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Meeting Document Type: 
Resolution
2020 Budget Amendments

ISSUE 

On March 11, 2020, the World Health Organization (WHO) declared the global outbreak of COVID-19 a pandemic. On March 20, 2020, the Windsor-Essex County Health Unit (WECHU) announced its first confirmed case of COVID-19. Since then, Windsor and Essex County (WEC) has seen confirmed cases rise to one thousand eight hundred (1,800) (as at July 12, 2020), with sixty-eight (68) deaths.

WEC is home to one of the busiest border crossings in North America. Approximately six thousand (6,000) residents in WEC work in the state of Michigan, and in particular, seventeen hundred (1,700) in the health care industry. In addition, WEC is home to eight thousand (8,000) to ten thousand (10,000) seasonal workers, one hundred seventy-six (176) farms and over seven hundred (700) seasonal accommodations. WEC has forty-four (44) long-term care and retirement homes. These characteristics make our community unique and create dynamics that are challenging to manage from a public health perspective. Adding to this, are the complexities of the Ministry of Health (MoH) requirements and performance targets.

Approximately eighty (80) staff with the WECHU, of varying roles, have been redeployed to address the response to COVID-19 within our WEC region. Programs and services, which had previously been halted, are now restarting, as our community moves through the stages of reopening. It is imperative that the WECHU formulate a strategy that will not only return staff to their originating programs, but responsibly address the continuing needs of COVID-19, within our community. To that end, Administration is proposing an amendment to the 2020 Budget to account for the additional FTE requirements. 

BACKGROUND

In May of 2020, the MoH, in a memo regarding Case and Contact Management, required that public health units address certain questions. The following is a summary of the WECHU’s responses. 

  • If you believe you are currently able to connect with new cases within 24 hours of referral – Yes, initial contact with ALL positive cases of COVID-19 is completed within 24 hours. Since our first case of COVID-19 until now, the average number of new cases per day is 13.9. In situations where a positive case cannot be located by phone within 24 hours, a letter is delivered by WECHU staff under the signature of the Medical Officer of Health providing notification of positive test result with mandate to contact public health. (Response as at May 2020) 

  • If you believe you are currently able to connect with new contacts within 24 hours of referral or identification – Not for all contacts of confirmed cases. The ability to complete all contact tracing interviews within 24 hours is dependant upon how many contacts each case has. On average, each case in Windsor-Essex has 2 close contacts, others can have upwards of 10. The WECHU makes every effort to complete this within 24 hours. (Response as at May 2020) 

  • If you believe that your health unit can sustain that capacity within the near term for case management – No, the WECHU would not be able to absorb the additional/current COVID-19 case management work within the current complement of staff allotted to infectious disease management in conjunction with resumed operations of other areas within the health unit (i.e. school based immunization, UIIP). The WECHU currently has 656 positive cases of COVID-19. Since our first case of COVID-19 until now, the average number of new cases per day is 13.9. (Response as at May 2020) 

  • If you believe that your health unit can sustain that capacity within the near term for contact tracing - No, the WECHU would not be able to absorb the additional/current COVID-19 contact tracing work within the current complement of staff allotted to infectious disease management in conjunction with resumed operations of other areas within the health unit (i.e. school based immunization, UIIP). The WECHU currently has 656 positive cases of COVID-19. Since our first case of COVID-19 until now, the average number of new cases per day is 13.9. Applying an average factor of 2 contacts per case that requires approx. 28 people to be contacted in regards to COVID-19 follow-up per day. (Response as at May 2020) 

  • The WECHU provided the MoH with a summary of the staff complement dedicated to the WECHU’s COVID19 response. 

    In order to support the COVID-19 response in Windsor-Essex, a number of public health activities have been deferred/reduced including but not limited to: 

    • School based immunization 
    • Oral health programming (non-emergency) 
    • Health promotion programming and planning 
    • Vaccine Distribution Programming (i.e. routine inspections) 
    • Healthy Families programming (non-critical) 
    • Breastfeeding support 
    • Food Safety and other Environmental Health program training (in person courses) 

    In addition, other internal support programs have all had staff seconded to work exclusively on COVID-19 in the areas of epidemiology and evaluation, IT, communications, and planning. All of these come at a cost of progress and backlog in a number of public health programming areas. 
    The current COVID-19 response team, which was formed to supplement the Infectious Disease Team that existed prior to the pandemic (13 public health nurses, 3 clerical staff and 1 manager) consists of the following cohorts of staff to support direct case and contact management activities including contact tracing, daily PUI monitoring, testing and assessment, iPHIS entry and other COVID-19 client based work: 

    • 8 managers (health promotion and protection programing) 
    • 2 NPs (seconded from clinical services and family health programming) 
    • 35 RNs (seconded from healthy schools, healthy families, HBHC, and vaccine programming) 
    • 7 RPNs (seconded from vaccine programming) 
    • 2 Health Promotion Specialists (seconded from health promotion programming) 
    • 11 Dental Hygienists/Assistants (seconded from oral health programming) 
    • 1.5 Epidemiology Supports (seconded from health promotion and protection programming) 
    • 9 clerical staff (seconded from health promotion and protection programming) 
    • 3 Public Health Inspectors (seconded from environmental health programming) 

    The COVID-19 response for the WECHU is a 7 day per week operation that consists of 2 weekday shifts per day and one shift per day on the weekend. It is supported 24/7 by the WECHU’s on-call program.

Implementation of Public Health Mutual Assistance Agreements

Due to a significant increase in cases and contacts related to the agri-farm sector in WEC and associated demands on WECHU resources, the WECHU implemented its Public Health Mutual Assistance Agreements with the following health units: 

  • Chatham-Kent Public Health 
  • Sarnia-Lambton Health Unit 
  • Southwest Public Health 
  • Grey Bruce Health Unit 
  • Huron Perth Public Health 
  • Middlesex-London Health Unit 

Nursing staff from these health units were oriented and supported to work remotely to assist with contact management including daily monitoring of cases/contacts. Overall, approximately 11 FTEs and 10 casual nurses have been assisting our health unit since late June. In addition, Public Health Ontario has been working with our health unit to support iPHIS data entry requirements related to COVID-19.

The Ministry of Health also expanded the assistance available to the WECHU through a call out on June 28th to all health units in Ontario. In addition, Dr. Alexander Summers, Associate Medical Officer of Health, was seconded from Middlesex-London Health Unit, to assist in the short term and has been on-site for the past 2 weeks. He will continue to support remotely. Our health unit also received epidemiological support from a Field Epidemiologist through the Public Health Agency of Canada (PHAC). The Field Epi has been assigned to our health unit for approximately 4 weeks and is working with our manager of Epidemiology and Evaluation to support the work of COVID-19.

Both the Emergency Operations Centre (Minister of Solicitor General) and the Emergency Operations Centre (Ministry of Health) continue to support the work of COVID-19 in coordinating the measures needed to address the agri-farm sector outbreaks in WEC.

COVID-19 Response Team

To address the MoH’s requirements, including performance goals related to case and contact management (24-hour action timeline) and iPHIS contact and case management data entry requirements, the WECHU would require additional staff directly allocated to COVID-19 response to work within the current complement of infectious disease management and prevention. This includes: 

  • 1 FTE, Associate Medical Officer of Health 
  • 1 FTE, Program Manager 
  • 3 FTEs, Clerical Support Staff;
  • 2 FTEs, Public Health Nurses; 
  • 10 FTEs, Registered Practical Nurses; 
  • 4 FTEs, Public Health Inspectors; 
  • 1 FTE, Epidemiologist.

The following is a summary of the annual operating budget for the remainder of 2020 and one-time capital costs to support the proposed COVID-19 Response Team. 

  2020 Operating Budget
Salaries and benefits $679,337
Operating costs (mileage, program supplies, licensing) 73,602
Total 2020 Operating Costs $752,939
One-time capital costs $104,390
Financial impact – 2020 $857,329

This budget assumes a September 7, 2020, start date to allow for appropriate recruitment. One-time capital costs include the cost of information technology infrastructure, both to expand current system capacity, as well as support the COVID-19 Response Team. Augments in building occupancy costs as well as furniture and fixtures have not be contemplated as this staff would work-from-home.

Funding

The WECHU has not received any communications for the MoH regarding the funding of a COVID-19 Response Team. If the WECHU assumes that funding will not be received to support the COVID-19 Response Team, the contributions from the Obligated Municipalities for the remainder of 2020 would be as follows:

Municipality Funding ($)
Corporation of the City of Windsor $466,726
Corporation of the County of Essex 390,098
Corporation of the Township of Pelee 505
  $857,329

If the MoH does provide funding for a COVID-19 Response Team using a 70%/30% funding formula for this specific initiative, the contributions from the Obligated Municipalities for the remainder of 2020 would be as follows:

Municipality Funding ($)
Corporation of the City of Windsor $140,018
Corporation of the County of Essex 117,030
Corporation of the Township of Pelee 152
  $257,200

For information purposes, Administration quantified the annual operating costs for the COVID-19 response team. 

  2021 Operating Budget
Salaries and benefits $2,077,971
Operating costs (mileage, program supplies, licensing) 130,982
Total 2020 Operating Costs $2,208,953

Increase in contributions from the Obligated Municipalities for 2021 related to the addition of a COVID-19 
Response Team, assuming no funding is received from the MoH:  

Municipality Funding ($)
Corporation of the City of Windsor $1,202,543
Corporation of the County of Essex 1,005,109
Corporation of the Township of Pelee 1,301
  $2,208,953

Increase in contributions from the Obligated Municipalities for 2021 related to the addition of a COVID-19 response team, assuming this specific initiative is funded by the MoH at a rate of 70%/30%. 

Municipality Funding ($)
Corporation of the City of Windsor $360,763
Corporation of the County of Essex 301,533
Corporation of the Township of Pelee 390
  $662,686

PROPOSED MOTION

Whereas, the WHO declared the global outbreak of COVID-19 a pandemic on March 11, 2020, and

Whereas, the growing number of confirmed cases of COVID-19, the absence of a vaccine, coupled with movement of WEC through the stages of reopening and restarting of the WECHU programs and services, and

Whereas, the Windsor-Essex County Health Unit is responsible for promoting, protecting and improving the health and well-being of the community of WEC as required by the Health Protection and Promotion Act, R.SO. 1990 (the HPPA).

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the amendment to the 2020 budget, resulting in the recruitment of a COVID-19 Response Team with an addition of 22 full-time equivalents, including an Associate Medical Officer of Health.

FURTHER THAT, the Windsor-Essex County Board of Health direct Administration to provide notice, as required under section 72(6) of the HPPA, to the Obligated Municipalities of the additional contributions required to fund the COVID-19 Response Team for the remainder of the 2020 fiscal year.