December 2021 Board of Health Meeting

Meeting Documents

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

  1. Call to Order
  2. Agenda Approval
  3. Announcement of Conflict of Interest
  4. Update (Dr. S. Nesathurai)
    1. COVID-19 Update
  5. Approval of Minutes
    1. Regular Board Meeting: November 18, 2021
  6. Business Arising
    1. Consumption and Treatment Services Update (N. Dupuis/E. Nadalin)
  7. Consent Agenda
    1. INFORMATION REPORTS
      1. Ontario Seniors Dental Care Program (E. Nadalin)
      2. Legacy for Children Parenting Program (F. Lawal)
      3. COVID-19 Surveillance and Epidemiology (N. Dupuis)
      4. Q3 Reporting (L. Gregg)
      5. November Communications Recap (E. Nadalin)
    2. RESOLUTIONS/RECOMMENDATION REPORTS – None
  8. New Business
    1. Project Governance Committee – Terms of Reference (N. Dupuis/J. Lund (Co-Chairs)
    2. Board of Health Meeting Schedule – 2022 (L. Damphouse)
  9. Correspondence
    1. Algoma Public Health – Letter to Hon. Christine Elliott – Request for Annualized IPAC Hub Funding and Increase in Provincial Based Funding for Local Public Health (Support) (K. McBeth)
    2. Haliburton, Kawartha, Pine Ridge Health Unit – Letter to Hon. Christine Elliott and Dr. Sheldon Salaba (Ontario Association of Optometrists) – Lack of Vision Services for patients under OHIP
    3. Town of Essex – Letter to Dr. S. Nesathurai, Acting MOH, and Nicole Dupuis, CEO, of the Windsor-Essex County Health Unit – Resolution in Opposition to the Letter of Instruction issued by the Windsor-Essex County Health Unit on December 5, 2021
  10. Committee of the Whole (Closed Session in accordance with Section 239 of the Municipal Act)
  11. Next Meeting: At the Call of the Chair January 20, 2022 – Via Video
  12. Adjournment

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:

Ontario Seniors Dental Care Program - Status Update


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)

Treatment Provided

Number of Procedures

Percentage of Total Procedures

Restorative Procedures

1,633

27%

Oral Surgery Procedures

571

10%

Endodontic Procedures

131

2%

Preventative Services*

2,298

39%

Dental Prosthetics (OSDCP only)*

Includes: Dentures and associated services

1,311

22%

TOTAL

5,944

100%

* 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

  1. Call to Order
    Board Chair, Gary McNamara, called the meeting to order at 4:14 p.m.
  2. Agenda Approval

    Moved by: Rino Bortolin
    Seconded by: Judy Lund
    That the agenda be approved.
    CARRIED

  3. Announcement of Conflicts of Interest – None
  4. Update (Dr. S. Nesathurai)
    1. COVID-19 Update

      Dr. S. Nesathurai said that it is clear that disease activity of COVID-19 has increased in our community.  There have been 45 deaths from COVID-19 in our region since August of this year, two-thirds among individual who were unvaccinated and one-third of those that were vaccinated living with serious medical conditions.  Hospitalizations due to COVID-19 has immediate consequences on our health care system, and is affecting access to timely medical treatment for other health issues. 

      The strategy to manage the spread of COVID-19 starts with containment of the virus, and the second part of the strategy is vaccination.  The Ministry of Health has asked us to shift our resources from containment to vaccination efforts.  With this request comes a trade off, meaning a decrease in resources in Case and Contact Management, and those who benefit most from containment are the unvaccinated.  With approximately 300,000 individuals eligible for vaccination in Windsor-Essex, the magnitude of this request is staggering.  Hundreds of thousands of individuals in our region will need to be vaccinated in short order.  Our region is equipped with a mass vaccination centre, participating pharmacies, some primary care providers and mobile clinics.  Vaccinating 300,000 people, at 6,000 people per day, would still take 50 days to complete.  The WECHU has exhausted every avenue to increase vaccine availability, and has reached out to family physicians, the Dean of the local Medical School for student resources, and anyone who can help with immunizations to get as many people vaccinated as possible.  

      G. McNamara asked how to address the public in the rationale that organized team sport activities are acceptable, but gatherings or informal sport activities are not.  N. Dupuis advised that we provide FAQ’s and include these interpretations on our website, however this is the health unit’s interpretation. Each region may obtain their own legal interpretation of the ROA and its regulations that differ from other areas. Many of the definitions we work from are already part of the legislation such as what is defined as a social gathering versus what is defined as sport and recreation. Dr. S. Nesathurai acknowledged there are apparent inconsistencies and that Medical Officers of Health have asked the province to provide more uniform measures across health units.  

      E. Nadalin advised that the WECHU meets every 2 weeks with regional enforcement who have their own legal council that interprets the ROA.  There are gray areas and this would be up to the municipalities to interpret.  This group has been meeting for over a year and things have changed at different points during the pandemic.  One members of this group has been collating all legislation, our Letters of Instruction and Section 22 Orders into a document for the group.  Communication is paramount and ongoing, and we have sought provincial support from multi-ministry agencies. 

      L. Snively asked how the Omicron Variant of Concern (VOC) compares to the Delta VOC.   Dr. S. Nesathurai said that the knowledge of the Omicron VOC is still evolving.  Evidence shows that the vast majority of people with COVID-19 recover, and those that are vaccinated are likely to have mild to moderate infections, but there will be deaths from COVID among healthy individuals.  The unvaccinated have a higher probability of severe disease and are more likely to be hospitalized, placed on a ventilator or die from COVID-19. 

      The Omicron VOC is expected to infect more people than the Delta VOC, but we cannot conclude that Omicron will be more or less severe than previous VOCs.  We are seeing case counts rising significantly and our biggest concern is hospital saturation with more people in ICU, more people requiring ventilators and hospitals being unable to admit those that need medical care for other diseases and health issues.  The major risk of hospital staff being infected could cripple our hospitals ability to function and we need to continue to encourage people to get vaccinated.  Under the old paradigm we would have been in complete lockdown, but we now have the vaccine.  The immediate problem is how to get through these next few weeks to provide sufficient containment and not overwhelm the health care system.

      Approximately 800 cohorts have been dismissed from schools, about 16,000 students, and are missing part of their education to prevent transmission to a parent, grandparent or an unvaccinated person.  R. Bortolin said he has been hearing from parents whose children were potentially exposed.  Some were dismissed from school for 10 days, some for 14 days, and is there a reason why we have not looked at rapid testing in school.  Dr. S. Nesathurai said that testing at home versus testing at the lab has its disadvantages, and it is best to be tested by a professional.  With over 800 cohort dismissals and no school closures, that means school boards have put public health measures in place.  If we start to relax public health measures we take the chance of penetration into schools and potential closure.  The current guidance from the ministry is to isolate all high risk contacts for 10 days and obtain a PCR (Polymerase Chain Reaction) Test at the Assessment Centre.

      Moved by:  Judy Lund
      Seconded by:  Larry Snively
      That the information be received.
      CARRIED

  5. Approval of Minutes
    1. Regular Board Meeting:  November 16, 2021
      Moved by: Joe Bachetti
      Seconded by: Gary Kaschak
      That the minutes be approved.
      CARRIED
  6. Business Arising
    1. Consumption and Treatment Services Update (N. Dupuis/E. Nadalin)

      N. Dupuis advised that the WECHU were scheduled to address Windsor City Council at its December 20, 2021 Council Meeting for the approval of the Consumption and Treatment Services Site at 628 Goyeau Street in Windsor, but have subsequently been rescheduled to appear before Council in January 2022.  We were originally scheduled to address City Council in November.  E. Nadalin is working on plans for the application, and we have also finalized various reports and materials to proactively address council and any potential questions they may have. 

      Moved by: Rino Bortolin
      Seconded: Judy Lund
      That the information be received.
      CARRIED

  7. Consent Agenda

    1. INFORMATION REPORTS
      1. Ontario Seniors Dental Care Program (E. Nadalin)

        E. Nadalin noted that the Ontario Seniors Dental Care Program (OSDCP) is geared to providing standard dental care to low income seniors and has been operational since the fall of 2019.  The OSDCP has been a priority during the pandemic, one challenge being the massive interest and we have initiatives in place to address the wait times.  The Report is attached and received for information by the Board.

      2. Legacy for Children Parenting Program (F. Lawal)
        F. Lawal noted that this new program will target low income mothers, infants and young children and will be launching in February 2022. The Report is attached and received for information by the Board.

      3. COVID-19 Surveillance and Epidemiology (N. Dupuis)
        L. Gregg noted that this report was submitted to the Ministry earlier this week. The Report is attached and received for information by the Board.

      4. November Communications Recap
        The Report is attached and received for information by the Board.

        Moved by:  Judy Lund
        Seconded by:  Rino Bortolin
        That the above information be received.
        CARRIED

    2. RESOLUTIONS/RECOMMENDATION REPORTS - None
  8. New Business
    1. Project Governance Committee – Terms of Reference (N. Dupuis/J. Lund)
      N. Dupuis noted that we have commenced meetings with the Project Governance Committee and resurrected the capital project for a potential new space for the WECHU.  The Terms of Reference have been updated and Judy Lund was voted in as a replacement for former Co-Chair, John Scott, whose term as a provincial member on our board expired in March 2021.

      Moved by:  Rino Bortolin
      Seconded by:  Judy Lund
      That the information be received.
      CARRIED

    2. Board of Health Meeting Schedule for 2022
      The Board agreed to continue with scheduling Board of Health meetings on the third Thursday of each month for 2022.  Calendar invites to follow.
      Moved by:  Joe Bachetti
      Seconded by:  Judy Lund
      That Board of Health meetings for 2022 be scheduled on the 3rd Thursday of each month. 
      CARRIED

  9. Correspondance
    1. Algoma Public Health – Letter to Hon. Christine Elliott – Request for Annualized IPAC Hub Funding and Increase in Provincial Based Funding for Local Public Health (for support) 

    2. Haliburton, Kawartha, Pine Ridge Health Unit – Letter to Hon. Christine Elliott and Dr. Sheldon Salaba (Ontario Association of Optometrists) – Lack of Vision Services for patients under OHIP

    3. Town of Essex – Letter to Dr. S. Nesathurai, Acting MOH, and Nicole Dupuis, CEO of the Windsor-Essex County Health Unit – Resolution in Opposition to the Letter of Instruction issued by the Windsor-Essex County Health Unit on December 5, 2021

      Moved by:    Judy Lund
      Seconded by:  Ed Sleiman
      That the Board support item 9.1, Algoma Public Health’s request for Annualized IPAC Hub Funding and an increase in Provincial Based Funding for Local Public Health
      CARRIED

      Moved by:  Joe Bachetti
      Seconded by: Ed Sleiman
      That items 9.2, and 9.3 be received.
      CARRIED

  10. Committee of the Whole (CLOSED SESSION, in accordance with Section 239 of the Municipal Act)
    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

  11. Next Meeting: At the Call of the Chair, or January 20, 2022 – Via Video 

  12. Adjournment

    Moved by: Rino Bortolin
    Seconded by: Judy Lund
    That the meeting be adjourned.
    CARRIED

    The meeting adjourned at 5:25 pm.

RECORDING SECRETARY: L. Damphouse

SUBMITTED BY: N. Dupuis

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