Addressing staffing and acute-care capacity needs at hospitals, making plans for dealing with an outbreak in a remote community and creating guidelines for work camps are just some examples of the planning work that has been taking place at the Northern Health (NH) Authority in response to the COVID-19 pandemic.
NH acting chief medical health officer (MHO) Dr. Raina Fumerton and president and CEO Cathy Ulrich provided an update during a teleconference call with media Friday, April 3, along with Nicole Cross, the First Nations Health Authority’s regional executive director for the northern region.
As of April 6, there are 23 lab-confirmed cases of COVID-19 in the NH jurisdiction and no deaths related to the virus.
Fumerton says there have been more than 850 tests in the north, and testing has been representative from across the region.
Testing prioritizes people who are hospitalized or likely to be hospitalized, long-term care health care workers and people who are part of a cluster or outbreak scenario that the public health teams are investigating, she explained.
The NH region covers an area of 600,000 square kilometres in the northern part of B.C., stretching south to Quesnel, north to the Yukon border, east to the Alberta border and west to Haida Gwaii.
Fumerton says the lab-confirmed cases in the NH region are in large and small communities across the entire region. Many have been linked to travel, but some have been acquired in the community.
“The majority of cases of COVID-19 will not be confirmed by lab testing, so it’s important that people understand that, and that northern B.C. residents should assume that COVID-19 could already be present anywhere in our communities and plan accordingly,” she said.
NH is part of an integrated provincial response to this pandemic, and the way the health authority plans its response is structured around the World Health Organization’s Pandemic Phases of Response, explained Ulrich.
There are six phases, and the fifth and sixth are about recovery, so NH is planning along the first four phases of that response and has already completed the first two phases in taking measures such as establishing a COVID-19 1-800 line and online clinic, restricting visitors to its facilities, and reducing and postponing services to create additional acute-care bed capacity,
“We’ve really appreciate the leadership from our staff and physicians across the organization as they’ve participated in this planning process,” said Ulrich. “The support from community has been very heartening, and we’ve really appreciated the way people have attended to the provincial health officer (PHO)’s directives.”
Last week, NH started into its Phase 3 and 4 planning and preparation processes.
The health authority has been working with emergency operations committees at each of its sites to prepare facilities for receiving patients and for providing care and has been working with B.C. Emergency Health Services on patient transportation across the region and putting together enhanced teams to support that patient transportation of critical care staff and paramedics, explained Ulrich.
NH has also been working with the provincial health services authority and the Ministry of Health on securing, managing and allocating personal protective equipment, according to the standards that have been set by experts within the B.C. Centre for Disease Control (BCCDC) and the Ministry of Health, she says.
“We’ve had communications with the Ministry of Health regarding the gap between the number of ventilators we might have now and what we might need, and we’ve been assured there will be a supply provided to us,” said Ulrich. “It’s a gap that can be met.”
Ulrich also highlighted the work NH is doing with the First Nations Health Authority to plan for supporting remote and isolated communities, in collaboration with physicians who are designing services for those communities, as well as for First Nations Health Authority staff and health staff within First Nations communities.
Ulrich says NH has also done “a significant amount of work” around how it supports its partners in communities to provide services safely for vulnerable populations.
She says the Mental Health and Substance Use team in NH, together with B.C. Housing and some of their other community services staff, have been connecting with non-profit organizations that operate shelters, food programs and provide others services to make sure they have clarity around the directives the PHO has provided and supported them in how to implement those. There have been a series of webinars across the region that a number of organizations have participated in, as well as individualized contact with the people who reach out for additional support.
Why we hear case counts by health authority, not by community
MHOs, other public health experts and health care leaders all have a legal obligation to protect the personal information they receive regarding cases of a reportable communicable disease such as COVID-19, and this includes the location of these cases, which is legally confidential patient information, explained Fumerton.
“This information can be shared on a need-to-know basis, so information that would be shared publicly includes case counts at the health authority level; notification of outbreaks in high-risk settings, such as acute care and long term care facilities, of which we have none at this time; as well as notification of high-risk public exposures involving contacts that are not otherwise identifiable,” she said. “There is provincial consensus among all B.C.’s medical health officers that more detailed information on cases, including comprehensive case counts for each and every community, is not necessary for communities to plan their responses and therefore will not be released.”
Fumerton says the cases diagnosed in the NH region have not been concentrated in any one area, and they have been diagnosed in both small and large communities across the entire region.
“If we had zero lab-confirmed cases in the community, that is absolutely not a guarantee that the virus is absent,” she said. “We know, given our current testing strategy, that the majority of cases are going to go undiagnosed, in terms of getting a lab confirmation, because we’re conserving our testing efforts for high-priority populations. So these types of announcements, community by community, could very well produce a false sense of security. If cases have been diagnosed in a community but all their close contacts are identifiable, a public health announcement of that case is an unnecessary violation of their privacy. We’ve seen multiple examples of stigma and vigilantism enacted across the province in people responding to the perceived threat of COVID-19 in their community; community-level data is unlikely to reduce and may, in fact, exacerbate those types of responses. I appreciate that this is frustrating for some people.”
COVID-19 and industry
Northern Health has had a Health and Resource Development office for some time that includes people with expertise in population health and epidemiology, as well as medical health officers who have developed guidelines for industrial camps on health and safety and in particular communicable disease control, explained Ulrich.
“When this situation emerged, those guidelines were enhanced to focus on COVID-19, and Raina in her chief medical officer role took those guidelines through to the Province, and together with BCCDC and the PHO’s office, those guidelines have been adapted and are now on the BCCDC website as communicable disease guidelines for industrial camps specific to COVID-19,” she said.
Fumerton says these guidelines include information about how industrial camps can enact the provincial recommendations around hand hygiene, respiratory etiquette, physical distancing and environmental cleaning, as well as information about food cleaning for the kitchen and dining areas, what to do if there is a suspected or confirmed case, what supplies the camp should have on-site and guidance for on-site medical clinics.
Long-term care facilities
A single staff or resident case of COVID-19 in a long-term care facility is considered an outbreak in the province, and at this time, thankfully, there are no outbreaks in any NH long-term care facilities at this time.
“For long-term care facilities, given we know that’s one of our highest-risk vulnerable populations, we also have very low thresholds for testing, and long-term care residents and staff are a high priority for testing if they become symptomatic,” said Fumerton. “We have a very solid long-term care facility outbreak protocol; we have teams ready to deploy to help manage an outbreak if it occurs.”
First Nations states of emergency
Several First Nations communities in B.C., including ?Esdilagh and the other five member nations of the Tsilhqot’in National Government, have declared states of emergency in response to COVID-19 and restricted access to their communities.
“I think our leadership have really taken the warnings and the risk very seriously and in turn put those additional measures in place to protect our most vulnerable individuals, inclusive of our Elders,” said Cross. “Those measures are within the authority of those nations; they’ve worked in those instances where they are limiting traffic into community. I’ve heard of the partnerships with the ministry of transportation to ensure everything is very clear that this really about trying to slow the spread, flatten the curve and protect our vulnerable citizens.”
Cross says the First Nations Health Authority stays in touch with those communities as they’re making decisions and makes sure they have continued access to care and continued access to services and works with the nations’ leadership on the decisions they’re making with the well-being of their community members in mind.