November 2021 Board of Health Meeting

Meeting held via video: https://youtu.be/3amhiiN2J90

SUBMITTED BY

Epidemiology and Evaluation Department

DATE

November, 2021

SUBJECT

COVID-19 Surveillance and Epidemiology – October, 2021

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 October (2021), the health unit reported 808 confirmed cases of COVID-19. This is a 47.6% decrease in case counts compared to the previous month of September (2021). Similarly, the monthly case rate for October was 186.95 cases per 100,000 population, which is lower compared to the monthly rate in September (356.8 cases per 100,000 population). In Ontario, during the month of October, the case rate was 91.5 cases per 100,000 population. This is approximately 2.0 times lower compared to the rate of Windsor-Essex County.

Age and Gender

Approximately 51% (413) of the cases were among males and 49% among females. A disproportionately (28.6%) higher number of cases, in October 2021,  were reported among those 0 to 18 years of age, followed by 15.6% among those 30 to 39 years of age, and 15.3% in the 19 to 29 year age group. Comparatively, from the onset of the pandemic locally (March 1, 2020 to October 31, 2021), approximately 15% of our cases were in the 0 to 19 age group.

Municipal Distribution

The Town of Leamington had the highest case rates (403.1 cases per 100,000 population), followed by Essex (349.8 cases per 100,000 population), Tecumseh (199.5 cases per 100,000 population), and the city of Windsor (17.1 cases per 100,000 population). However, looking at the distribution of cases, 49% of cases were from the City of Windsor, 15% from Leamington, and 9% from Essex.

Risk Factors

For the month of October 2021, the top five risk factors reported were being an elementary or secondary student (19.1%), being a resident of congregate living setting (5.0%), being a health care worker (2.4%), being a farm worker (2.1%), and being an educational staff member (1.9%).

Variants of Concern (VOCs)

Of the 1,542 cases reported in the month of October, genomic sequencing results were available for 718 cases (89% of cases). Overall, 69% of cases reported were due to the Delta variant (B.1.617.2), 7% of cases reported results without a variant, and 24% were not sequenced to identify a mutation or a VOC.

Source of Acquisition

Approximately, 38% of cases in October 2021 acquired COVID-19 from their household contact, 20% from a close contact outside of their household, 5% due to being related to an outbreak, and 4% from travel-related outside of the province (e.g., to another province and/or outside of Canada).

Outcome Status

Of the 808 cases reported in October 2021, 72% (582) had their infection resolved, 194 cases (24%) were active and being followed by the health unit, and 2.6% (21) of cases were lost to follow-up. Six deaths were reported in October (2021) due to COVID-19.

Vaccination Status

21,889 doses were administered to Windsor-Essex County residents in the month of October compared to over 34,500 doses in the month of September. This represents a 36% decrease for the month of October (2021). Approximately 62% of the doses administered were second doses to complete a vaccination series, 32% were first doses to individuals who were previously unvaccinated, and 6% were among those in the highest risk priority groups (e.g., residents of long-term care and retirement homes).

Among the 808 cases reported in October 2021, 63% were unvaccinated (or not eligible to receive a vaccine), 29% were fully vaccinated, 6% were partially protected with one dose, and 2% were not yet protected after receiving the first dose. Among the 356 unvaccinated cases, approximately 58% 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

Communications Department

DATE

November, 2021

SUBJECT

October 2021 - Communications Update

October Metrics

Media Monitoring Highlights

Facebook Highlights

Twitter Highlights

Media Participating in Media Briefings

• AM 800 CKLW, Blackburn News, CBC Windsor, CTV Windsor, CFTV and the Windsor Star join regularly.

Current Notable Projects

• Maintaining marketing and communication efforts regarding ongoing vaccine rollout in the region by public health and our partners.
• Shift of media responses from media requests to proactive recorded media sessions in order to reduce burden on Communications and Leadership Team staff while maintaining and improving responsiveness to inquiries.
• Maintaining and updating website as new information changes regarding COVID-19.

Data Notes:

1. Media requests received is a compiled list of documented requests we captured for interviews, data clarification, or general request for information from the media. Given the volume of requests during COVID-19, many exchanges with the media through text messages or quick phone calls to answer questions may not be captured. In many instances, each request led to multiple interactions with reporters.

2. Dr. Ahmed joined Mike and Lisa on the AM 800 Morning Drive every morning at 8:06 a.m. starting on Wednesday, March 17, 2020. On August 17, 2020, we went to a Monday, Wednesday, and Friday schedule with holidays off. On July 19, 2021, Dr. Ahmed continued to join Mike and Lisa Monday and Wednesday mornings to keep the community informed. On September 16, 2021, Nicole Dupuis and Dr. Nesathurai were conducting interviews with Mike and Lisa on Monday and Wednesday mornings.

3. YouTube Live videos started on June 23, 2020. Prior Public Health Update videos on YouTube were exported videos recorded through Facebook Live. In July 2021, YouTube Live broadcasts were scaled down to Fridays only from a Monday, Wednesday, and Friday rotation. In September 2021, media briefings were increased to Monday, Wednesdays and Fridays and streamed live. On September 20, 2021, media briefings were recorded and then posted to YouTube.

4. Website analytics are provided by Site improve. The metric provided is for page views to wechu.org. Previously, we were reporting on the local-updates webpage only.

6. Email subscribers are those individuals who signed up to receive promotional emails from the Windsor-Essex County Health Unit. The analytics are provided through Mailchimp.

7. Social media metrics are provided through Hootsuite.

8. Graphs and media exposure information in this report were generated using Meltwater Media Monitoring Solution. News stories may be duplicates or missing as the platform is currently being optimized to better track Windsor-Essex County Health Unit mentions in the media landscape.

ISSUE

On Thursday October 28, 2021, Chief Medical Officer of Health Dr. Kieran Moore indicated during a news briefing that the Province of Ontario would not be adding COVID-19 to the list of nine diseases that public school students must be immunized against.

Currently, there is no requirement for eligible students to provide proof of vaccination against COVID-19 for school attendance. Schools are a high-risk setting for COVID-19 and other communicable diseases as they bring together large numbers of individuals for long and extended periods of time increasing the likelihood transmission of certain diseases. As of November 15th, there have been more than 450 cohorts of students dismissed through schools and daycares due to COVID-19 exposure. The Immunization of School Pupils Act (Ministry of Health, 2021)requires that children and youth attending school be immunized against designated diseases, unless they have a valid exemption. The addition of COVID-19 as a ”designated disease” within the Immunization of School Pupils Act would support a number of important public health priorities including:

• Increased uptake of the vaccine, providing protection for those who are too young or medically unable to be vaccinated in school communities and beyond. This will result in a safer learning environment for students, staff, their families and the broader community.
• A systematic framework for parental vaccine education. 

BACKGROUND

Vaccines are the safest and most efficient way to guard against communicable diseases and prevent outbreaks. The Immunization of School Pupils Act (ISPA) R.S.O. 1990 (Ministry of Health, 2021) requires that specified vaccines to be given for a child to attend school in Ontario making sure that all school aged children are protected from vaccine preventable diseases. Currently under the ISPA, students must be immunized against measles, mumps, rubella, diphtheria, tetanus, meningococcal, varicella and polio, or have a valid Medical, or Conscience or Religious Belief exemption on file at the Health Unit. There is no cost for vaccines covered by the publicly funded immunization program in Ontario.

MOTION

Whereas available COVID-19 vaccines have been approved by Health Canada to be safe and effective for students born in 2009 or earlier; and

Whereas additional approval by Health Canada to vaccinate individuals born after 2009 with COVID-19 vaccine is anticipated by the end of 2021; and

Whereas the COVID-19 pandemic is a global pandemic;

Whereas the Windsor-Essex region has been disproportionately affected by the COVID-19 pandemic; and

Whereas the Windsor-Essex region has lower rates of vaccination against COVID-19 particularly among eligible children and youth; and

Whereas the purpose of the Immunization of School Pupils Act is to increase the protection of the health of children against the diseases that are designated diseases; and

Whereas the IPSA requires that students be immunized for “designated diseases”: diphtheria, measles, mumps, poliomyelitis, rubella, and tetanus, unless a specific exemption is sought through the act.

Now therefore be it resolved that the Windsor-Essex County Board of Health recommends that the Province of Ontario amend the Immunization of School Pupils Act to include COVID-19 as a “designated disease”.

References:

Ministry of Health. (2021, April 19). Immunization of School Pupils Act, R.S.O. 1990, c. | .1. Retrieved from Government of Ontario Laws: ontario.ca/laws/statute/90i01

ISSUE

The Windsor-Essex County Health Unit (WECHU) requires the Board of Health to approve the annual operating budget, as this budget forms the basis of the Annual Service Plan and Budget Submission to the Ministry of Health (MOH).

BACKGROUND

The WECHU is a publicly funded organization; as such, the WECHU has a responsibility to spend funds prudently with the objective of providing public health programs and services as required by the Health Protection and Promotion Act (HPPA) and the Ontario Public Health Standards:  Requirements for Programs, Services, and Accountability (OPHS).

The WECHU receives funding in the following manner:

• The Province of Ontario, more specifically the Ministry of Health, annually grants the WECHU funding to a maximum of 70% of admissible expenditures for its Mandatory Program.  In addition, the WECHU receives required contributions for the Corporation of the City of Windsor, The Corporation of the County of Essex, and the Corporation of the Township of Pelee (hereinafter collectively referred to as the Obligated Municipalities) at a minimum of 30% of admissible expenditures.
• The Ministry of Health annually provide grants for certain related health protection and promotion programs at a rate of 100% of admissible expenditures.  More specifically this includes the Ontario Seniors Dental Care Program and the AMOH/MOH Compensation Initiative.
• The Ministry of Children, Community and Social Services (MCCSS) provides annual grants to fund the Healthy Babies Healthy Children Program Initiative and the Nurse Practitioner Program Initiative at a rate of 100% of admissible expenditures.

On an annual basis, the WECHU prepares its operating budgets for review and approval by the Board of Health.  This budget approval than becomes the foundation of the Annual Service Plan and Budget Submissions to the Ministry of Health.  The due date for the 2022 Annual Service Plan and Budget Submission to the Ministry of Health is tentatively set for March of 2022. 

The operating budgets for programs funded by MCCSS will be reported to the Board of Health in a separate report in March of 2022.

Mandatory Program

The Mandatory Program budget supports 151.98 FTEs, more specifically:

• Leadership Team 6.75 FTEs
• Management Team 9.60 FTEs
• Coordinators 5.75 FTEs
• Administrative support staff (all departments) 25 FTEs
• Communications staff 4.0 FTEs
• Oral health staff 13.50 FTEs
• Nursing staff (all) 32.50 FTEs
• Enforcement staff (Public health inspectors and Tobacco and Vaping Enforcement officers) 22 FTEs
• Corporate services staff including Human Resources 13 FTEs
• Health promotion and mental health specialists 14.88 FTEs
• Other program staff 5.00 FTEs

The following represents a summary of changes in the 2022 Mandatory Program budget compared to 2021:

• Salaries and employee benefits decreased $876,716.  In 2022, the Mandatory Program budget supported 152.23 FTEs as compared to 164.50 FTEs in 2021.  In 2022, additional human resource capacity was shifted from Mandatory Programs to support the COVID-19 activities and recovery activities.
• Increase in other operating costs of $34,499.  The most notable changes are as follows:
  • A decrease in office equipment rental of $19,000 due to the decline in rental fees in the latter part of the agreement. 
  • A net decrease in professional fees of $34,100, namely legal fees.
  • An increase in purchased services of $161,358. The WECHU will employ third party consultants/services to support the Corporate Services division, namely in the areas of Finance and Facilities.  From a Facilities perspective, these services will be focused on the Windsor Facility Project. 
  • A decrease in building occupancy costs of $99,514.  In 2022, the WECHU will only lease two (2) office facilities (Windsor and Leamington), as compared to three (3) in 2021 (Windsor, Essex and Leamington).

Vector-Borne Diseases Programs

Included within the Mandatory Program budget are costs associated with the Vector-Borne Diseases Program (VBD).

The VBD Program is further divided into three sub-programs, the West Nile Virus Program, the Enhanced Mosquito Surveillance Program and the Tick-Borne Disease Program.

In totality, these programs support the salaries and benefits of five (5.0) public health inspection student FTEs and one-half (0.5) of a public health inspector FTE.

COVID-19 Program

The COVID-19 Program budget includes activities to support the response to COVID-19 pandemic in Windsor and Essex County including vaccination efforts. This budget supports 62.04 FTEs, more specifically:

• Leadership Team 1.00 FTE
• Management Team 7.00 FTEs
• Coordinators, including Performance Improvement and Accountability Specialists 1.25 FTEs
• Administrative support staff (all departments) 4.50 FTEs
• Communications staff 1.00 FTEs
• Nursing staff (all) 34.50 FTEs
• Enforcement staff (Public health inspectors and Tobacco and Vaping Enforcement officers) 7.00 FTEs
• Corporate services staff 1.25 FTEs
• Other program staff 4.54 FTEs

The COVID-19 Program budget has decreased $3,245,937 over 2021 primarily due to the following:

• Decrease in salaries and employee benefits of $1,971,404.
• Decrease in operating expenditures of $1,274,533.  This is attributed to:
  • Decrease in Mileage of $125,448.  The 2021 COVID-19 Program budget contemplated additional mileage costs associated with multiple mass vaccination sites operating throughout Windsor and Essex County.  In 2022, only one mass vaccination site will be in operation supplemented by mobile vaccination events.
  • Decrease in Program supplies of $441,670.  The 2021 COVID-19 Program budget contemplated expenditures on such items as personal protective equipment (PPE), information equipment and medical supplies.  In 2021, vaccine administration supplies including PPE were provided by the MOH with vaccine deliveries.  Additionally, iPads, and other information technology accessories, were provided to public health units to support mass vaccination centres and other related efforts.  Nominal expenditures associated with Program supplies are anticipated for 2022.
  • Decrease in Purchased services of $703,415. In 2021, the WECHU employed a third party provider to support case and contact management ($549,504).  This support is not anticipated to continue in 2022. 

The WECHU will include the COVID-19 Program budget as a one-time request for funding from the MOH.

Recovery

The Recovery Program budget includes activities related to recovery from the COVID-19 pandemic in the community of Windsor and Essex County as well as catch-up efforts.  This budget supports 22.73 FTEs, more specifically:

• Management Team 1.40 FTEs
• Coordinators, including Performance Improvement and Accountability Specialists 2.50 FTEs
• Administrative support staff (all departments) 0.50 FTEs
• Communications staff 1.00 FTEs
• Nursing staff (all) 9.50 FTEs
• Corporate services staff 1.00 FTEs
• Epidemiology and evaluation staff 5.00 FTEs
• Other program staff 1.83 FTEs

The WECHU will include the Recovery Program budget as a one-time request for funding from the MOH.

Ontario Seniors Dental Care Program

The Ontario Seniors Dental Care Program (OSDCP) supports eleven and one-half (16.5) FTEs comprised of one and one-half (1.5) manager FTEs; one and one-half (1.5) dentist FTEs, one (1.0) denturist FTE, five (5) dental assistant FTEs, four (4) dental hygienist FTEs, one (1.0) health promotion specialist FTE, and two and one-half (2.5) support staff FTEs.  The ODSCP expenditure budget is funded in its entirety by the MOH.

The OSDCP budget has increased $706,678 over 2021 primarily due to the following:

• Increase in salaries and employee benefits of $547,050. This is attributed to the following:
  • one (1) denturist FTE ($121,845)
  • two (1) dental assistant FTEs ($174,760)
  • one (1) dental hygienist FTE ($97,138)
  • one-half (0.5) health promotion specialist FTE ($53,903)
  • one-half (0.5) support staff FTE ($36,487)
  • other salaries and benefits increases ($62,917)
• Increase in operating expenditures of $159,628.  This is primarily attributed to an increase in professional services of $150,000.

FUNDING

Administration has arrived at three funding scenarios for consideration by the Board of Health. The purpose of these scenarios is to define the financial risk to the WECHU and the Obligated Municipalities for the 2022 Budget, if additional funding is not available for COVID-19 related expenditures or to support recovery efforts.

SCENARIO 1

Under scenario 1, the Mandatory funding approval from the MOH for 2022 would be $16,301,232.  It anticipates a two (2) percent increase in the 2021 funding approval of $15,981,600.  Additionally, this scenario contemplates the opportunity for one-time funding for costs in excess of the Mandatory funding approval, funded at a rate of one hundred (100) percent.  Total contributions from the Obligated Municipalities for 2022 would be $6,986,242 (Table 1).  These contributions do not contemplate the Mitigation funding approval for 2022 in the amount of $1,260,800.  Such Mitigation funding will be apportioned to the Obligated Municipalities during the 2022 settlement process, if eligibility requirements have been met.

Table 2 below summarizes total funding compared to total budgeted expenditures for all programs except OSDCP, as this program is funded entirely by the MOH.

SCENARIO 2

Under scenario 2, total contributions from the Obligated Municipalities for 2022 would be $8,664,410 or 30% of total 2022 expenditures as noted in table 2 above of $28,881,369.  Similar to Scenario 1, contributions do not contemplate the Mitigation funding approval for 2022 in the amount of $1,260,800.  Such Mitigation funding will be apportioned to the Obligated Municipalities during the 2022 settlement process, if eligibility requirements have been met.

SCENARIO 3

Under scenario 3, total contributions from the Obligated Municipalities for 2022 would be $12,580,137. This represents the Obligated Municipalities 30% share of the Mandatory program funding plus 100% of costs in excess of the Mandatory program budget.  Similar to Scenarios 1 and 2, contributions do not contemplate the Mitigation funding approval for 2022 in the amount of $1,260,800.  Such Mitigation funding will be apportioned to the Obligated Municipalities during the 2022 settlement process, if eligibility requirements have been met.

RISK ASSESSMENT

The inherent risk associated with the budget process is other than low, due to the number of factors:

• Mandatory Funding approval from the MOH.  A risk exists that the Mandatory funding approval for 2022 will be greater than or less than 2021 approval of $15,981,600.  If less, the Obligated Municipalities will be required to increase their contributions to fund programs and services in excess of the required 30%.  If greater, Obligated Municipalities will be required to increase their contributions to bring their funded portion of the WECHU’s budget to 30%.  Should Obligated Municipalities not increase their contributions in response to changes in funding by the MOH, the WECHU would be required to curtail programs and services.
• One-time Funding approval from the MOH.  A risk exists that the MOH will not provide on-going financial support to public health units for expenditures incurred on account of COVID-19 response, including vaccination.  In addition, there is a risk that the MOH will not provide financial support to public health units for program restart and program development as we enter Recovery.
• The future state of the COVID-19 pandemic continues to be the most substantial risk impacting public health.  The question of whether the COVID-19 pandemic will transition from a pandemic to an endemic disease state in 2022, remains unknown.
• Costs associated with capital projects.  Except for project management costs, no other costs associated with the capital project have been contemplated in the 2022 budget.  Administration will investigate capital funding opportunities through the Health Capital Investment Branch of the MOH to mitigate the WECHU’s exposure to this financial risk.
• Other operating costs.  In arriving at budgeted operating costs, Administration attempted to factor in the impact of external pressures, such as inflation and market pressures.  Administration will mitigate these risks by ensuring appropriate procurement processes and procedures have been followed.  Additionally, the WECHU will actively monitor budget to actual financial results and implement mitigation strategies when required.

MOTION

Whereas, the Windsor-Essex County Health Unit receives grants annually from the Ministry of Health to a maximum of 70% of admissible expenditures associated with the Mandatory Program.  In addition, the WECHU receives required contributions from the Obligated Municipalities at a minimum of 30% of admissible expenditures, and

Whereas the Ministry of Health annually provides grants for certain related health protection and promotion programs at a rate of 100% of admissible expenditures,

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the 2022 Mandatory Program budget, requiring $16,301,232 in base funding from the Ministry of Health and $6,986,242 in contributions from the Obligated Municipalities, the Corporation of the City of Windsor, the Corporation of the County of Essex and the Corporation of the Township of Pelee, be approved.

FURTHER THAT the Windsor-Essex County Board of Health approve the 2022 Mandatory Program budget with total expenditures of $20,261,732 and offset revenue of $147,724, and

FURTHER THAT the Windsor-Essex County Board of Health approve the 2022 COVID-19 Program budget with total expenditures of $6,289,784, and

FURTHER THAT the Windsor-Essex County Board of Health approve the 2022 Recovery Program budget with total expenditures of $2,329,853, and

FURTHER THAT the Windsor-Essex County Board of Health apply for one-time funding for costs in excess of the Mandatory funding approval, funded at a rate of one hundred (100) percent in the amount of $5,593,895 associated with the 2022 COVID-19 Program budget and the 2022 Recovery Program budget.