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January 14, 2021 Hosted by: Dr. Susan Shaw Dr. John Froh Physician Town Hall WELCOME!
January 14, 2021Hosted by: Dr. Susan Shaw
Dr. John Froh
Physician Town Hall
WELCOME!
Town Hall Reminders
• This event is being recorded and will be available to view on the Physician Town Hall webpage
• If you have any questions or comments during the event, please enter them in the Q&A section
• Watch for this icon during the event and respond to our live polls
Truth and Reconciliation
We would like to acknowledge that we are gathering on Treaty 2, 4, 5, 6, 8 and 10 territory and the Homeland of the Métis. Recognizing this history is important to our future and our efforts to close the gap in health outcomes between Indigenous and non-Indigenous peoples. I pay my respects to the traditional caretakers of this land.
COVID-19 Surveillance and Epidemiological Trends Dr. Julie Kryzanowski
COVID-19 Modelling Update Dr. Jenny Basran
COVID-19 Offensive Strategy• COVID Vaccine Update
Dr. Johnmark OpondoDr. Kevin Wasko and Dr. Jessica Minion
COVID-19 Defensive Strategy• PSE Update• PPE Update
Dr. John Froh and John Ash
Dr. John FrohDr. Michael Kelly
Physician Wellness Dr. Andriyka Papish
Your Turn! Poll on Topics/Q&A Vote in our live poll and submit questions!
Agenda
Dr. Julie KryzanowskiSenior Medical Health Officer
COVID-19 Surveillance and Epidemiological Trends
Epidemic curve, SK-COVID-19 pandemic, by zone, Feb 1, 2020 – Jan 13, 2021 (n = 19,017)
Source: Panorama, IOM
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Central East Central West
Far North East Far North West
North Central North East
North West Regina
Saskatoon South Central
South East South West
Unknown Region Far North Central
New COVID-19 cases per 100,000 last 7-days, by province, March 2020 - Jan 12 2021
Source: Public Health Agency of Canada https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html
COVID-19 cases, rate per 100,000, last 7-days, by province/territory, Jan 13 2021
SK now has the second highest case rate in the country after Quebec
Source: Public Health Agency of Canada https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html
Active cases and test rates per 100,000, by subzone, January 13, 2021
7-day rolling average, COVID-19 cases and test positivity, SK, Dec 1, 2020 - Jan 10, 2021
Source: Interactive epi file
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COVID-19 deaths, SK-COVID-19 pandemic, Mar 31, 2020 – Jan 13, 2021 (N = 206)
Source: Saskatchewan Ministry of Health, Dashboard (https://dashboard.saskatchewan.ca/health-wellness)
The majority of deaths (n = 159; 77%) have occurred in the last 6 weeks 2 4 5 2 5 6
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Monitoring Indicator summary, Dec 28, 2020 to Jan 10, 2021
• Epidemic DT and R(t) indicating potential PLATEAU in exponential growth
• Testing rate increasing
• Hospitalization decreased
• All indicators demonstrating concerning trend
Source: Saskatchewan Ministry of Health, Weekly Integrated Epi Report
Previous weekCurrent week
Colour*
Threshold level for Epidemic Spread
“The New Normal”
COVID transmission is controlled, but there is a risk of community transmission.
High risk that COVID transmission is not controlled.
High likelihood that COVID transmission is not controlled.
Source: COVID-19 Coordinating Committee and SK-MHO Committee
Assessed Risk of Epidemic Transmission, by Zone,
Dec 30, 2020 – Jan 12, 2021
Week Dec 30 – Jan 5 Week Jan 6 – 12
Dr. Jenny BasranSenior Medical Health Officer
COVID-19 Modelling Update
Impact of Public Health Measures on Lab Confirmed Cases
CEPHIL Agent Based Model study results with 95% quantile
Modelling chart includes holiday season trend.
Rate of growth depends on degree of update of public health measures.
SK COVID-19 Modelling Initiative – Joint partnership between U of S CEPHIL lab, SHA and the MOH
Impact of Public Health Measure on Hospital Census
CEPHIL Agent Based Model study results with 95% quantile
SK COVID-19 Modelling Initiative – Joint partnership between U of S CEPHIL lab, SHA and the MOH
Modelling chart includes holiday season trend.
Hospital census changes lag behind changes to cases by 1-2 weeks.
Rate of growth slower with higher uptake of public health measures.
Impact of Public Health Measures on ICU Census
CEPHIL Agent Based Model study results with 95% quantile
SK COVID-19 Modelling Initiative – Joint partnership between U of S CEPHIL lab, SHA and the MOH
Modelling chart includes holiday season trend.
ICU census changes lag behind cases by 1-2 weeks and hospital census by another week.
Rate of growth depends on degree of update of public health measures.
Dr. Johnmark OpondoMedical Health Officer – Offensive Strategy
Offensive Strategy Update
COVID-19 Health System Readiness Update
Offensive Strategy
Key goal: prevent, contain and mitigate viral spread and promote population healthKey work of Public Health:
1. Emergency preparedness and response, including cross-sector business and service continuity 2. Epidemiology and surveillance: understand patterns of transmission to adjust response measures3. Case, contact and outbreak investigation and management
• Population-based measure that aims to interrupt networks of transmission and control epidemic• Notification Isolation/Quarantine Investigation Reporting Monitoring Evaluation• Assisted Self-Isolation Sites (ASIS), ASIS Medical and Secure isolation sites (SIS)• Risk assessment: case communicability period, acquisition, exposure setting(s), contacts
4. Testing strategy: symptomatic, active case finding (investigations), public health surveillance5. Enforcement: Public Health Orders, Public Health inspection, compliance/education6. Risk communication: public awareness, behavior change, population health promotion7. Covid-19 Immunization planning and delivery
New Canadian Border Measures
As of January 7th, Canada is implementing pre-departure testing for any flight coming into Canada.
Anyone 5 years+ is required to have a negative molecular test within 72hr (some cases extended to 96hr) prior to boarding.
Passengers are required to bring the documentation to the airline (if don’t have, then prohibited from boarding) and need to be ready to produce to government/public health officials if asked during quarantine).
A 14-day quarantine period is still required. Federal government is procuring security to do quarantine site visits. Desire to strengthen
enforcement. Some exemptions exist (e.g. for crew members, emergency providers, essential service
providers, Canadian officials on foreign assignment, etc).
Expand the scope of who can do contact tracing
Amendments to Disease Control Regulations re: COVID
1. All persons who are assigned contact tracing or related duties by the SHA; and
2. All persons who are assigned contact tracing or related duties by an entity contracted by the SHA to provide an external workforce in relation to contact tracing.
With respect to section 8.2(2) and the requirement that designated persons have the qualifications, educational background or experience that the Chief Medical Officer has determined is appropriate, please be advised that the classes of persons outlined above have some or all of the following experience/qualifications:· They are employees or contractors of the SHA;· They are employees of the Saskatchewan Public Service Commission;· They are employees of Statistics Canada or related agencies; or· They are learners in Nursing, Medicine, or other medical fields
Outbreak Mx. Response Current Strategies
Outbreak Prevention Outbreak Response
Continuing Care Resource Team
HR Affiliate Workforce Plan
LTC Pathway
POCT
Daily contact and support with LTC Home
Continuing Care Director on call 7 days a week to support Homes in outbreak
Outbreak simulations
Equipment and PPE Monitoring
Temporary Closure of 4 bed rooms
Daily Outbreak Calls
Daily Staffing Huddles
IPC Consultant Site Visits
Dr. Kevin WaskoCo-Chair COVID-19 Immunization Clinical Expert Advisory Committee
COVID-19 Vaccine Update
Updated HCW & Vulnerable Populations Framework
NACI guidelinesPriority for early COVID-19 vaccination will be given to the following populations:
• residents and staff of shared living settings who provide care for seniors• adults 70 years of age and older, with order of priority:
• beginning with adults 80 years of age and older• decreasing the age limit by 5-year increments to age 70 years as supply
becomes available• adults in Indigenous communities
Definition of Vulnerable Populations: those at high risk for severe illness and death, those most likely to transmit to those at high-risk and those in living or working conditions with elevated risk for infection or disproportionate consequences
Phase 1: HCW/Vulnerable Populations
Health Care Worker Vulnerable Populations
• HCW of congregate living settings for
older adults (long term care and personal
care homes)
• Adult ICU
• Emergency department
• Respiratory Therapy
• Covid-19 designated wards
• Code blue and trauma teams
• Covid-19 assessment and testing centers
• EMS, road and air transport teams
• All HCW over age 70
LTC/PCH residents and staff
Residents of First Nations Communities over
the age of 40
Age > 80 and Indigenous adults age >60
Age > 70 and Indigenous Adults age > 50
Planned or post solid organ and bone
marrow/stem cell transplant
Patients on Dialysis
Phase 2a: HCW Vulnerable Populations
Health Care Worker Vulnerable Populations
• HCW of congregate living situations for
vulnerable adult populations
• Anesthesia / Operating Rooms
• All other critical care
• Hemodialysis
• Vaccination team
• Radiology technicians
• ECG/echo
• Phlebotomy/Lab Workers handling COVID
specimens
• Home care (direct care providers)
Residents and staff of shared living situations [language
from NACI guidelines] for seniors not included above
• seniors’ assisted living
Residents and staff of other shared living settings2
• homeless shelters and other emergency shelters
• group homes
• mental health residential care
• non-federally regulated correctional institutions
• Congregate Living Arrangements
Medically vulnerable populations
• Malignant Hematology patients on active treatment
• Solid Tumor Oncology patients on active treatment
Phase 2b and c: HCW Vulnerable PopulationsHealth Care Worker Vulnerable Populations
Phase 2b: All other direct clinical care including:
• Physicians
• RN and LPN
• Therapists (physical, occupational, speech
• Ward clerks
• Outpatient clinic staff
• Mental health providers
• Patient registration
• Housekeeping/environmental services
• Dietary staff
• Security
• Social workers & case managers
• CPAs
• Chaplain staff
• Dentists and dental clinics (direct care providers)
• Pharmacists and pharmacies (direct care providers)
• Community based health workers on First Nations Communities
• Traditional/cultural workers
Phase 2c: HCWs not included above
Phase 2b• We recommend further engagement with Indigenous
partners for additional sequencing of Indigenous populations in the province.
• We recommend further engagement with community partners for additional sequencing of socially vulnerable populations in the province.
Phase 2c• Outreach as general population roll out
John & Shirley
Phase One - Priority Populations
Currently planned Federal allocations for Phase One leave us approximately 50% short of fully immunizing the high priority populations approved by the COVID-19 Immunization Oversight Committee and as recommended by clinical and ethical experts
Category
Long term care/personal care home residents and staff
Prioritized health care workers
Ages 80+ years
Ages 70-79
Remote/North 50+
Faster – Key Strategies
Speed matters. Every day counts to save lives and reduce the overall impact of COVID-19.
Hub Model: Establish Pfizer/Moderna distribution hubs in approx. 20 locations
All hands on deck: Deliver through all appropriate health care providers and available external resources
Continue supporting & strengthening mobile immunizations teams
Test new delivery methods locally for priority populations and determine ability to scale up or utilize in other locations
Forecast vaccine distribution further in to the future to enable teams to better prepare for rapid distribution• Stable, predictable and large volume allocations enable more rapid delivery
Ensuring all areas of the province are in a state of readiness for rapid and safe delivery of the vaccine as quickly as possible once they receive it
Learning matters: Continuous improvement is already resulting in more rapid delivery
Smarter
Leveraging our experience from the influenza vaccine, but also recognizing where it’s different and adapt accordingly• Key differences: limited, variable and unpredictable allocations, the need to sequence priority
populations, multiple vaccines and more complex transportation/distribution
Identifying improvements from initial pilot/early phases• e.g. transportation improvements are already increasing pace of delivery
Empowering teams to identify creative/innovative delivery methods• Power of a single health authority is that good ideas can be more easily scaled/replicated in different
areas of the province
Learning from our partners: Planning and vaccine delivery will be coordinated with stakeholders (First Nations/Metis Partners, CBOs, etc)
Safety matters: High uptake requires strong communications to ensure the public knows the vaccine is safe
The COVID-19 Vaccine is:• Safe – Health Canada approved• Effective – 90%+ reduction in infection• Simple – like getting a flu shot
The World Health Organization:• Estimates that vaccines save 2-3 million lives in a normal year• Lists vaccine hesitancy as one of the top 10 global health risks
Safe
• Delivering to high risk populations up North in early phases was the right decision, but did slow initial rollout
• Pfizer is more logistically challenging to distribute to rural/remote locations
• Time-intensive consent process, high volume booking processes
• Limited, variable and unpredictable allocations
• Adverse winter weather may cause transportation challenges at times, especially in rural and remote settings
• Resources strained given the need for continued pandemic response• Significant challenges given high COVID cases, hospitalizations, etc.
Key Challenges
Key Next Steps:
• Continue to build out prioritization of groups for phase two
• Continue to prepare for widespread immunization in phase two
• Ensure teams are ready to deliver vaccine as soon as possible on arrival to enhance speed of delivery
Key Messages:
• Safety of our patients, residents and health care workers is our #1 priority
• Speed matters. That is why we need to continually get faster and smarter.
• Stable, predictable and large volume allocations make rapid delivery easier
• Our health care system is at its most fragile point yet. The public needs to remain vigilant.
Key Next Steps & Key Messages
COVID Vaccine Update Week of January 11, 2021
SHA COVID Vaccine Administration Data
Area Distribution Administered Remaining % Administered
Regina 3900 4001 0 103%
Saskatoon 11700 3537 8378 30%
North Central 3900 1258 2642 32%
Far Northwest 1450 956 494 66%
Far Northeast 1370 1261 109 92%
Northeast 1370 715 655 52%
Athabasca Health Authority 710 257 453 36%
Provincial Totals
Saskatchewan 24400 11985 12630 49%
*Extra DosesIn Vials
New SK Vaccine Administration Targets
Date # of Doses Administered in SK/day
January 13-14, 2021 1000/day
January 15-19, 2021 1500/day
January 20-31, 2021 2000/day
February 1, 2021 2500/day
Emerging SARS-CoV-2 VariantsDr. Jessica MinionProvincial Clinical Lead Public Health – Laboratory Medicine
New Viral Variants
• Viruses constantly change through mutation, and new variants of a virus are expected to occur over time.• Sometimes new variants emerge and disappear. • Other times, new variants emerge and persist. • Multiple variants of the virus that causes COVID-19 have
been documented globally during this pandemic
• SARS-CoV-2 has not mutated very quickly in general• Accumulation of mutations averages 1-2/month• i.e. most genomes sequenced today have ~20-25
mutations compared to isolates from China in January 2020
https://www.nature.com/articles/s41564-020-0770-5
UK Variant
• In the United Kingdom (UK), a new variant has emerged• Known as 20B/501Y.V1, VOC 202012/01, or B.1.1.7 lineage • First detected in September 2020• Unusually large number of mutations (17 from nearest branch)• Evidence that it appears to spread more easily: epidemiologic & in vitro
studies• No indication that it causes more severe illness or increased risk of death
• Unusually large number of mutations• 17 from nearest branch, 8 in the gene that encodes the spike protein on
surface of virus• N501Y = at position 501, amino acid asparagine (N) has been replaced with
tyrosine (Y): increases how tightly it binds onto ACE-2 receptor, its entry point into human cells
• 69-70del = deletion of 2 amino acids in the spike protein: has been found in viruses that elude immune response in immunocompromised patients
UK Variant
UK variant has been detected in 35 countries
23 cases have been detected in Canada (ON=14, AB=4, BC=4, QC=1); all have been connected to international travel (3 investigations still pending)
http://cov-lineages.org/global_report_B.1.1.7.html Accessed January 14, 2021
South African Variant
• In South Africa, another variant has emerged independently of the variant detected in the UK.• Known as 20C/501Y.V2 or B.1.351 lineage
• First detected in October 2020
• Shares some mutations with the B.1.1.7 lineage, including multiple mutations in the spike protein such as N501Y.
• Evidence that it appears to spread more easily
• No indication that it causes more severe illness or increased risk of death
• As of January 13, 2021, one case has been identified in Canada (=AB) in a recent traveler.
South African Variant
N=12 countrieshttps://cov-lineages.org/global_report_B.1.351.html accessed January 14, 2021
Ongoing Surveillance
• Other variants are constantly being recognized and investigated
• Currently no others have been classified as a “VOC” or Variant of Concern
• Looking for both epidemiologic associations with increased transmission and specific mutations hypothesized to cause changes to transmissibility or antigenicity
• Epidemiologic monitoring of viral sequences varies greatly across different countries, with UK being the gold standard globally
• In Canada, national surveillance program: CanCoGen• Has sequenced over 25,000 viral genomes so far
• SK Selection strategy• 50% randomly selected cases to determine background transmission
• 50% directed: all travel-related, potential reinfections, vaccine escape, unusual severity, outbreaks
Potential Consequences of Emerging Variants
• Ability to spread more quickly in people.• Epidemiologic evidence, in vitro evidence
• Ability to cause either milder or more severe disease in people.• There is no evidence that these recently identified SARS-CoV-2 variants cause more severe disease than earlier ones.
• Ability to evade detection by specific diagnostic tests.• Most polymerase chain reaction (PCR) tests have multiple targets to detect the virus, such that even if a mutation impacts one of the
targets, the other PCR targets will still work.
• Decreased susceptibility to therapeutic agents such as monoclonal antibodies.
• Ability to evade natural or vaccine-induced immunity.• Both vaccination against and natural infection with SARS-CoV-2 produce a “polyclonal” response that targets several parts of the
spike protein. The virus would likely need to accumulate multiple mutations in the spike protein to evade immunity induced byvaccines or by natural infection.
References
• Genetic Variants of SARS-CoV-2—What Do They Mean?• https://jamanetwork.com/journals/jama/fullarticle/2775006
• The British variant of the new coronavirus-19 (Sars-Cov-2) should not create a vaccine problem• https://pubmed.ncbi.nlm.nih.gov/33377359/
• UK Government: New SARS-CoV-2 variant• https://www.gov.uk/government/collections/new-sars-cov-2-variant
• Covid-19: What have we learnt about the new variant in the UK?• https://www.bmj.com/content/371/bmj.m4944
• Could new COVID variants undermine vaccines? Labs scramble to find out• https://www.nature.com/articles/d41586-021-00031-0
• WHO: Episode #20 - COVID-19 - Variants & Vaccines• https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/science-in-5/episode-20-
--covid-19---variants-vaccines
Dr. John Froh
Deputy Chief Medical Officer – Pandemic
John Ash
Executive Director of Acute Care Regina
Defensive Strategy
COVID-19 Health System Readiness Update
Provincial Acute Capacity Report
COVID-19 Hospital Census
Acute Care Surge – Provincial Strategies
Target Condition: Proactively prepare for anticipated acute care surge.
Multiple strategies underway at local and provincial level. Some of the key provincial strategies:
• Weekly operational COVID requirement of all IHICCs issued this morning with updated acute care capacity targets based upon modeling data.
• Implementation of rapid point of care testing in acute care to support screening, placement and outbreak management strategies.
• Acute Care oxygen system monitoring and upgrades• Provincial load balancing of inpatients across acute care facilities • Needs assessment and planning to enhance critical care transport capacity • Establishment of local multidisciplinary outbreak management teams
Physician Skills Enhancement Update
Emergency Pandemic Skills Program% to Target (Target = 95 Trained Physicians)
ICU Pandemic Skills Program% to Target (Target = 80 Trained Physicians)
Hospital Pandemic Skills Program% to Target (Target = 160 Trained Physicians) Red - <50%
Yellow - 50%-74%Green - 75%+
Physician Skill Enhancement (PSE) Program Update
Hospital remains most urgent need!
Sign up through Pandemic Skills Inventory!
Physician Deployment Update
Week Location(s) Physician(s) Actively Deployed
December 27, 2020 – January 2, 2021
Weyburn Yes
January 3 – 9, 2021 Weyburn Yes
January 10 – 16, 2021 Weyburn Yes
Dr. Michael Kelly
EOC Safety Officer
Personal Protective Equipment (PPE) Update
PPE Update
• Current PPE supply is secure• Now receiving 100K/month - Kimberly Clark N95s on top
of 3M allocation• Vaccination status does not impact PPE requirements
and isolation requirements after exposure
Safety Bulletins
- PPE guidelines can be found at Saskatchewan.ca/COVID19-providers
- In the spring the SHA released a weekly PPE Bulletin every Friday that provided information to staff and physicians on PPE recommendations
- The PPE bulletin is now the Safety Bulletin and includes a wider variety of topics all under the Safety umbrella as it relates to COVID-19.
Droplet Contact Plus Precautions for COVID-19
Dr. Andriyka Papish
Consulting Psychiatrist, Regina, SK
Co-Lead, Psychiatry Response Team for COVID-Care Providers
Physician Health Program, SMA
Physician Wellness
I see my colleagues struggling…
What can I do?
CMA Physician Wellness Hub: 4 key points
How leaders can support team resilience in a pandemic
1. Educate yourself about signs of stress & trauma
2. Carve out regular time for reflective discussions with your team• Strive for the “Hobfoll five”: 5 essential elements of psychosocial support
i. a sense of safety
ii. promote calming
iii. remind team members of their sense of efficacy individually and as a team
iv. Connectedness
v. talk about hope and sense of purpose
• https://www.cma.ca/physician-wellness-hub/resources/resilience/how-leaders-can-support-team-resilience
• https://www.mentalhealthcommission.ca/English/online-training-psychological-health-and-safety
• https://haruv.org.il/wp-content/uploads/2020/04/Hobfoll-et-al-2009.pdf
CMA Physician Wellness Hub: 4 key points
How leaders can support team resilience in a pandemic
3. Model the behaviours you want to see• “Real leaders are forged in crisis”
• 10 steps to help ensure psychological
wellbeing of health care staff during COVID
4. Find champions that also model
these behaviors
• https://hbr.org/2020/04/real-leaders-are-forged-in-crisis
• https://www.bps.org.uk/sites/www.bps.org.uk/files/News/News%20-%20Files/Psychological%20needs%20of%20healthcare%20staff.pdf
• https://healthcare.utah.edu/publicaffairs/news/2021/01/covid-mental-health.php
Thank you for attending to your own self care -this improves patient
care.
Saskatoon, NE, NW: Brenda Senger
306-657-4553
Regina, SE/SW: Jessica Richardson
306- 359-2750
Saskatchewan Medical Association Physician Health Program
Town Hall Physician Wellness Webex Series Physician Wellness and Support webpage
Health Care Worker Mental Health Support Hotline: 1-833-233-3314 (8am – 4:30pm, Monday-Friday)
Your Physician Health & Wellness Supports Reflect on one thing that
brought you hope and a sense of purpose in
your work today.
Thank you to our partners!
Partners
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