By Cecilia Nasmith
While getting at least one COVID-19 shot into 53% of the Haliburton Kawartha Pine Ridge District Health Unit's eligible population is an extraordinary feat, Medical Officer of Health Dr. Natalie Bocking told the board of health's May meeting, it's even more extraordinary when you realize that the HKPR region gets the lowest vaccine allocation per capita in the province.
This news was part of Dr. Bocking's monthly update, in which she provided a look at the mechanics behind the mass-immunization clinics and at how the health unit is planning for a time when COVID-19 does not take up the majority of its time and resources.
Dr. Bocking said some of their essential programs and services are continuing like environmental health services (such as food-premises inspections), other reportable diseases, support for harm-reduction services and the Healthy Babies Healthy Children program.
“Things are improving for the province overall, which is promising,” she said, sharing some local epidemiology.
The HKPR region has had 1, 842 confirmed cases of which 79 are currently active (29 of those in Northumberland County).
“The seven-day rolling incidence rate is 42 cases per 100,000 population. Just to put things in perspective, the highest incidence rate we have experienced has been around 90, and that was about a month ago at the peak of the third wave.
“We seem to be stagnating between 30 and 40, and that equates to between 10 and 15 new cases per day. Every once in a while, we see 20 to 30, but we haven't quite gotten back down to where we were seeing five cases a day consistently,” Dr. Bocking stated.
“The positivity rate is higher than what we would like to see, but lower than the provincial average. It's 2.8% and we would like to see it at under 1%.”
Trends that have developed in the last two weeks show that the largest demographic reporting new cases is those aged 30 to 39. A surprising increase was seen in those under 20, possibly due to activities outside of school.
“The majority of cases are household contact or close contact – over 50%. There's still around 32% where we don't know the exposure source.
“COVID is still circulating in the community,” Dr. Bocking declared.
Case and contact management necessitated the creation of specific teams to handle such duties as contact tracing, case investigation and school-age cases. The teams have a variety of specialists in addition to nurses, as needed.
The teams also have to pivot from days where there are six cases to days where there are 36, then scale back down again. Though they are emerging from a third wave, they must still stand ready to deal with any surge.
“As we start to talk about recovery, we need to think about how we integrate this on-going work with all our usual activities and essential services,” Dr. Bocking said.
“COVID is not going to just go away. We won't see it at the same levels, but we'll likely have to continue to have some (COVID) activities – maintain a response but continue other essential core activities.
“With vaccination, we've made quite tremendous progress, given the resources we have. As of Monday this week, doses administered in the HKPR region total 66,231 given by health-unit staff, hospital staff, pharmacies or primary care.
“HKPR residents who have received a first dose – 85,785 – equates to 53% of the eligible population, which is aged 18 and over.
“We know clinics have happened Tuesday and Wednesday, so that number has already changed.”
The province is moving to equalize the allocation of vaccines across regions, so Dr. Bocking is expecting to see an increase locally.
“From my perspective, given that allocation and given the coverage we have, it demonstrates that vaccine that comes in rolls out the door as fast as it is received. We know we are receiving more allocation in the coming weeks and into June, and we have been planning with our partners to ensure it will roll out the door.
“There's also a number of things that happen behind the scenes that the health unit is responsible for,” she continued, citing what is called cold-chain inspections – making sure vaccines are handled properly at all sites. They are also responsible for inventory, the tracking and daily reporting to the ministry.
They also manage and operate five mass-immunization centres, and are fielding mobile teams to take care of long-term-care and group homes as well as those from areas where there is not reliable transit.
They co-ordinate information flow with weekly meetings to ensure everyone is on the same page.
They receive reports of adverse events following an immunization.
“With any vaccine there are going to be adverse events. We have to do an assessment, make sure forms are filled out appropriately and make sure they are submitted to the province,” she noted
“This is the stuff that is not seen every day that the health unit is still responsible for.”
Other areas of responsibility include communications, which they do through weekly media scrums, open virtual information sessions and interactive features on the website, not to mention their call centre.
“All these things have continued to happen, and they do require dedicated staff and resources. HR requirements have upscaled throughout our response. Since March 2021, we have worked with a staff agency and hired 60 additional staff to support large vaccine roll-out but also COVID containment activities.
“Volunteers are a huge component, as well as our partners, but there's also a significant addition of staff to our workforce that are temporary positions and funded through a one-time funding request to the province.
“It's a 35% increase to our staff component, and they all need additional training, equipment, supervision – so it's not just making sure they show up,” Dr. Bocking said.
“Depending on the size of the mass-immunization clinic, we need at least 12 to 15 staff – not just for giving the needles, but entering data, ensuring quality control, getting the vaccine into the needles. And there are 15 to 20 volunteers helping with traffic flow, orientation and making sure everything is running smoothly. It's a tremendous feat of logistics.
“These are very calm, positive places. I was a bit surprised. This is the really hopeful, positive aspect of our pandemic response. Our staff would often prefer to be there than on the receiving end of the phone calls from community members who are frustrated.”
Getting past COVID will be a long-term recovery, not a short-term one. Lessons on pandemic response must be learned, but it is hoped that COVID booster vaccinations can be taken over by pharmacies and clinics much as flu vaccines are.
“There are a lot of competing demands. We continue to deal as best we can with the cards that were dealt, whether it's through vaccine allocation, through other resources, through changing priorities as to eligibility of vaccine. All these require day-to-day assessment of how we are moving forward.
“The most significant area we are starting to ramp up is environmental health. Our core activities are dragging for ticks, Lyme disease surveillance, mosquito traps for West Nile Virus,” she listed.
They are also working with camp operators and trailer parks, continuing to support Healthy Babies Healthy Children and harm-reduction programming and looking ahead to working out a framework for school-based immunization.
They are also on the front lines of the opioid crisis, “which certainly has not gone away and, if anything, has been exacerbated by the pandemic.”
They have issued bulletins when there are concerns over contaminated supply, for example.
“That continues to be high on our radar as a priority that has been pronounced throughout the pandemic,” she said.
