December 2021 Board of Health Meeting

Meeting held via video: https://youtu.be/wHQogjtcW28

SUBMITTED BY:

Epidemiology and Evaluation Department

DATE:

December, 2021

SUBJECT:

COVID-19 Surveillance and Epidemiology

BACKGROUND

Overview

The Epidemiology & Evaluation department conducts on-going population health assessment and surveillance. The data and surveillance for COVID-19 plays an integral role in understanding and managing the pandemic locally. The evidence provides information on how the pandemic has and is evolving, assessing the risk and severity, and assists in the development of timely interventions to limit further spread in the community.

Trends

In the month of November (2021), the health unit reported 1,391 confirmed cases of COVID-19. This is a 72.2% increase in case counts compared to the previous month of October (2021). Similarly, the monthly case rate for November was 321.8 cases per 100,000 population, which is higher compared to the monthly rate in October (187.0 cases per 100,000 population). In Ontario, during the month of November, the case rate was 125.0 cases per 100,000 population. This is approximately 2.6 times lower compared to the rate of Windsor-Essex County.

Age and Gender

Approximately 52% (729) of the cases were among females and 47% among males. A disproportionately (21.9%) higher number of cases, in November 2021,  were reported among those 0 to 18 years of age, followed by 15.6% among those 30 to 39 years of age, and 15.5% in the 40 to 49 year age group. Comparatively, from the onset of the pandemic locally (March 1, 2020 to November 30, 2021), approximately 16% of our cases were in the 0 to 19 age group.

Municipal Distribution

The Town of Leamington had the highest case rates (548.7 cases per 100,000 population), followed by Amherstburg (469.0 cases per 100,000 population), Tecumseh (461.3 cases per 100,000 population), and Essex (433.7 cases per 100,000 population). However, looking at the distribution of cases, 46% of cases were from the City of Windsor, 12% from Leamington, 8% from Tecumseh and 8% from Essex.

Risk Factors

For the month of November 2021, the top three risk factors reported were being an elementary or secondary student (15.6%), being a healthcare worker (2.4%) and being an educational staff (2.2%).

Variants of Concern (VOCs)

Of the 1,391 cases reported in the month of November, genomic sequencing results were available for 528 cases (38% of cases). Overall, 36% of cases reported were due to the Delta variant (B.1.617.2).

Source of Acquisition

Approximately, 33% of cases in November (2021) acquired COVID-19 from an unknown source (no epi-link identified), 29% from a household contact, 20% from a close contact outside of their household, 8% due to being related to an outbreak, and 1.6% from travel-related outside of the province (e.g., to another province and/or outside of Canada).

Outcome Status

Of the 1,391 cases reported in November (2021), 51% (706) had their infection resolved, 574 cases (45%) were active and being followed by the health unit, and 2.4% (21) of cases were lost to follow-up. Six deaths were reported in November (2021) due to COVID-19.

Vaccination Status

36,141 doses were administered to Windsor-Essex County residents in the month of November (2021) compared to over 21,889 doses in the month of October. This represents a 65% increase for the month of November (2021). Approximately 57% of the doses administered were third doses/boosters, 23% were first doses to individuals who were previously unvaccinated, and 20% were among those completing their vaccination series (fully vaccinated).

Among the 1,391 cases reported in November (2021), 49% were fully vaccinated, 46% were unvaccinated, 4.5% were partially protected with one dose, and 1% were not yet protected after receiving the first dose. Among the 636 unvaccinated cases, approximately 42% were among those 0 to 18 years of age which includes children who were ineligible to receive the vaccine.

CURRENT INITIATIVES

The health unit will continue to monitor and provide epidemiological expertise on COVID-19 to internal leadership, community partners, and residents to support evidence-informed decision-making. This includes daily epidemiological updates, weekly epidemiological presentations to the community and supporting policy decisions through data driven approaches

SUBMITTED BY:

Healthy Families Department

DATE:

December, 2021

SUBJECT:

COVID-19 Surveillance and Epidemiology

BACKGROUND

The quality of parenting children receive during infancy and childhood has a significant impact on their development, well-being, and life opportunities. Positive parenting practices provide children with many developmental and life advantages such as secure attachment, higher academic achievement, and improved physical health to name a few. Positive parenting practices are associated with reduced risk of substance misuse problems and anti-social behaviors among children and youth, and can buffer children from the consequences of other hardships (e.g. the stresses of living in poverty).

Local data pertaining to child poverty, and school readiness identify that positive parenting interventions need to be a priority for the vulnerable in our community. As well, the Mental Health Promotion Framework (WECHU, 2019) identified the domain related to family, including parenting style as a key area for future intervention.

Poverty remains a significant issue children face in Windsor- Essex County. Approximately, one in four (26%) children under 5 years live in low-income households (Windsor-Essex County Health Unit, 2019). This proportion is higher than any other age group, and the proportion of children under age 5 living in low-income is higher than the provincial average (19.8%) (Windsor-Essex County Health Unit, 2019). Children living in low-income households are at greater risk for poor outcomes related to healthy and growth and development (Perou et al., 2019).

Research has identified that warm, sensitive parent-child relationships and positive parenting practices play an important role for children’s readiness for school (Welsh, 2014).  Local Early Development Instrument (EDI) data (2017/2018) indicated 28.1% of kindergarten students were vulnerable in at least one of the five early development domains (i.e., physical health and well-being, communication skills and general knowledge, emotional health and maturity, social competence, and language and cognitive development).

Additionally the COVID-19 pandemic has had a significant impact on supports and services for parents and young children. Many of the supports and services that families rely upon were cancelled, delayed or reduced during the COVID-19 pandemic. As well, public health measures such social distancing impact the development of many skills for children, including socialization and self-regulation.

CURRENT INITIATIVES

Legacy for Children™ is an evidenced-based, parent-focused program geared towards low-income, low-resourced mothers of infants and young children. The Legacy model was developed by the Centers for Disease Control and Prevention (CDC). Legacy aims to positively influence child development by: promoting sensitive and responsive mother-child interactions; enhancing maternal self-efficacy; and promoting a sense of community. Research through a randomized control trial has shown that children whose mothers participated in Legacy had significantly higher cognitive scores, and experienced fewer behavioral and social emotional problems than non-legacy children.

Legacy is a three- year program, offered in a group setting starting ideally in the third trimester of pregnancy, and ends when the child reaches age three. Each Legacy group meets for 2 hours per week. In addition, the program includes one-on-one time (e.g., home visits, phone calls) between program staff, (referred to as the Intervention Specialist) and the participant during program breaks. This is an opportunity for the Intervention Specialist to reinforce curriculum content, and provide extra support to participants.

Legacy is facilitated by Intervention Specialists, who are trained by University of California, Los Angeles and CDC.  To date, some Healthy Families’ Public Health Nurses and Social Workers have been trained as Intervention Specialists.  The Intervention Specialists use a variety of techniques during group sessions: videos, slides, role-playing, structured discussion activities, etc.

Starting in February 2022, the Healthy Families Department will be partnering with Connections Early Years Family Centre (Connections) to pilot a hybrid model of Legacy due to the pandemic. The plan is to have 8 participants in-person with the two Intervention Specialists at Connections, and roughly 7 participants online for a total of 15 participants. The WECHU will work through existing partners to assist with identifying and recruiting potential participants including: Healthy Babies Healthy Children prenatal clients, Building Blocks for Better Babies, WECHU’s Nurse Practitioner, local Obstetricians, Windsor-Regional Hospital Social Worker(s), Connections, Ready Set Go, Windsor Youth Centre, VON Immigrant Health Centre, Children First, etc.

Connections is supporting the pilot by providing their facility in-kind, and offering child care to in-person participants needing child care. The child care will be provided by Connections’ Early Childhood Educators.

In addition, a Legacy Stakeholder Advisory Committee has been established to provide guidance and support to WECHU in the implementation of the Legacy program in Windsor- Essex County. The scope of the committee will be to: assist with recruitment and retention of participants, inform and guide evaluation, and provide recommendations for future sites based on community needs.

SUBMITTED BY:

Oral Health Department

DATE:

December, 2021

SUBJECT:

BACKGROUND

In the fall of 2019, the Ministry of Health launched the Ontario Seniors Dental Care Program (OSDCP) to improve access to regular dental care for low-income seniors. Locally, the Windsor-Essex County Health Unit (WECHU) is implementing the OSDCP through the Leamington and Windsor oral health clinics and in partnership with the Southwest Ontario Aboriginal Health Access Centre (SOAHAC). The OSDCP provides free dental care to low-income seniors who are age 65 years and older, and have no access to other dental benefits.

Services covered under the OSDCP include:

• Preventive services (e.g., cleanings)
• Restorative services to repair broken teeth and cavities (e.g., crowns)
• Oral surgery services to remove teeth or abnormal tissue
• Endodontic services to treat infection and pain (e.g., root canals)
• Periodontal services to treat gum conditions and diseases
• Dental prosthetics (prosthodontic services), including dentures (partially covered)

In order to be eligible for the OSDCP, seniors must also have an annual net income of $22,200 or less, or a combined annual net income of $37,100 or less for senior couples (one or both people aged 65 or older). Lastly, the program is restricted to those who are not covered by dental benefits, including private insurance, Ontario Works, Ontario Disability Support Program, or Non-Insured Health benefits.

CURRENT INITIATIVES

The WECHU began to operationalize the OSDCP protocols in January 2020 with an 8:30 a.m. to 8 p.m. clinic in its downtown Windsor office and an 8:30 a.m. to 4:30 p.m. clinic at its county location in the downtown core of Leamington. The OSDCP funding currently supports three dental assistants, three dental hygienists, 1.5 dentists, one part-time denturist, two clerks, one manager and one health promotion specialist. With early implementation hindered by service alterations caused by COVID-19, the clinic has now resumed full operation and is being promoted throughout the region through the WECHU.org website, a local magazine targeting those over the age of 55, and referrals from partnering agencies.

Prior to the WECHU’s implementation of the OSDCP, the Oral Health Department’s clinic exclusively treated eligible children and youth (under 17) who qualified for the Healthy Smiles Ontario (HSO) program. With the seniors program now in full operation servicing 810 unique clients in 2021, the proportion of WECHU dental clients is now split relatively evenly between the two client groups.  Although the characteristics of the clients between the two programs are quite different, the types of treatment offered to clients under both the HSO and OSDCP are similar with the exception of certain services offered exclusively to seniors (i.e., dental prosthetics). The total number of procedures and appointments for both programs are outlined in Table 1 below:

Table 1: Services Offered to Oral Health Department Clients (January 1st – November 29th, 2021)

* Refers to number of appointments rather than individual procedures

With respect to the figures in Table 1, the WECHU anticipates the need for services will continue to increase for the senior population as only an estimated 22% of all eligible seniors in Windsor and Essex County have accessed the program to date.

Future Plans

After its first year of full operation of the OSDCP, ongoing planning regarding the best staffing model, space utilization, and resource allocation continue to be a priority of the WECHU management and leadership team. Currently, the clinics are booking appointments approximately 2 months into the future for appointments with our dental hygienist or denturist and potential for up to 5 months to see a dentist for treatment. Future directions aim to improve this wait time through a number of different program modifications:

• Exploring the provision of service in Long-term Care Homes:
  • A needs assessment survey will be distributed for those residents of long-term care homes to determine whether or not expansion into this setting is appropriate and feasible given the current funding provided.
• Expanding Clinic Capacity:
  • One large dental operatory will be split to provide an additional space for client service.
• Increasing the number of appointment times:
  • Reducing the requisite time between appointments by enhancing air filtration to allow for more appointment times throughout the day.
• Improving efficiency of professional staffing resources:

Decreasing wait times for services which can only be completed by dentists by increasing denturist time.

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Fabio Costante, Gary Kaschak, Judy Lund, Ed Sleiman, Larry Snively

Board Member Regrets:

Robert Maich

Administration Present:

Nicole Dupuis, Dr. Shanker Nesathurai, Lorie Gregg, Felicia Lawal, Kristy McBeth, Eric Nadalin, Dan Sibley, Lee Anne Damphouse

QUORUM:  Confirmed

The Board moved into Committee of the Whole at 4:02 pm
The Board moved out of Committee of the Whole at 4:14 pm

RECORDING SECRETARY: L. Damphouse

SUBMITTED BY: N. Dupuis

APPROVED BY: WECHU Board of Health, January 20, 2022