The second public COVID-19 forum hosted by the Ontario Health Team-Northumberland went on-line Thursday – a day when the Haliburton Kawartha Pine Ridge Health Unit reported 131 confirmed cases to date in Northumberland.
This partnership of community, municipal, acute-care, public health, long-term care and other partners in health was established just prior to the pandemic, panel moderator Linda Davis said.
“It allowed us to quickly mobilize our resources and maximize our response.”
In April, at the time of their first forum, there were fewer than two dozen cases. Now, when Northumberland – like almost every community – is experiencing a sharp increase, Davis introduced her panel and gave each of its four members a chance to say how they have responded.
Like Davis – president and chief executive officer of Northumberland Hills Hospital – Varouj Eskedjian is her counterpart at Campbellford Memorial Hospital.
These hospitals, like many across the province, have actually increased capacity through the course of the pandemic and are back to normal (if not even higher) service levels being offered with certain COVID precautions.
“The Emergency Department and in-patient units, along with surgical services, are open and available to patients who require that level of care,” Eskedjian said.
Health care providers from various sectors have partnered to run three assessment and testing centres – at the two hospitals and at the Canton municipal building in Port Hope. Combined, he estimates, they have performed more than 23,000 tests. All are on an appointment-only basis, and you can arrange this by calling 905-377-7783 for the Cobourg or Port Hope sites and 705-395-7801 for the Campbellford site.
Northumberland chief administrative officer Jennifer Moore was proud of the swift and thorough precautions and testing schedules implemented at the only municipal long-term-care home, the Golden Plough Lodge, with no cases there to date.
The Community Paramedicine program was launched in May to leverage the skills and training of the paramedics to increase the capacity of the local health-care system. They help deliver the testing at the three centres, and also take appropriate referrals to provide in-home testing where it is needed.
Social services continue uninterrupted but within a COVID framework to ensure the most vulnerable members of the community can still get the support they need in terms of such core needs as food security and shelter.
Northumberland Family Health Team executive director Adrienne Bell-Smith outlined precautions being taken in doctors' offices, whose capacity is being tightly restricted.
“You can expect your first appointment may be booked as a phone appointment,” Bell-Smith said.
“In may cases, your health-care provider can assess and manage your case without an in-person visit.”
Should a visit be required, she continued, you are asked to arrive just on time and alone, if possible. You will be required to wear a mask, sanitize your hands and answer a number of screening questions.
To help this go more smoothly, they have added phone lines and made nurses and nurse-practitioners more available.
Community Care Northumberland chief executive officer Trish Baird said the isolated and vulnerable people they serve will get Meals On Wheels deliveries of medication and groceries, but more personal services (like visits) are done by phone call or virtual options.
While coffee clubs, book clubs and even exercise classes can be offered online, she said, there are many avenues for volunteers who want to help to provide deliveries and transportation to vital medical appointments.
And while their hospice-related services have gone virtual, the county's two residential hospices – The Bridge in Warkworth and Ed's House in Hamilton Township – accept patients with appropriate COVID restrictions.
Following these brief presentations, questions were presented to the panel, the one being posed by the most people having to do with the reporting of cases. Why does the health unit not pinpoint where cases are occurring, they wondered – not by person, not by address, but at least by municipality.
As no health unit representative was present, Moore explained that the agency is legally obliged to protect the personal health information of patients and clients. But they have to balance that with the obligation to report vital public-health information.
“Because we have such a small population, it would be easy to identify individuals if they were to break that data down,” Moore said.
Bell-Smith posed a question of her own: if you knew the individual beside you was positive, how would you respond? Since COVID-positive individuals have the capacity to spread the virus whether they are symptomatic or not, she figured, “we never know who net to us or who around us might have COVID-19, so it's important always to wear a mask, stay home if you are ill, maintain physical distance, wash your hands.”
“It's certainly a question we hear quite frequently,” Davis said.
“And we have heard from individuals who are positive how difficult it is when they are identified, and how difficult for their families.”
She echoed Bell-Smith's answer, stressing the importance of always striving to keep oneself safe vs. worrying if someone in your neighbourhood might be infected.
Another questioner wondered about the health unit's ability to prevent people from places with higher transmission rates from coming into Northumberland County.
“Unless the Federal government invokes the War Measures Act, which limits the movement of individuals, there is limited capability of limiting people's movements,” Eskedjian said.
They do advise everyone, no matter the colour of their zone, to limit their travels. This is the approach, he said, rather than seeking to force people to stay within their own area.
“Don't travel to red zones if you don't have to. Stay within your area as much as possible. If people do that, we can manage until such time as the vaccines arrive and we can distribute them to the general population.”
Several questions involved the vaccine, but every panel member agreed that it is too early in this process to have hard-and-fast information to offer.
It is as yet unknown, for example, if someone vaccinated might still be a carrier of the virus.
When the county might get the vaccine is also unknown – although Davis pointed out that the fact that Toronto and Ottawa get it first might indicate the province's wish to have people in so-called hot zones inoculated first.
People are suspicious of much of the information circulating about the pandemic and asked what sources might be reliable. Bell-Smith suggested public-health websites or the Canada Health site. Davis's recommendation was the Ontario Health website, which she has found consistently reliable.
One question expressed concern for hospital capacity in terms of Intensive Care Unit beds – though, to date, there have been only five hospitalizations of confirmed cases through the course of the pandemic.
Eskedjian said there's a cluster of hospitals – the two Northumberland hospitals, Ross Memorial, Haliburton Highlands – that can step in to help should an ICU crisis arise.
Davis said NHH has six ICU beds and just received funding for an additional four – though she is concerned about ventilator capacity. But they acted swiftly to do contingency planning when the pandemic began, so they feel reasonably prepared.
While hospitals might reasonably expect a surge during flu season, she added, this has not happened at NHH.
In fact, Adrienne Bell-Smith reported a higher-than-usual interest in this year's flu vaccine and higher-than-usual attendance at flu clinics.
A question was posed about contact tracing, and Davis said the health unit had brought in more resources to beef up these efforts.
Baird had more detailed information from a recent meeting. When an individual tests positive, she said, they go back three weeks to investigate where he or she went and what people he or she might have encountered. These people are told to isolate and self-monitor for symptoms.
As for how much testing is done, Eskedjian said they are averaging about 60 tests a day in Campbellford. Davis said they usually see 90 in a day at NHH, and the Canton centre is up to maybe 70 a day.
For those who call for an appointment and have serious reason to believe they're at risk, Davis continued, they try to see them the same day. For that purpose, they set aside a limited number of appointments each day. And the NHH clinic offers access to a primary-care practitioner for those in more acute crisis.
Turn-around time varies depending on demand. They aim to have the news in two to three days, thought it has been as long as three to five days in the past.
Davis closed the panel with a warning about the Christmas season in light of the social gatherings that she suspects have been spreader events that contributed to the recent steep increase in cases.
“We probably need to recognize that is not possible this year,” she stated.
“We need to keep this virus under control, so I would really ask that you follow those very simple principles in not having gatherings – only gather with those in your own household and practice physical distancing, wear a face covering if you are going outside your home and certainly wash your hands as frequently as possible. And if you are feeling ill, stay home.
“It truly is important we try to keep away from others.
“We do know the holidays will be different this year. But let's make it just this year, and not have another year or another six months of the virus.”