The Wellington-Dufferin-Guelph Board of Health met on Wednesday for the first time since July to get an update about the local response to COVID-19. While the number of new cases have been holding steady, the Public Health staff explained that we can’t rest on our laurels, and there’s some hard work we’ve all got to do to prepare for that dreaded second wave.
“We’ve been fairly flat in our curve, and in particular since August we’ve had a fairly low number of weekly cases,” medical officer of health Dr. Nicola Mercer explained. “What has shifted, and it’s not just a local phenomenon, is that we’ve been having increasing numbers of young adults driving some of our new infections locally.”
Back to School
“I think from our perspective, it is critically important that this go right,” associate medical officer of health Dr, Matthew Tenenbaum said of the return to school strategy. “With public health measures we can, and we will, do this safely in a way that supports students and families while also keeping everyone in the school environment safe.”
Among the precautions that public health has taken is the hiring of 14 new school nurses thanks to an investment of funds from the Provincial government. Each nurse will be responsible for about 10 schools, or between 3,000 and 4,000 students, and while Mercer concedes that’s a lot of ground to cover for a single nurse, they’ve established protocols for rapid response to health issues.
“We have supported our schools by providing a direct name and phone number for each principal so that they are able to contact somebody very quickly about concerns that occur, whether it’s policy concerns, procedural concerns, some infection prevention and control measures, or public health measures,” Mercer said.
Concerns about schools re-opening were not helped this week with the news that 190 students and as many as 10 teachers from five schools in Ottawa were self-isolating because they were all tied to the same school bus.
“If you look at the root causes of what began that outbreak in their (Ottawa) school system, it was children being sent to school either not being properly screened or, more likely, because somebody in the family was symptomatic, and they were still sent to school,” Mercer explained. “We have a lot of work to do locally to ensure that parents in particular know what to do [to screen for COVID.]”
“What we have been thinking a lot about is how linked the risk in schools is to the risk in the broader community,” Tenenbaum added. “If there’s one takeaway from this report I hope you get it’s that risk in schools is linked to the risk in our broader community, and that everything we talk about in our response is all about protecting schools and other settings like it.”
Schools in the area have been given guidance, in some cases in-person by public health staff, on making their schools as safe as possible, not just with advice on physical distancing and personal protective equipment, but screening and cleaning procedures, documentation and record keeping, cohorting, and how to manage people who become ill. Mercer’s added that the difficulty in preparing for schools to re-open is that there’s no “one size fits all” solution.
“We know that not every school is going to look the same – they come in different shapes, sizes and ages – and we recognize that there isn’t one specific model that’s going to be perfect in every school,” Mercer explained. “We’ve been working closely with the schools to enable them to maximize the public health measures that they have available to them within the environment that they have.”
Public health’s case data dashboard will also be updated to include schools along with other institutions like hospitals, retirement and long-term care homes that are monitored for outbreaks.
Along with concerns specifically about back to school, public health said in a report that increased instances of COVID-19 is “highly probably” in the weeks and months to come.
To keep a handle on the rates in Wellington, Dufferin and Guelph, the report prepared by manager of health analytics Jennifer MacLeod said that public health will be looking for indicators in COVID hospitalizations, availability of PPE, and reports of school absences. They’re also setting up thresholds for action like sustained increases in the number of institutional outbreaks, or the percentage of occupied acute care beds.
“In this list of indicators, the ones that we’re really most interested in are the ones around hospitalization,” MacLeod said. “We’re not seeing any big changes there, but we’re anticipating, perhaps, seeing some changes.”
Mercer added that the burden of infections in the first wave was on seniors that live in congregate settings like long-term care homes, but the trend lately, 62 per cent, is being driven by young adults between the ages of 16 and 40 who are less likely to require hospitalization.
The danger, Mercer explained, is that there could be a “larger burden of disease simmering in the community,” with younger adults showing mild or no symptoms, which is a challenge that will be increased with the arrival of cold and flu season. The main course of treatment right now is to keep physical distancing, wearing masks, and washing hands so that the healthcare system isn’t overwhelmed.
“What you want to achieve to get through this pandemic is a slow burn, just enough cases that the healthcare system can manage easily, and public health can deal with it in the community,” Mercer added. “If we continue to see a trickle of cases, or that slow burn concept in our communities, we can manage until we end up with a either a treatment or a vaccine.”
Public health says that they can manage about 50 new cases of COVID per day to do proper contact tracing for each case, which would include some assistance from Public Health Ontario. Wellington-Dufferin-Guelph has come no where near that threshold even during the peak of the pandemic back in April.
In early March, public health advised people who had gotten a pedicure or manicure at Victoria’s Nail Salon on Stone Road to get tested for hepatitis B, hepatitis C and HIV after they discovered a “lapse in infection control procedures.” That public health matter was overshadowed by COVID a few short weeks later, and Mercer said that dealing with the issues at the nail salon were happening at the same time they we’re prepping for COVID.
“I think it’s important for the board to recognize that despite us diverting a tremendous amount of resources to COVID throughout 2020, the Board of Health is still able to respond to other kinds of population health threats that occur within our communities such as an infection control lapse that occurred at this nail salon,” Mercer said.
Mercer said that her team processed 1,000 blood test from customers of the nail salon after public health set up a series of clinics back in March; all customers over a nearly two-year stretch were told to get test at one of the clinics, or by their own personal physician. No results were given about positive tests because Mercer said you can’t necessarily connect blood-born diseases to one specific factor.
“What we do find is that we’re able to identify people who should have been picked up anyway if it wasn’t anything to do with the nail salon,” Mercer said. “They’re still able to be directed into the care system for some sort of preventative care, as well as follow up for any blood borne disease they may have.”
Mercer added that the records of the salon were incomplete, so they can’t be sure that everyone who went to Victoria Nails was tested.