEs (the reference to 19 FTEs in the report was verbally corrected), including an Associate Medical Officer of Health; that the Windsor-Essex County Board of Health direct Administration to provide notice, as required under section 72(6) of the HPPA, to the Obligated Municipalities of the additional contributions required to fund the COVID-19 Response Team for the remainder of the 2020 fiscal year; that the final deficit numbers be provided to the Obligated Municipalities as soon as possible; that the Obligated Municipalities write to the Province of Ontario and the Ministry of Health requesting financial support for the shortfall.
         CARRIED

8. Board Correspondence – None
9. New Business
   1. COVID-19 Task Force
      T. Marentette noted that during the Committee of the Whole on June 18, 2020, the COVID-19 Task Force was discussed which includes the members of the Executive, namely the Chair, Vice Chair and Treasurer of the Board, the CEO and MOH, as well as Rino Bortolin, representing the City of Windsor. After consulting with legal counsel, it was determined that the formation of the COVID-19 Task Force should be discussed and membership approved by the Board as a whole in open session, similar to how other committees of the Board are formed.
      Moved by: Fabio Costante
      Seconded by: Ed Sleiman
      That the COVID-19 Task Force be approved.
      CARRIED
   2. Resumption of Water Testing and Utilizing a Third-party Contract – Addition to Agenda (T. Bailey)

      With the COVID-19 pandemic and resources at full capacity at the WECHU, the health unit was forced to make decisions on deferring programs, one of those programs being beach testing. T. Bailey put forth that the health unit fulfil their responsibilities for beach testing and contract out those services due to capacity issues. A letter will be forthcoming from the Town of Lakeshore and the Town of Essex who are conducting their own testing. Municipalities do not have the mechanisms for this and is looking for the Board to support moving forward in some way to keep beaches safe. Another barrier for municipalities is the communication piece with messaging to the public.

      Dr. W. Ahmed said that the pandemic has had a significant impact on staff at the WECHU. Our public health inspectors have been working to support the prevention of outbreaks in Long-Term Care Homes and Retirement Homes, supporting restaurants with the opening to Stage 2 and education and enforcement activities and Section 22 Orders if those served are not compliant. This decision was based fully on resources, and the WECHU is one of the few health units that still conducts beach testing. When beach sampling is conducted water samples are sent to the public health lab and it takes 2 days to receive results. This can bring a false sense of security with testing results, as water samples can change daily. G. McNamara asked if there was an opportunity through the Canada Summer Program for Biology Students from the University or College to assist with testing or to reach out to MPP’s for support. T. Marentette advised that we are using students for our vector-borne programs and enhanced surveillance, and beach sampling not only includes students but experienced public health inspectors as well as epidemiologists. All of the information is tracked and posted to our website which involves our communications team, making this a time and resource intensive program. If a sample identifies that we need to close the beach, that also requires resampling as well. To say it can be done easily with students, it’s just not that simple. Municipalities can consider signage on the beaches that they are not currently being tested.

      T. Bailey asked how challenging the communication piece would be for WECHU if the service was contracted out. T. Marentette advised that they have redeployed a Director for the communication piece for COVID which has taken a significant amount of time. We will need to have internal discussions of what we can and cannot do as the province reopens. We currently have 1,500 people on the waiting list for dental services and cannot go any leaner than we are. As we start to resume these services this will leave a gap in resources for COVID.

      T. Bailey said she would like to put forward a motion.

      Moved by: Tracey Bailey
      Seconded by: Gary Kaschak

      That the WECHU Board of Health make a decision whether or not to go forward to resume beach testing or contract out to a third-party.
      R. Bortolin said that although he understands the desire to reinitiate testing and that it is a valuable resource, he has concerns if we approve this motion as Dr. Ahmed and T. Marentette just mentioned that if we resume beach testing we would need to displace resources. He would like to see what program(s) would be displaced if the WECHU resumes beach testing. He asked T. Bailey as the mover of this motion would she consider an amendment or a deferral to understanding what public health programs will be displaced should beach testing resume before we consider or support this motion, and what the impact would be.

      G. McNamara noted that staff resources are also his concern. All public health programs are important, but if staff are working 7 days a week and the WECHU is saying that it needs 22 FTEs to deal with services to meet the challenges of the pandemic, adding more programs would create more challenges. G. McNamara agrees with what R. Bortolin is stressing, such as a good compromise or an amendment to the motion, and to continue the conversation to see what programs would need to be deferred should beach testing resume. Contracting out would likely be the solution if testing would resume, as WECHU cannot afford to pull away resources from COVID support.

      E. Sleiman asked what the cost would be to resume the testing. T. Marentette said she would not know the cost of contracting out beach sampling, as the costs for testing is embedded in the program where there are protocols and procedures, and getting samples securely to the public health lab. The public health inspectors are trained to do that. When recruiting public health inspection students we recruit them early on in the year, as they are in high demand across health units. Even if municipalities took on the responsibility of testing, public health would still need to be involved. E. Sleiman said it would be too difficult to vote on something without knowing the cost.

      G. McNamara said that if municipal water divisions sample the water and send it out for testing (as they do under the Safe Drinking Act), the health unit would still need to be involved at some point when results are received.

      T. Marentette let the Board know that the public health inspectors did an initial assessment of all the beaches at the beginning of the season, which typically runs from May to September. G. Kaschak said with only 6 weeks to the end of the season, that he would support that the public health inspectors resume the services of testing.

      J. Bachetti said that in terms of the motion this is a fair ask of the health unit and a decision needs to be made, but notes that COVID-19 is currently the priority and whatever the board decides on testing, the municipalities can inform their residents. Dr. Ahmed noted that most health units do not conduct beach testing and samples can change quickly. Some beaches are open, but it is “swim at your own risk”. In August, the health unit will be very much involved in plans for reopening schools and staff are currently working 24/7 on the pandemic. There are still a lot of unknowns to come. Even if the municipalities conduct their own testing, public health will still need to be involved. It is “all hands on deck” now for the health unit with COVID-19. He feels that going to the beach is a leisure activity, and is concerned about using health unit resources for this.

      J. Lund agreed with J. Bachetti and R. Bortolin that without knowing the cost and what programs will be displaced, she cannot support the resumption of beach testing. The WECHU needs to look at its priorities, which is the pandemic, and they are already looking at increasing staff to meet their current needs.

      F. Costante asked Dr. Ahmed and T. Marentette if the health unit resumed beach testing would that take away resources from COIVD-19 and is beach testing a priority over COVID. T. Marentette said that under the Emergency Management and Civil Protection Act, which has been extended to July 29, 2002, it notes that health units can cancel or postpone services that are not related to responding to, preventing or alleviating the outbreak of the virus. All of WECHU’s resources are focused on the virus, and the order talks about reallocation of resources and prioritization for COVID-19. The WECHU continues to work with many farms across Essex County to decrease the transmission of COVID-19 which includes our nursing staff, our public health inspection staff and our management staff so, yes, it will take away resources from COVID-19, and that beach testing is not a priority over the pandemic.

      F. Costante said that it is clear where the priorities are and may we have a vote on this.

      G. McNamara said that the Board would vote on R. Bortolin’s amendment to T. Bailey’s Motion, and then the Motion itself. That information would need to be brought back to WECHU’s August Board meeting. R. Bortolin said that he will rescind his amendment to T. Baily’s Motion as deferring until the August Board meeting will be untimely to resume testing beaches. He will let T. Bailey’s Motion stand as is.

      Moved by: Tracey Bailey
      That the WECHU Board of Health vote on whether to go forward to resume beach testing or contract out to a third-party.
      All in favour: 3
      Opposed: 7
      DEFEATED

10. Other Board of Health Resolutions/Letters
    1. Resolution from Town of Essex – Request for Raw Data on Positive COVID-19 Cases in Essex County – That the Windsor Essex County Health Unit provide a detailed breakdown of data reporting on positive COVID-19 cases in our municipality and the region, based on classification relating to Travel, Close Contact, Community Contact and Agri-Farm as examples.
       Moved by: Rino Bortolin
       Seconded by: John Scott
       That the information be received.
       CARRIED
11. Committee of the Whole (CLOSED SESSION, in accordance with Section 239 of the Municipal Act)
    The Board moved into Committee of the Whole at 5:15 pm
    The Board moved out of Committee of the Whole at 5:50 pm
12. Next Meeting: At the Call of the Chair, or August 20, 2020 – Via Video
13. Adjournment
    Moved by: Tracey Bailey
    Seconded by: Rino Bortolin
    That the meeting be adjourned.
    CARRIED

The meeting adjourned at 5:51 pm.