Board of Health Meeting Documents

SUBMITTED BY:

Epidemiology and Evaluation Department

DATE:

March, 2022

SUBJECT:

COVID-19 Surveillance and Epidemiology – February, 2022

BACKGROUND

Overview

The Epidemiology & Evaluation department conducts on-going population health assessment and surveillance. The data and surveillance for COVID-19 plays an integral role in understanding and managing the pandemic locally. The evidence provides information on how the pandemic has and is evolving, assessing the risk and severity, and assists in the development of timely interventions to limit further spread in the community.

Due to the recent surge in Omicron cases and changes in eligibility for testing, testing capacity is limited and case, contact, and outbreak management has been modified to focus on high-risk settings. As a result, case counts in the report are an underestimate of the true number of individuals with COVID-19 in Windsor-Essex County and may impact data completeness. Please interpret these data accordingly. Due to these changes, data from before December 31, 2021 should not be compared to data after the testing changes.

Trends

In the month of February, the health unit reported 2,751 confirmed high-risk cases of COVID-19. As the weeks progressed in February, the weekly high-risk incidence rate decreased from 228.1 cases per 100,000 population (Week 5) to 130.3 cases per 100,000 population (Week 8).  

In-Patient and ICU Admissions

In February, in-patient COVID-19 hospitalizations continued to decrease in Windsor-Essex County up until the third week of the month. Since then, COVID-19 related hospitalizations has started to trend upwards. However, COVID-19 related ICU admissions has continued to decline throughout the month of February.

Percent Positivity

Locally, Windsor-Essex County continued to experience a week-over-week decline in percent positivity in February. As the month drew to a close, the local percent positivity rate for COVID-19 stabilized to approximately 13.6% in the last week of the month. It is also important to note that these were for high-risk individuals that were eligible for testing.

Wastewater Surveillance

For the month of February, viral signal for COVID-19 in wastewater declined from levels experienced in the previous month. Current levels are beginning to reach levels observed prior to onset of the recent Omicron wave in December 2021.  

Outbreaks

In the month of February, 24 outbreaks were declared in high-risk settings. In comparison, 105 outbreaks were declared in January (a 77% decline in February). This includes nine outbreaks in long-term care and retirement homes, two in hospital settings, five in the agriculture sector and eight in other congregate settings. As of February 28, 2022, there were 20 active outbreaks in comparison to 77 active outbreaks at the end of January.

Deaths

For the month of February 2022, 29 deaths were reported that were attributed to COVID-19. This represents a 45% decline in comparison to the deaths reported in January.

CURRENT INITIATIVES

With the changes in testing eligibility, and guidance with case, contact and outbreak management, the health unit has modified its public reporting to better understand the burden of illness locally. New indicators, such as wastewater data, have been included as a proxy indicator for COVID-19 case counts, which are underestimated. The health unit will continue to monitor and provide epidemiological expertise on COVID-19 to internal leadership, community partners, and residents to support evidence-informed decision-making. This includes daily epidemiological updates, weekly epidemiological presentations to the community and supporting policy decisions through data driven approaches.

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Fabio Costante, Aldo DiCarlo, Judy Lund, Robert Maich, Ed Sleiman

Board Member Regrets:

Gary Kaschak

Meeting held via video: https://youtu.be/C8Dnxn2T01k

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Fabio Costante, Aldo DiCarlo, Gary Kaschak, Judy Lund, Ed Sleiman

Board Member Regrets:

Robert Maich

Meeting held via video: https://youtu.be/wPLC3gHLecA

SUBMITTED BY

Communications Department

DATE

January 2022

SUBJECT

December 2021 - Communications Update

Metrics

Media Exposure Overview

Website Overview

Social Media Growth

Current Notable Projects

• Maintaining marketing and communication efforts regarding ongoing vaccine rollout in the region by public health and our partners. In particular, the opening of the especially with the opening of the Hôtel-Dieu Grace Healthcare (HDGH) in West Windsor and Nature Fresh Farms Recreation Centre in Leamington.
• Responding to media and public inquiries through multiple channels including emails, calls, and web form submissions. Social media direct messages are currently redirected to the wechu.org web form.

Data Notes:

1. Media requests received is a compiled list of documented requests we captured for interviews, data clarification, or general request for information from the media. Given the volume of requests during COVID-19, many exchanges with the media through text messages or quick phone calls to answer questions may not be captured. In many instances, each request led to multiple interactions with reporters.
2. Dr. Ahmed joined Mike and Lisa on the AM 800 Morning Drive every morning at 8:06 a.m. starting on Wednesday, March 17, 2020. On August 17, 2020, we went to a Monday, Wednesday, and Friday schedule with holidays off. On July 19, 2021, Dr. Ahmed continued to join Mike and Lisa Monday and Wednesday mornings to keep the community informed. On September 16, 2021, Nicole Dupuis and Dr. Nesathurai were conducting interviews with Mike and Lisa on Monday and Wednesday mornings. Staring the week of November 15, 2021, interviews were being conducted on Wednesdays only. December 8 was the last Wednesday WECHU appearance on the program as a regular weekly guest.
3. YouTube Live videos started on June 23, 2020. Prior Public Health Update videos on YouTube were exported videos recorded through Facebook Live. In July 2021, YouTube Live broadcasts were scaled down to Fridays only from a Monday, Wednesday, and Friday rotation. In September 2021, media briefings were increased to Monday, Wednesdays and Fridays and streamed live. On September 20, 2021, media briefings were recorded and then posted to YouTube.
4. Website analytics are provided by Siteimprove. The metric provided is for page views to wechu.org. Previously, we were reporting on the local-updates webpage only.
5. Email subscribers are those individuals who signed up to receive promotional emails from the Windsor-Essex County Health Unit. The analytics are provided through Mailchimp.
6. Social media metrics are provided through Hootsuite.
7. Media exposure information in this report were generated using Meltwater Media Monitoring Solution. News stories may be duplicates or missing as the platform is currently being optimized to better track Windsor-Essex County Health Unit mentions in the media landscape.

SUBMITTED BY:

Epidemiology and Evaluation Department

DATE:

January, 2022

SUBJECT:

COVID-19 Surveillance and Epidemiology

BACKGROUND

Overview

The Epidemiology & Evaluation department conducts on-going population health assessment and surveillance. The data and surveillance for COVID-19 plays an integral role in understanding and managing the pandemic locally. The evidence provides information on how the pandemic has and is evolving, assessing the risk and severity, and assists in the development of timely interventions to limit further spread in the community.

Due to the recent surge in Omicron cases and changes in eligibility for testing, testing capacity is limited and case, contact, and outbreak management has been modified to focus on high-risk settings. As a result, case counts in this report are an underestimate of the true number of individuals with COVID-19 in Windsor-Essex County and may impact data completeness. Please interpret these data accordingly.

Trends

In the month of December (2021), the health unit reported 3,811 confirmed cases of COVID-19. This is a 174.0% increase in case counts compared to the previous month of November (2021). Similarly, the monthly case rate for December was 881.8 cases per 100,000 population, which is higher compared to the monthly rate in November (321.8 cases per 100,000 population). In Ontario, during the month of December, the case rate was 935.7 cases per 100,000 population.

Age and Gender

Approximately 52% (1,971) of the cases were among females and 47% (1,828) among males. A disproportionately (22.0%) higher number of cases, in November 2021,  were reported among those 20 to 29 years of age, followed by 20.9% among those 0 to 19 years of age, and 16.5% in the 30 to 39 year age group. Comparatively, from the onset of the pandemic locally (March 1, 2020 to December 31, 2021), approximately 16% of our cases were in the 0 to 19 age group.

Municipal Distribution

The Town of Tecumseh had the highest case rates (1184.3 cases per 100,000 population), followed by Amherstburg (976.8 cases per 100,000 population), Leamington (972.1 cases per 100,000 population), and Kingsville (925.1 cases per 100,000 population). However, looking at the distribution of cases, 53% of cases were from the City of Windsor, 9% from Lakeshore, 8% from Tecumseh and 8% from Leamington.

Risk Factors

For the month of December 2021, the top three risk factors reported were being an elementary or secondary student (15.6%), being a healthcare worker (2.4%) and being an educational staff (2.2%).

Source of Acquisition

Approximately, 23.0% of cases in December (2021) acquired COVID-19 from an unknown source (no epi-link identified), 19.9% from a household contact and 12.9% from a close contact outside of their household. With the change in testing eligibility in the province in December alongside the high number of cases, approximately 29.7% of cases are still under investigation.

Outcome Status

Of the 3,811 cases reported in December (2021), 47.4% (1,808) had their infection resolved, 1,145 cases (30.0%) were active and being followed by the health unit, and 20.0% (764) of cases were lost to follow-up. Twenty-four deaths were reported in December (2021) due to COVID-19.

Vaccination Status

107,139 doses were administered to Windsor-Essex County residents in the month of December (2021) compared to over 36,141 doses in the month of November. This represents a 196.4% increase for the month of December (2021) due to the eligibility of 5 to 11 year olds and access for third dose boosters. Approximately 86.7% of the doses administered were third doses/boosters, 8.8% were first doses to individuals who were previously unvaccinated, and 4.5% were among those completing their vaccination series (fully vaccinated).

Among the 3,811 cases reported in December (2021), 64.0% were fully vaccinated, 29.6% were unvaccinated, 4.7% were partially protected with one dose, and 1.8% were not yet protected after receiving the first dose. Among the 1,129 unvaccinated cases, approximately 65.6% were among those 0 to 18 years of age, which includes children who were ineligible to receive the vaccine.

CURRENT INITIATIVES

With the changes in testing eligibility, and guidance with case, contact and outbreak management, the health unit is exploring other methods to conduct COVID-19 surveillance and epidemiological analyses. The health unit will continue to monitor and provide epidemiological expertise on COVID-19 to internal leadership, community partners, and residents to support evidence-informed decision-making. This includes daily epidemiological updates, weekly epidemiological presentations to the community and supporting policy decisions through data driven approaches.

SUBMITTED BY:

Healthy Schools Vaccine Department

DATE:

January 20, 2022

SUBJECT:

Influenza Vaccine Update

BACKGROUND

The Windsor-Essex County Health Unit (WECHU) plays a key role in the implementation of the Ministry of Health’s Universal Influenza Immunization Program (UIIP) which offers influenza vaccine free of charge each year to all individuals six months of age and older who live, work, or attend school in Ontario. The WECHU receives influenza vaccine shipments from the Ontario Government Pharmacy (OGP) and is responsible for the distribution to local health care providers and approved facilities in the community.  Allocation to providers is based on total community allocation, number of clients to be served, past usage by the provider, available fridge space, and the proportion of high-risk clients the provider is responsible for. As of December 7, 2021 there were no laboratory-confirmed cases of influenza in Windsor and Essex County (WEC).

SUMMARY OF VACCINE ALLOCATION & DISTRIBUTION

The WECHU received initial shipments of the influenza vaccine on September 21, 2021.  In total, the WECHU received 110,990 doses of the vaccine from the Ministry. Of these, 27,430 doses were the High-Dose Quadrivalent Inactivated Vaccine (HD-QIV) for individuals 65 and over; and 10,000 doses were the standard dose Adjuvanted Trivalent Vaccine (TIV-adj) for individuals 65 and over.

As of December 9, the WECHU has distributed 83% (92,240 doses) of our total allocation of the influenza vaccine, 85% (62,580 doses) of the QIV, 100% (27,430 doses) of the HD-QIV, and 22% (2,230 doses) of the TIV-adj to the community. This includes 37 long-term care facilities and registered retirement homes, 4 hospitals, and approximately 200 healthcare providers. The OGP distributed the influenza vaccine directly to 124 pharmacies in WEC that were approved by the Ministry of Health and at the time this report was written, pharmacies have administered 35,714 doses to WEC residents.

HIGH DOSE-QIV

Although the WECHU is out of stock of the HD-QIV, and will not be available for the remainder of the season, the TIV-adj is still available for individuals 65 and over. There is no preferential recommendation for HD-QIV over TIV-adj or QIV. National Advisory Committee on Immunization (NACI) states that all three vaccines protect against influenza, the most important thing is for seniors to be vaccinated.

LONG-TERM CARE/RETIREMENT HOMES

The initial supply of influenza vaccine was prioritized for the immunization of high-risk individuals, such as residents and staff of long-term care homes and retirement homes. Overall, the WECHU has distributed 5,140 influenza vaccine doses to 19 long-term care homes, and 2,480 doses to 18 registered retirement homes in WEC. A further breakdown is provided below:

CURRENT INITIATIVES

The WECHU continues to support widespread availability of the influenza vaccine in our community by working collaboratively with many community partners, including those in primary care, to identify service gaps and promote vaccine uptake.

The WECHU continues to raise awareness of the risks of contracting influenza (especially for high-risk groups), and the importance of being vaccinated amongst the COVID-19 pandemic through our social media platforms (i.e., Facebook, Twitter, and Instagram).

SUBMITTED BY:

Chronic Disease and Injury Prevention Department (CDIP)

DATE:

January 20, 2022

SUBJECT:

Smoking Cessation Programing and Vaping Supports

BACKGROUND

Tobacco remains the leading cause of preventable disease and death in Canada. Tobacco use and exposure to second-hand smoke are linked to cancer, heart disease, and several other diseases. Locally the burden of premature illness and death caused by smoking remains high in Windsor and Essex County with one in five adults (19.6%) reporting that they currently smoke tobacco.¹

In addition to tobacco smoking, the rise of vaping or e-cigarette use, particularly in youth, has been a concern from both health officials and local schools in Windsor-Essex. In Windsor-Essex, 6% of grade 9 to 12 students are current smokers and 26% of students have used an e-cigarette.² In Ontario, while the rate of past year use of tobacco cigarettes has been declining (from 7% to 5% from 2017-2019), the past year use of e-cigarettes doubled from 11% to 23% in the same period.³  Vaping can expose youth to chemicals that could negatively impact their health in several ways, such as lung damage, nicotine dependence, and negative effects on brain development, including memory and concentration.⁴ 

CURRENT INITIATIVES

Tobacco and Vaping Cessation

The health unit has continued to provide eligible Windsor-Essex County residents with individual cessation programming throughout the pandemic, where clients enter the program by self-referral, or by referral from a community partner.  Through a one-on-one cessation program, clients are provided with behavioural counseling sessions and up to 16 weeks of nicotine replacement therapy (NRT) such as patches or gum. Follow-up counseling sessions are also provided to active clients for additional support and adjustment of their NRT dosing as needed.

In 2021, 107 new clients were added to the program with nearly 600 counselling sessions completed. Currently, there are 53 active clients enrolled in the program who meet with the counsellor on a weekly or bi-weekly basis to ensure goals are being met, challenges are being addressed, and NRT dosage remains appropriate.

Tobacco and Vaping Prevention with Local School Boards                    

To address rising rates of vaping among youth, the WECHU Chronic Disease and Injury Prevention Department and Healthy Schools Department developed a toolkit for educators. This toolkit includes a presentation for high school students, posters, and educational handouts. This toolkit will continue to be promoted to schools and community partners in 2022.

With limitations to in-person school access in 2021, health promotion support related to tobacco and vaping moved to a virtual format. Health unit staff provided virtual trainings for parents and staff as well as smoking and vaping presentation to students led by Tobacco Vaping Enforcement Officers and Healthy Schools Department Public Health Nurses.  Assistance in education and enforcement was also provided by Tobacco and Vaping Enforcement Officers to address concerns of smoking and vaping in and around school property. Ongoing support of these initiatives will continue to be prioritized in the current school year as staffing allows.

References

1. The Windsor-Essex County Health Unit. (2019). Community needs assessment: June 2019 update. Retrieved from https://www.wechu.org/sites/default/files/edit-resource/em-community-needs-assessments-report-2019/cnareport2019.pdf   
2. University of Waterloo. (2018). COMPASS Study data (Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, Sedentary behavior).
3. Centre for Addiction and Mental Health. (2020). Ontario Student Drug Use and Health Survey Data Brief. Retrieved from https://camh.ca/-/media/files/pdfs---ebulletin/osduhs_databrief_march2020_drugusehighlights-pdf.pdf
4. Health Canada. (2020). Risks of vaping. Retrieved from https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/risks.html
5. Centre for Addiction and Mental Health. (2020). Ontario Student Drug Use and Health Survey Data Brief. Retrieved from https://camh.ca/-/media/files/pdfs---ebulletin/osduhs_databrief_march2020_drugusehighlights-pdf.pdf

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Aldo DiCarlo, Gary Kaschak, Judy Lund, Ed Sleiman, Robert Maich (4:11 pm)

Board Member Regrets:

Fabio Costante

Meeting held via video: https://youtu.be/wHQogjtcW28

SUBMITTED BY:

Oral Health Department

DATE:

December, 2021

SUBJECT:

BACKGROUND

In the fall of 2019, the Ministry of Health launched the Ontario Seniors Dental Care Program (OSDCP) to improve access to regular dental care for low-income seniors. Locally, the Windsor-Essex County Health Unit (WECHU) is implementing the OSDCP through the Leamington and Windsor oral health clinics and in partnership with the Southwest Ontario Aboriginal Health Access Centre (SOAHAC). The OSDCP provides free dental care to low-income seniors who are age 65 years and older, and have no access to other dental benefits.

Services covered under the OSDCP include:

• Preventive services (e.g., cleanings)
• Restorative services to repair broken teeth and cavities (e.g., crowns)
• Oral surgery services to remove teeth or abnormal tissue
• Endodontic services to treat infection and pain (e.g., root canals)
• Periodontal services to treat gum conditions and diseases
• Dental prosthetics (prosthodontic services), including dentures (partially covered)

In order to be eligible for the OSDCP, seniors must also have an annual net income of $22,200 or less, or a combined annual net income of $37,100 or less for senior couples (one or both people aged 65 or older). Lastly, the program is restricted to those who are not covered by dental benefits, including private insurance, Ontario Works, Ontario Disability Support Program, or Non-Insured Health benefits.

CURRENT INITIATIVES

The WECHU began to operationalize the OSDCP protocols in January 2020 with an 8:30 a.m. to 8 p.m. clinic in its downtown Windsor office and an 8:30 a.m. to 4:30 p.m. clinic at its county location in the downtown core of Leamington. The OSDCP funding currently supports three dental assistants, three dental hygienists, 1.5 dentists, one part-time denturist, two clerks, one manager and one health promotion specialist. With early implementation hindered by service alterations caused by COVID-19, the clinic has now resumed full operation and is being promoted throughout the region through the WECHU.org website, a local magazine targeting those over the age of 55, and referrals from partnering agencies.

Prior to the WECHU’s implementation of the OSDCP, the Oral Health Department’s clinic exclusively treated eligible children and youth (under 17) who qualified for the Healthy Smiles Ontario (HSO) program. With the seniors program now in full operation servicing 810 unique clients in 2021, the proportion of WECHU dental clients is now split relatively evenly between the two client groups.  Although the characteristics of the clients between the two programs are quite different, the types of treatment offered to clients under both the HSO and OSDCP are similar with the exception of certain services offered exclusively to seniors (i.e., dental prosthetics). The total number of procedures and appointments for both programs are outlined in Table 1 below:

Table 1: Services Offered to Oral Health Department Clients (January 1st – November 29th, 2021)

* Refers to number of appointments rather than individual procedures

With respect to the figures in Table 1, the WECHU anticipates the need for services will continue to increase for the senior population as only an estimated 22% of all eligible seniors in Windsor and Essex County have accessed the program to date.

Future Plans

After its first year of full operation of the OSDCP, ongoing planning regarding the best staffing model, space utilization, and resource allocation continue to be a priority of the WECHU management and leadership team. Currently, the clinics are booking appointments approximately 2 months into the future for appointments with our dental hygienist or denturist and potential for up to 5 months to see a dentist for treatment. Future directions aim to improve this wait time through a number of different program modifications:

• Exploring the provision of service in Long-term Care Homes:
  • A needs assessment survey will be distributed for those residents of long-term care homes to determine whether or not expansion into this setting is appropriate and feasible given the current funding provided.
• Expanding Clinic Capacity:
  • One large dental operatory will be split to provide an additional space for client service.
• Increasing the number of appointment times:
  • Reducing the requisite time between appointments by enhancing air filtration to allow for more appointment times throughout the day.
• Improving efficiency of professional staffing resources:

Decreasing wait times for services which can only be completed by dentists by increasing denturist time.

SUBMITTED BY:

Healthy Families Department

DATE:

December, 2021

SUBJECT:

COVID-19 Surveillance and Epidemiology

BACKGROUND

The quality of parenting children receive during infancy and childhood has a significant impact on their development, well-being, and life opportunities. Positive parenting practices provide children with many developmental and life advantages such as secure attachment, higher academic achievement, and improved physical health to name a few. Positive parenting practices are associated with reduced risk of substance misuse problems and anti-social behaviors among children and youth, and can buffer children from the consequences of other hardships (e.g. the stresses of living in poverty).

Local data pertaining to child poverty, and school readiness identify that positive parenting interventions need to be a priority for the vulnerable in our community. As well, the Mental Health Promotion Framework (WECHU, 2019) identified the domain related to family, including parenting style as a key area for future intervention.

Poverty remains a significant issue children face in Windsor- Essex County. Approximately, one in four (26%) children under 5 years live in low-income households (Windsor-Essex County Health Unit, 2019). This proportion is higher than any other age group, and the proportion of children under age 5 living in low-income is higher than the provincial average (19.8%) (Windsor-Essex County Health Unit, 2019). Children living in low-income households are at greater risk for poor outcomes related to healthy and growth and development (Perou et al., 2019).

Research has identified that warm, sensitive parent-child relationships and positive parenting practices play an important role for children’s readiness for school (Welsh, 2014).  Local Early Development Instrument (EDI) data (2017/2018) indicated 28.1% of kindergarten students were vulnerable in at least one of the five early development domains (i.e., physical health and well-being, communication skills and general knowledge, emotional health and maturity, social competence, and language and cognitive development).

Additionally the COVID-19 pandemic has had a significant impact on supports and services for parents and young children. Many of the supports and services that families rely upon were cancelled, delayed or reduced during the COVID-19 pandemic. As well, public health measures such social distancing impact the development of many skills for children, including socialization and self-regulation.

CURRENT INITIATIVES

Legacy for Children™ is an evidenced-based, parent-focused program geared towards low-income, low-resourced mothers of infants and young children. The Legacy model was developed by the Centers for Disease Control and Prevention (CDC). Legacy aims to positively influence child development by: promoting sensitive and responsive mother-child interactions; enhancing maternal self-efficacy; and promoting a sense of community. Research through a randomized control trial has shown that children whose mothers participated in Legacy had significantly higher cognitive scores, and experienced fewer behavioral and social emotional problems than non-legacy children.

Legacy is a three- year program, offered in a group setting starting ideally in the third trimester of pregnancy, and ends when the child reaches age three. Each Legacy group meets for 2 hours per week. In addition, the program includes one-on-one time (e.g., home visits, phone calls) between program staff, (referred to as the Intervention Specialist) and the participant during program breaks. This is an opportunity for the Intervention Specialist to reinforce curriculum content, and provide extra support to participants.

Legacy is facilitated by Intervention Specialists, who are trained by University of California, Los Angeles and CDC.  To date, some Healthy Families’ Public Health Nurses and Social Workers have been trained as Intervention Specialists.  The Intervention Specialists use a variety of techniques during group sessions: videos, slides, role-playing, structured discussion activities, etc.

Starting in February 2022, the Healthy Families Department will be partnering with Connections Early Years Family Centre (Connections) to pilot a hybrid model of Legacy due to the pandemic. The plan is to have 8 participants in-person with the two Intervention Specialists at Connections, and roughly 7 participants online for a total of 15 participants. The WECHU will work through existing partners to assist with identifying and recruiting potential participants including: Healthy Babies Healthy Children prenatal clients, Building Blocks for Better Babies, WECHU’s Nurse Practitioner, local Obstetricians, Windsor-Regional Hospital Social Worker(s), Connections, Ready Set Go, Windsor Youth Centre, VON Immigrant Health Centre, Children First, etc.

Connections is supporting the pilot by providing their facility in-kind, and offering child care to in-person participants needing child care. The child care will be provided by Connections’ Early Childhood Educators.

In addition, a Legacy Stakeholder Advisory Committee has been established to provide guidance and support to WECHU in the implementation of the Legacy program in Windsor- Essex County. The scope of the committee will be to: assist with recruitment and retention of participants, inform and guide evaluation, and provide recommendations for future sites based on community needs.

SUBMITTED BY:

Epidemiology and Evaluation Department

DATE:

December, 2021

SUBJECT:

COVID-19 Surveillance and Epidemiology

BACKGROUND

Overview

The Epidemiology & Evaluation department conducts on-going population health assessment and surveillance. The data and surveillance for COVID-19 plays an integral role in understanding and managing the pandemic locally. The evidence provides information on how the pandemic has and is evolving, assessing the risk and severity, and assists in the development of timely interventions to limit further spread in the community.

Trends

In the month of November (2021), the health unit reported 1,391 confirmed cases of COVID-19. This is a 72.2% increase in case counts compared to the previous month of October (2021). Similarly, the monthly case rate for November was 321.8 cases per 100,000 population, which is higher compared to the monthly rate in October (187.0 cases per 100,000 population). In Ontario, during the month of November, the case rate was 125.0 cases per 100,000 population. This is approximately 2.6 times lower compared to the rate of Windsor-Essex County.

Age and Gender

Approximately 52% (729) of the cases were among females and 47% among males. A disproportionately (21.9%) higher number of cases, in November 2021,  were reported among those 0 to 18 years of age, followed by 15.6% among those 30 to 39 years of age, and 15.5% in the 40 to 49 year age group. Comparatively, from the onset of the pandemic locally (March 1, 2020 to November 30, 2021), approximately 16% of our cases were in the 0 to 19 age group.

Municipal Distribution

The Town of Leamington had the highest case rates (548.7 cases per 100,000 population), followed by Amherstburg (469.0 cases per 100,000 population), Tecumseh (461.3 cases per 100,000 population), and Essex (433.7 cases per 100,000 population). However, looking at the distribution of cases, 46% of cases were from the City of Windsor, 12% from Leamington, 8% from Tecumseh and 8% from Essex.

Risk Factors

For the month of November 2021, the top three risk factors reported were being an elementary or secondary student (15.6%), being a healthcare worker (2.4%) and being an educational staff (2.2%).

Variants of Concern (VOCs)

Of the 1,391 cases reported in the month of November, genomic sequencing results were available for 528 cases (38% of cases). Overall, 36% of cases reported were due to the Delta variant (B.1.617.2).

Source of Acquisition

Approximately, 33% of cases in November (2021) acquired COVID-19 from an unknown source (no epi-link identified), 29% from a household contact, 20% from a close contact outside of their household, 8% due to being related to an outbreak, and 1.6% from travel-related outside of the province (e.g., to another province and/or outside of Canada).

Outcome Status

Of the 1,391 cases reported in November (2021), 51% (706) had their infection resolved, 574 cases (45%) were active and being followed by the health unit, and 2.4% (21) of cases were lost to follow-up. Six deaths were reported in November (2021) due to COVID-19.

Vaccination Status

36,141 doses were administered to Windsor-Essex County residents in the month of November (2021) compared to over 21,889 doses in the month of October. This represents a 65% increase for the month of November (2021). Approximately 57% of the doses administered were third doses/boosters, 23% were first doses to individuals who were previously unvaccinated, and 20% were among those completing their vaccination series (fully vaccinated).

Among the 1,391 cases reported in November (2021), 49% were fully vaccinated, 46% were unvaccinated, 4.5% were partially protected with one dose, and 1% were not yet protected after receiving the first dose. Among the 636 unvaccinated cases, approximately 42% were among those 0 to 18 years of age which includes children who were ineligible to receive the vaccine.

CURRENT INITIATIVES

The health unit will continue to monitor and provide epidemiological expertise on COVID-19 to internal leadership, community partners, and residents to support evidence-informed decision-making. This includes daily epidemiological updates, weekly epidemiological presentations to the community and supporting policy decisions through data driven approaches

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Fabio Costante, Gary Kaschak, Judy Lund, Ed Sleiman, Larry Snively

Board Member Regrets:

Robert Maich

Administration Present:

Nicole Dupuis, Dr. Shanker Nesathurai, Lorie Gregg, Felicia Lawal, Kristy McBeth, Eric Nadalin, Dan Sibley, Lee Anne Damphouse

QUORUM:  Confirmed

The Board moved into Committee of the Whole at 4:02 pm
The Board moved out of Committee of the Whole at 4:14 pm

RECORDING SECRETARY: L. Damphouse

SUBMITTED BY: N. Dupuis

APPROVED BY: WECHU Board of Health, January 20, 2022

Meeting held via video: https://youtu.be/3amhiiN2J90

SUBMITTED BY

Epidemiology and Evaluation Department

DATE

November, 2021

SUBJECT

COVID-19 Surveillance and Epidemiology – October, 2021

BACKGROUND

Overview

The Epidemiology & Evaluation department conducts on-going population health assessment and surveillance. The data and surveillance for COVID-19 plays an integral role in understanding and managing the pandemic locally. The evidence provides information on how the pandemic has and is evolving, assessing the risk and severity, and assists in the development of timely interventions to limit further spread in the community.

Trends

In the month of October (2021), the health unit reported 808 confirmed cases of COVID-19. This is a 47.6% decrease in case counts compared to the previous month of September (2021). Similarly, the monthly case rate for October was 186.95 cases per 100,000 population, which is lower compared to the monthly rate in September (356.8 cases per 100,000 population). In Ontario, during the month of October, the case rate was 91.5 cases per 100,000 population. This is approximately 2.0 times lower compared to the rate of Windsor-Essex County.

Age and Gender

Approximately 51% (413) of the cases were among males and 49% among females. A disproportionately (28.6%) higher number of cases, in October 2021,  were reported among those 0 to 18 years of age, followed by 15.6% among those 30 to 39 years of age, and 15.3% in the 19 to 29 year age group. Comparatively, from the onset of the pandemic locally (March 1, 2020 to October 31, 2021), approximately 15% of our cases were in the 0 to 19 age group.

Municipal Distribution

The Town of Leamington had the highest case rates (403.1 cases per 100,000 population), followed by Essex (349.8 cases per 100,000 population), Tecumseh (199.5 cases per 100,000 population), and the city of Windsor (17.1 cases per 100,000 population). However, looking at the distribution of cases, 49% of cases were from the City of Windsor, 15% from Leamington, and 9% from Essex.

Risk Factors

For the month of October 2021, the top five risk factors reported were being an elementary or secondary student (19.1%), being a resident of congregate living setting (5.0%), being a health care worker (2.4%), being a farm worker (2.1%), and being an educational staff member (1.9%).

Variants of Concern (VOCs)

Of the 1,542 cases reported in the month of October, genomic sequencing results were available for 718 cases (89% of cases). Overall, 69% of cases reported were due to the Delta variant (B.1.617.2), 7% of cases reported results without a variant, and 24% were not sequenced to identify a mutation or a VOC.

Source of Acquisition

Approximately, 38% of cases in October 2021 acquired COVID-19 from their household contact, 20% from a close contact outside of their household, 5% due to being related to an outbreak, and 4% from travel-related outside of the province (e.g., to another province and/or outside of Canada).

Outcome Status

Of the 808 cases reported in October 2021, 72% (582) had their infection resolved, 194 cases (24%) were active and being followed by the health unit, and 2.6% (21) of cases were lost to follow-up. Six deaths were reported in October (2021) due to COVID-19.

Vaccination Status

21,889 doses were administered to Windsor-Essex County residents in the month of October compared to over 34,500 doses in the month of September. This represents a 36% decrease for the month of October (2021). Approximately 62% of the doses administered were second doses to complete a vaccination series, 32% were first doses to individuals who were previously unvaccinated, and 6% were among those in the highest risk priority groups (e.g., residents of long-term care and retirement homes).

Among the 808 cases reported in October 2021, 63% were unvaccinated (or not eligible to receive a vaccine), 29% were fully vaccinated, 6% were partially protected with one dose, and 2% were not yet protected after receiving the first dose. Among the 356 unvaccinated cases, approximately 58% were among those 0 to 18 years of age which includes children who were ineligible to receive the vaccine.

CURRENT INITIATIVES

The health unit will continue to monitor and provide epidemiological expertise on COVID-19 to internal leadership, community partners, and residents to support evidence-informed decision-making. This includes daily epidemiological updates, weekly epidemiological presentations to the community and supporting policy decisions through data driven approaches

SUBMITTED BY

Communications Department

DATE

November, 2021

SUBJECT

October 2021 - Communications Update

October Metrics

Media Monitoring Highlights

Facebook Highlights

Twitter Highlights

Media Participating in Media Briefings

• AM 800 CKLW, Blackburn News, CBC Windsor, CTV Windsor, CFTV and the Windsor Star join regularly.

Current Notable Projects

• Maintaining marketing and communication efforts regarding ongoing vaccine rollout in the region by public health and our partners.
• Shift of media responses from media requests to proactive recorded media sessions in order to reduce burden on Communications and Leadership Team staff while maintaining and improving responsiveness to inquiries.
• Maintaining and updating website as new information changes regarding COVID-19.

Data Notes:

1. Media requests received is a compiled list of documented requests we captured for interviews, data clarification, or general request for information from the media. Given the volume of requests during COVID-19, many exchanges with the media through text messages or quick phone calls to answer questions may not be captured. In many instances, each request led to multiple interactions with reporters.

2. Dr. Ahmed joined Mike and Lisa on the AM 800 Morning Drive every morning at 8:06 a.m. starting on Wednesday, March 17, 2020. On August 17, 2020, we went to a Monday, Wednesday, and Friday schedule with holidays off. On July 19, 2021, Dr. Ahmed continued to join Mike and Lisa Monday and Wednesday mornings to keep the community informed. On September 16, 2021, Nicole Dupuis and Dr. Nesathurai were conducting interviews with Mike and Lisa on Monday and Wednesday mornings.

3. YouTube Live videos started on June 23, 2020. Prior Public Health Update videos on YouTube were exported videos recorded through Facebook Live. In July 2021, YouTube Live broadcasts were scaled down to Fridays only from a Monday, Wednesday, and Friday rotation. In September 2021, media briefings were increased to Monday, Wednesdays and Fridays and streamed live. On September 20, 2021, media briefings were recorded and then posted to YouTube.

4. Website analytics are provided by Site improve. The metric provided is for page views to wechu.org. Previously, we were reporting on the local-updates webpage only.

6. Email subscribers are those individuals who signed up to receive promotional emails from the Windsor-Essex County Health Unit. The analytics are provided through Mailchimp.

7. Social media metrics are provided through Hootsuite.

8. Graphs and media exposure information in this report were generated using Meltwater Media Monitoring Solution. News stories may be duplicates or missing as the platform is currently being optimized to better track Windsor-Essex County Health Unit mentions in the media landscape.

ISSUE

On Thursday October 28, 2021, Chief Medical Officer of Health Dr. Kieran Moore indicated during a news briefing that the Province of Ontario would not be adding COVID-19 to the list of nine diseases that public school students must be immunized against.

Currently, there is no requirement for eligible students to provide proof of vaccination against COVID-19 for school attendance. Schools are a high-risk setting for COVID-19 and other communicable diseases as they bring together large numbers of individuals for long and extended periods of time increasing the likelihood transmission of certain diseases. As of November 15th, there have been more than 450 cohorts of students dismissed through schools and daycares due to COVID-19 exposure. The Immunization of School Pupils Act (Ministry of Health, 2021)requires that children and youth attending school be immunized against designated diseases, unless they have a valid exemption. The addition of COVID-19 as a ”designated disease” within the Immunization of School Pupils Act would support a number of important public health priorities including:

• Increased uptake of the vaccine, providing protection for those who are too young or medically unable to be vaccinated in school communities and beyond. This will result in a safer learning environment for students, staff, their families and the broader community.
• A systematic framework for parental vaccine education. 

BACKGROUND

Vaccines are the safest and most efficient way to guard against communicable diseases and prevent outbreaks. The Immunization of School Pupils Act (ISPA) R.S.O. 1990 (Ministry of Health, 2021) requires that specified vaccines to be given for a child to attend school in Ontario making sure that all school aged children are protected from vaccine preventable diseases. Currently under the ISPA, students must be immunized against measles, mumps, rubella, diphtheria, tetanus, meningococcal, varicella and polio, or have a valid Medical, or Conscience or Religious Belief exemption on file at the Health Unit. There is no cost for vaccines covered by the publicly funded immunization program in Ontario.

MOTION

Whereas available COVID-19 vaccines have been approved by Health Canada to be safe and effective for students born in 2009 or earlier; and

Whereas additional approval by Health Canada to vaccinate individuals born after 2009 with COVID-19 vaccine is anticipated by the end of 2021; and

Whereas the COVID-19 pandemic is a global pandemic;

Whereas the Windsor-Essex region has been disproportionately affected by the COVID-19 pandemic; and

Whereas the Windsor-Essex region has lower rates of vaccination against COVID-19 particularly among eligible children and youth; and

Whereas the purpose of the Immunization of School Pupils Act is to increase the protection of the health of children against the diseases that are designated diseases; and

Whereas the IPSA requires that students be immunized for “designated diseases”: diphtheria, measles, mumps, poliomyelitis, rubella, and tetanus, unless a specific exemption is sought through the act.

Now therefore be it resolved that the Windsor-Essex County Board of Health recommends that the Province of Ontario amend the Immunization of School Pupils Act to include COVID-19 as a “designated disease”.

References:

Ministry of Health. (2021, April 19). Immunization of School Pupils Act, R.S.O. 1990, c. | .1. Retrieved from Government of Ontario Laws: ontario.ca/laws/statute/90i01

ISSUE

The Windsor-Essex County Health Unit (WECHU) requires the Board of Health to approve the annual operating budget, as this budget forms the basis of the Annual Service Plan and Budget Submission to the Ministry of Health (MOH).

BACKGROUND

The WECHU is a publicly funded organization; as such, the WECHU has a responsibility to spend funds prudently with the objective of providing public health programs and services as required by the Health Protection and Promotion Act (HPPA) and the Ontario Public Health Standards:  Requirements for Programs, Services, and Accountability (OPHS).

The WECHU receives funding in the following manner:

• The Province of Ontario, more specifically the Ministry of Health, annually grants the WECHU funding to a maximum of 70% of admissible expenditures for its Mandatory Program.  In addition, the WECHU receives required contributions for the Corporation of the City of Windsor, The Corporation of the County of Essex, and the Corporation of the Township of Pelee (hereinafter collectively referred to as the Obligated Municipalities) at a minimum of 30% of admissible expenditures.
• The Ministry of Health annually provide grants for certain related health protection and promotion programs at a rate of 100% of admissible expenditures.  More specifically this includes the Ontario Seniors Dental Care Program and the AMOH/MOH Compensation Initiative.
• The Ministry of Children, Community and Social Services (MCCSS) provides annual grants to fund the Healthy Babies Healthy Children Program Initiative and the Nurse Practitioner Program Initiative at a rate of 100% of admissible expenditures.

On an annual basis, the WECHU prepares its operating budgets for review and approval by the Board of Health.  This budget approval than becomes the foundation of the Annual Service Plan and Budget Submissions to the Ministry of Health.  The due date for the 2022 Annual Service Plan and Budget Submission to the Ministry of Health is tentatively set for March of 2022. 

The operating budgets for programs funded by MCCSS will be reported to the Board of Health in a separate report in March of 2022.

Mandatory Program

The Mandatory Program budget supports 151.98 FTEs, more specifically:

• Leadership Team 6.75 FTEs
• Management Team 9.60 FTEs
• Coordinators 5.75 FTEs
• Administrative support staff (all departments) 25 FTEs
• Communications staff 4.0 FTEs
• Oral health staff 13.50 FTEs
• Nursing staff (all) 32.50 FTEs
• Enforcement staff (Public health inspectors and Tobacco and Vaping Enforcement officers) 22 FTEs
• Corporate services staff including Human Resources 13 FTEs
• Health promotion and mental health specialists 14.88 FTEs
• Other program staff 5.00 FTEs

The following represents a summary of changes in the 2022 Mandatory Program budget compared to 2021:

• Salaries and employee benefits decreased $876,716.  In 2022, the Mandatory Program budget supported 152.23 FTEs as compared to 164.50 FTEs in 2021.  In 2022, additional human resource capacity was shifted from Mandatory Programs to support the COVID-19 activities and recovery activities.
• Increase in other operating costs of $34,499.  The most notable changes are as follows:
  • A decrease in office equipment rental of $19,000 due to the decline in rental fees in the latter part of the agreement. 
  • A net decrease in professional fees of $34,100, namely legal fees.
  • An increase in purchased services of $161,358. The WECHU will employ third party consultants/services to support the Corporate Services division, namely in the areas of Finance and Facilities.  From a Facilities perspective, these services will be focused on the Windsor Facility Project. 
  • A decrease in building occupancy costs of $99,514.  In 2022, the WECHU will only lease two (2) office facilities (Windsor and Leamington), as compared to three (3) in 2021 (Windsor, Essex and Leamington).

Vector-Borne Diseases Programs

Included within the Mandatory Program budget are costs associated with the Vector-Borne Diseases Program (VBD).

The VBD Program is further divided into three sub-programs, the West Nile Virus Program, the Enhanced Mosquito Surveillance Program and the Tick-Borne Disease Program.

In totality, these programs support the salaries and benefits of five (5.0) public health inspection student FTEs and one-half (0.5) of a public health inspector FTE.

COVID-19 Program

The COVID-19 Program budget includes activities to support the response to COVID-19 pandemic in Windsor and Essex County including vaccination efforts. This budget supports 62.04 FTEs, more specifically:

• Leadership Team 1.00 FTE
• Management Team 7.00 FTEs
• Coordinators, including Performance Improvement and Accountability Specialists 1.25 FTEs
• Administrative support staff (all departments) 4.50 FTEs
• Communications staff 1.00 FTEs
• Nursing staff (all) 34.50 FTEs
• Enforcement staff (Public health inspectors and Tobacco and Vaping Enforcement officers) 7.00 FTEs
• Corporate services staff 1.25 FTEs
• Other program staff 4.54 FTEs

The COVID-19 Program budget has decreased $3,245,937 over 2021 primarily due to the following:

• Decrease in salaries and employee benefits of $1,971,404.
• Decrease in operating expenditures of $1,274,533.  This is attributed to:
  • Decrease in Mileage of $125,448.  The 2021 COVID-19 Program budget contemplated additional mileage costs associated with multiple mass vaccination sites operating throughout Windsor and Essex County.  In 2022, only one mass vaccination site will be in operation supplemented by mobile vaccination events.
  • Decrease in Program supplies of $441,670.  The 2021 COVID-19 Program budget contemplated expenditures on such items as personal protective equipment (PPE), information equipment and medical supplies.  In 2021, vaccine administration supplies including PPE were provided by the MOH with vaccine deliveries.  Additionally, iPads, and other information technology accessories, were provided to public health units to support mass vaccination centres and other related efforts.  Nominal expenditures associated with Program supplies are anticipated for 2022.
  • Decrease in Purchased services of $703,415. In 2021, the WECHU employed a third party provider to support case and contact management ($549,504).  This support is not anticipated to continue in 2022. 

The WECHU will include the COVID-19 Program budget as a one-time request for funding from the MOH.

Recovery

The Recovery Program budget includes activities related to recovery from the COVID-19 pandemic in the community of Windsor and Essex County as well as catch-up efforts.  This budget supports 22.73 FTEs, more specifically:

• Management Team 1.40 FTEs
• Coordinators, including Performance Improvement and Accountability Specialists 2.50 FTEs
• Administrative support staff (all departments) 0.50 FTEs
• Communications staff 1.00 FTEs
• Nursing staff (all) 9.50 FTEs
• Corporate services staff 1.00 FTEs
• Epidemiology and evaluation staff 5.00 FTEs
• Other program staff 1.83 FTEs

The WECHU will include the Recovery Program budget as a one-time request for funding from the MOH.

Ontario Seniors Dental Care Program

The Ontario Seniors Dental Care Program (OSDCP) supports eleven and one-half (16.5) FTEs comprised of one and one-half (1.5) manager FTEs; one and one-half (1.5) dentist FTEs, one (1.0) denturist FTE, five (5) dental assistant FTEs, four (4) dental hygienist FTEs, one (1.0) health promotion specialist FTE, and two and one-half (2.5) support staff FTEs.  The ODSCP expenditure budget is funded in its entirety by the MOH.

The OSDCP budget has increased $706,678 over 2021 primarily due to the following:

• Increase in salaries and employee benefits of $547,050. This is attributed to the following:
  • one (1) denturist FTE ($121,845)
  • two (1) dental assistant FTEs ($174,760)
  • one (1) dental hygienist FTE ($97,138)
  • one-half (0.5) health promotion specialist FTE ($53,903)
  • one-half (0.5) support staff FTE ($36,487)
  • other salaries and benefits increases ($62,917)
• Increase in operating expenditures of $159,628.  This is primarily attributed to an increase in professional services of $150,000.

FUNDING

Administration has arrived at three funding scenarios for consideration by the Board of Health. The purpose of these scenarios is to define the financial risk to the WECHU and the Obligated Municipalities for the 2022 Budget, if additional funding is not available for COVID-19 related expenditures or to support recovery efforts.

SCENARIO 1

Under scenario 1, the Mandatory funding approval from the MOH for 2022 would be $16,301,232.  It anticipates a two (2) percent increase in the 2021 funding approval of $15,981,600.  Additionally, this scenario contemplates the opportunity for one-time funding for costs in excess of the Mandatory funding approval, funded at a rate of one hundred (100) percent.  Total contributions from the Obligated Municipalities for 2022 would be $6,986,242 (Table 1).  These contributions do not contemplate the Mitigation funding approval for 2022 in the amount of $1,260,800.  Such Mitigation funding will be apportioned to the Obligated Municipalities during the 2022 settlement process, if eligibility requirements have been met.

Table 2 below summarizes total funding compared to total budgeted expenditures for all programs except OSDCP, as this program is funded entirely by the MOH.

SCENARIO 2

Under scenario 2, total contributions from the Obligated Municipalities for 2022 would be $8,664,410 or 30% of total 2022 expenditures as noted in table 2 above of $28,881,369.  Similar to Scenario 1, contributions do not contemplate the Mitigation funding approval for 2022 in the amount of $1,260,800.  Such Mitigation funding will be apportioned to the Obligated Municipalities during the 2022 settlement process, if eligibility requirements have been met.

SCENARIO 3

Under scenario 3, total contributions from the Obligated Municipalities for 2022 would be $12,580,137. This represents the Obligated Municipalities 30% share of the Mandatory program funding plus 100% of costs in excess of the Mandatory program budget.  Similar to Scenarios 1 and 2, contributions do not contemplate the Mitigation funding approval for 2022 in the amount of $1,260,800.  Such Mitigation funding will be apportioned to the Obligated Municipalities during the 2022 settlement process, if eligibility requirements have been met.

RISK ASSESSMENT

The inherent risk associated with the budget process is other than low, due to the number of factors:

• Mandatory Funding approval from the MOH.  A risk exists that the Mandatory funding approval for 2022 will be greater than or less than 2021 approval of $15,981,600.  If less, the Obligated Municipalities will be required to increase their contributions to fund programs and services in excess of the required 30%.  If greater, Obligated Municipalities will be required to increase their contributions to bring their funded portion of the WECHU’s budget to 30%.  Should Obligated Municipalities not increase their contributions in response to changes in funding by the MOH, the WECHU would be required to curtail programs and services.
• One-time Funding approval from the MOH.  A risk exists that the MOH will not provide on-going financial support to public health units for expenditures incurred on account of COVID-19 response, including vaccination.  In addition, there is a risk that the MOH will not provide financial support to public health units for program restart and program development as we enter Recovery.
• The future state of the COVID-19 pandemic continues to be the most substantial risk impacting public health.  The question of whether the COVID-19 pandemic will transition from a pandemic to an endemic disease state in 2022, remains unknown.
• Costs associated with capital projects.  Except for project management costs, no other costs associated with the capital project have been contemplated in the 2022 budget.  Administration will investigate capital funding opportunities through the Health Capital Investment Branch of the MOH to mitigate the WECHU’s exposure to this financial risk.
• Other operating costs.  In arriving at budgeted operating costs, Administration attempted to factor in the impact of external pressures, such as inflation and market pressures.  Administration will mitigate these risks by ensuring appropriate procurement processes and procedures have been followed.  Additionally, the WECHU will actively monitor budget to actual financial results and implement mitigation strategies when required.

MOTION

Whereas, the Windsor-Essex County Health Unit receives grants annually from the Ministry of Health to a maximum of 70% of admissible expenditures associated with the Mandatory Program.  In addition, the WECHU receives required contributions from the Obligated Municipalities at a minimum of 30% of admissible expenditures, and

Whereas the Ministry of Health annually provides grants for certain related health protection and promotion programs at a rate of 100% of admissible expenditures,

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the 2022 Mandatory Program budget, requiring $16,301,232 in base funding from the Ministry of Health and $6,986,242 in contributions from the Obligated Municipalities, the Corporation of the City of Windsor, the Corporation of the County of Essex and the Corporation of the Township of Pelee, be approved.

FURTHER THAT the Windsor-Essex County Board of Health approve the 2022 Mandatory Program budget with total expenditures of $20,261,732 and offset revenue of $147,724, and

FURTHER THAT the Windsor-Essex County Board of Health approve the 2022 COVID-19 Program budget with total expenditures of $6,289,784, and

FURTHER THAT the Windsor-Essex County Board of Health approve the 2022 Recovery Program budget with total expenditures of $2,329,853, and

FURTHER THAT the Windsor-Essex County Board of Health apply for one-time funding for costs in excess of the Mandatory funding approval, funded at a rate of one hundred (100) percent in the amount of $5,593,895 associated with the 2022 COVID-19 Program budget and the 2022 Recovery Program budget.