By Cecilia Nasmith
A week after assuming Medical Officer of Health duties for the Haliburton Kawartha Pine Ridge District Health Unit, Dr. Natalie Bocking gave her initial update at the April Board of Heath meeting.
“This is a really critical time, and we need people to be working together to try and prevent further transmission of COVID-19,” Dr. Bocking urged.
“Things are changing so rapidly – over the last week we have had a significant increase in the number of new cases identified in the HKPR jurisdiction, accompanied by the continued roll-out of mass-immunization clinics across the region.”
The health unit does have an enforcement role with COVID-19, and Dr. Bocking said 44 warning letters and two tickets have been issued under the Health Protection and Promotion Act under the current provincial orders.
This is a phased procedure, she said, with enforcement as a last step that follows engagement, discussion, education and warning.
But the numbers are becoming more troubling, and one example is that – of 1,412 cases to date, 180 are considered not resolved.
“They are active cases,” she said, adding that 124 of them are in Northumberland County.
Other numbers followed – 263 new cases in the past 14 days, 400 to 500 high-risk contact identified, a cases-per-100,000 rate that has doubled in the last week to almost 90, a significant increase in the test-positivity rate to 2.6% over the last week.
“If we were not in a provincial shutdown, this would put us in the red zone definitely, if not the gray lock-down zone,” Dr. Bocking declared.
The age group with the highest proportion of new cases at this time is those under 20. This may have to do with the aggressive push to vaccinate the oldest and most vulnerable, but she also suspects it speaks to the changing dynamic of virus transmission with the new variants.
“We know in the last 14 days, almost 50% of identified cases did not have identifiable transmission sources.
“We know we have five people in hospital and five in ICU,” she continued.
“That doesn't necessarily mean ICUs in our region, but their condition has required ICU care somewhere in the province.”
Staff have been scrambling to streamline their work where they can in order to address incoming cases as they are identified.
“This is not unique to our health unit – this is across the board in Ontario,” Dr. Bocking said.
“Even the provincial support services that do contact tracing or reach out to cases are overwhelmed. We are finding we are equally fast, if not faster, at contacting cases than the provincial work force.”
COVID response is one of the two key pressures the health unit is addressing, she said, the other being the mass-immunization clinics.
“We continue to be on the right track. As of April 12, 30,052 COVID-19 vaccines had been administered in the HKPR jurisdiction, either by a staff or partners or hospital partners,” she said.
This is a contrast to what she termed 38,415 doses received.
“This is a reflection that some people may have received doses out of our jurisdiction, or at pharmacies or other locations.”
At this time, the health unit is running five mass-immunization clinics and Ross Memorial Hospital is running one. The number of pharmacies offering vaccinations has risen to 16 within the HKPR region, and a number of primary-care teams are working with the health unit to administer AstraZeneca vaccinations that will begin this week or next.
Residents of long-term-care homes who can and wish to be vaccinated have both shots, and their coverage rate is 84%. The same can be said of residents of higher-risk retirement homes, and their coverage rate is 88%. Residents of other retirement homes have at least their first shot, and that coverage rate is 65%.
“We continue to be affected by supply issues that are also impacting the entire province,” Dr. Bocking said.
“With the two vaccines – Moderna and Pfizer – we receive for mass-immunization clinics, there continue to be challenges.
“Moderna has had significant delays for the province to be receiving. Moderna shipments we were supposed to get April 19 we were notified will be coming April 29. This then causes a considerable amount of work for our staff to go and reconfigure clinics to ensure we don't cancel any clinics but have to accommodate further delays.
“Pfizer doses are also decreasing. We previously would get 5,800 doses per week. Starting next week, it will be closer to 3,500 per week.
“Again, as the demand for vaccine increases, supply for those mass-immunization clinics is decreasing.
“We are trying to compensate by improving access through primary care and pharmacies, but we know the province continues to expand age eligibility, This contributes to the pressures on both the health unit and our partners, with increased demand and insufficient supply.
“In a couple of months' time, it will be a different picture. But we are still in an era of vaccine shortage right now.”
The health unit works with the province to upload mass-immunization clinic spots on to their on-line booking system as they become available, and Dr. Bocking acknowledged the problems some experience with the system – such as those residents without internet connection. Unfortunately, the health unit has little flexibility to address these problems.
“I do think we are at a critical point in the pandemic, though I am at risk of sounding like a broken record. What is different in this resurgence of COVID – at the same time we are using resources to try and roll out the vaccine, there's a bit of a dance to ensure we can still do virus containment with case investigation and outbreak management,” she said.
Northumberland representative Bill Cane noted reports that 10,000 people in Toronto with appointments for vaccinations had those appointments cancelled. What are the implications locally, he wondered.
“We are trying our absolute best and have made a commitment not to cancel clinics,” Dr. Bocking stated.
“We are in furious discussions right now to see how we can maintain our staffing needed for case investigation and still run our mass-immunization clinics, and we will continue to reach out to partners to do that.”
The Toronto cancellation were related to supply shortages, she added.
“We are only offering appointments at mass-immunization clinics at HKPR when we have doses that are confirmed. Other health units have made plans for doses that have been promised but are still tentative, so some health units have had to go back and cancel appointments.
“Grey Bruce have had to cancel appointments because they had to divert staff back to virus containment and case investigation.”
Representatives from all three HKPR communities reported on smoothly functioning clinics, some relating positive experiences of their own in receiving vaccinations.
Andrea Roberts of Haliburton County offered a shout-out to members of the Rotary Club of Cobourg for visiting personally to offer help and advice on setting up the Haliburton clinic, which is now humming along.
“We have more volunteers than there are jobs” Roberts said.
Following a whirlwind stretch of meetings with both internal staff and external stakeholders during her first week, Dr. Bocking said, “It's easy to underappreciate that the team has really been working on this for the last year.”
She applauded her predecessor's active communications strategy, and pledged to resume his weekly media scrums next week.
