Board of Health Meeting Documents

DATE:

June 2021

SUBJECT:

COVID-19 Vaccine Rollout in Windsor and Essex County

BACKGROUND

The Windsor-Essex County Health Unit (WECHU) was mandated to lead the COVID-19 vaccine rollout in Windsor-Essex County (WEC). The projected population of eligible individuals for vaccination in WEC in 2021 is 438,001. In order to achieve a 75% threshold coverage rate, approximately 328,501 individuals must be immunized. Based on the two-dose vaccine requirement to complete the COVID-19 vaccine series, this equates to 657,002 doses that will need to be administered. In January of 2021, the WECHU developed a three-stage plan to support the provincial rollout of COVID-19 vaccine in our community.

In April 2021, the provincial government identified seven postal codes in WEC as COVID-19 "hot spots" that were prioritized for phase 2 of Ontario's Vaccine Distribution Plan. Hot spots are categorized as having historic and ongoing high rates of death, hospitalization and transmission of the COVID-19 disease. 

In WEC, the identified areas include: 

• N8X – South Central Windsor
• N8Y – Walkerville and East Windsor area
• N9A – Downtown Windsor
• N9B – Sandwich Towne and University of Windsor area 
• N9C – Sandwich Towne
• N8H – Leamington area
• N9Y – Kingsville area

As of June 4, 2021, 253,255 (71.7%) WEC adults 18 years or older received at least 1 dose of a vaccine.

CURRENT INITIATIVES

Mass Immunization Clinics

In order to administer the COVID-19 vaccine to a larger proportion of individuals quickly there are 6 mass vaccination clinics supported full time across WEC, three of which are located in “hot spot” postal code areas. These sites are being supported by our municipal partners in both the City and County. In addition, Windsor Regional Hospital (WRH) continues to operate 2 sites. Daily client volumes range between 400 – 1000 and collectively 202,922 individuals have been immunized at one of the 6 clinics (184,767 with first doses, 18,155 with second doses). The mass immunization clinic model was the primary method to support the vaccination of approximately 6,000 temporary foreign workers (TFW) in April and early May and is currently the primary support for youth vaccinations (12-17 years old).

Pop Up Clinics

Pop up vaccination clinics are defined as clinics in the community that target a specific location with the objective of reducing barriers to access, with a time limited operational period. The WECHU has supported 9 single day pop up clinics in various WEC locations targeting specific hot spot communities and high risk populations, youth, and the urban Indigenous community. Pop up clinics have ranged between 400 and 800 individuals in a single day.

Mobile Strategy – Mobile Teams and Delivery

Mobile teams and delivery strategies operate with the objective of reaching a specific targeted priority population, usually in one day, with lists of individuals identified beforehand. WECHU staff, and partner groups including the CRST team, travel to pre-existing sites (some without pre-existing infrastructure) to provide vaccine to designated target populations. The WECHU began leading the first mobile strategy on January 1, 2021 targeting Long Term Care Homes (19) followed by registered Retirement Homes (24). All of these facilities have received both first and second doses for the majority of interested/eligible staff and residents. Maintenance plans to vaccinate new residents and staff on an ongoing basis are being implemented.

Additional mobile strategies have supported 24 locations, primarily high-risk congregate living facilities including:

• The Southwest Detention Centre
• Assisted living facilities
• Private retirement homes
• Lodging and boarding homes
• Supportive housing for at risk populations
• Community Living Windsor and Community Living Essex County locations

In addition, with coordination support from Home and Community Care Services, the WECHU has provided direct immunization support to approximately 200 registered homebound individuals. The WECHU has also provided support for non-registered homebound individuals through collaborations with primary care and the provision of direct client service (as required).

Pharmacy Rollout

WEC was designated as a pilot site for the vaccine rollout of AstraZeneca and 47 pharmacies have collectively administered over 37 000 doses to WEC residents over the age of 40 years.

Currently, 65 pharmacies are providing Pfizer-BioNTech or Moderna vaccines (first doses and second doses) throughout Windsor and Essex County (WEC); as well, 30 pharmacies are providing AstraZeneca 2nd doses throughout WEC. Local pharmacies are actively recruiting and vaccinating individuals aged 12 and older (for those with Pfizer-BioNTech allocations). For those with Moderna allocations, they are actively recruiting and vaccinating individuals 18 years and older. Pharmacies providing Pfizer-BioNTech or Moderna vaccines are also providing second doses to those 70 years of age or older.

Pharmacies who participated in the early pilot project began administering second doses of AstraZeneca to individuals who received their first dose of the AstraZeneca COVID-19 vaccine between March 10th and March 19th. As of June 3, 2021, 5,369 second doses of AstraZeneca have been administered to eligible individuals. The Ministry of Health will be providing 19,300 additional AstraZeneca doses to WEC pharmacies over the coming weeks.  

Health Care Provider Rollout

Starting as an early adopter of the health care provider rollout model, the WECHU engaged 8 primary care partners and locations in a pilot project using the Moderna vaccine in March/April. The pilot project involved strategic partnerships with local Family Health Teams, the Windsor-Essex Community Health Centre (multiple locations), and Nurse Practitioner Led Clinics in WEC.

In addition to the pilot project participants, the WECHU has on-boarded 46 physicians’ offices to administer both the Pfizer-BioNTech and the Moderna vaccines (based on available supply) to rostered patients in their offices and/or to the general public through physician-led clinics. As of June 2, 2021, 14,611 vaccinations had occurred through a physician-led office or clinic – this represents the 6th highest amount in the Province of Ontario. The WECHU continues to onboard new health care providers to the COVID-19 vaccination rollout on a weekly basis.

DATE:

June 2021

SUBJECT:

Recruitment through the COVID-19 Pandemic

BACKGROUND

This report will outline recruitment for the Windsor-Essex County Health Unit throughout the ever-changing COVID-19 Pandemic. The needs of the community required additional staff across the entire Windsor-Essex County Health Unit organization.

CURRENT INITIATIVES

The below information will provide a snapshot of the Windsor-Essex County Health Unit’s staffing numbers in March 2020 and current day information.

As the WECHU moved through the pandemic, there has been increased staffing throughout Non-Union and Management, CUPE and ONA positions.

WECHU has recruited approximately 118 new WECHU staff members between the time periods of March 1, 2020 to June 1, 2021. In addition to this group of individuals WECHU has also organized over 100 volunteer staff members (paid and non-paid positions) to assist with the COVID-19 vaccine clinics. Furthermore WECHU’s recruitment efforts have been supported by the Ministry of Health who hired a consultant, Ian Martin, to bring on over 40 Case Managers and Case and Contact tracing staff to assist with the large volume of COVID-19 cases in the Windsor-Essex area. WECHU has also hired a number of independent consultants to assist with the vaccine clinics. In addition, the WECHU received external assistance from other health units in Summer 2020 due to decreased capacity and increased cases. 

At the end of February 2020, the Windsor-Essex County Health Unit had approximately 230 total staff members in the organization. As of June 1, 2021, there are approximately 320 total staff members representing an increase of 39.13%. At this time, ongoing recruitment continues which will increase the total overall number of WECHU staff.  

• Non-Union/Management group had approximately 40 staff at the beginning of March 2020 and saw an increase of 47.5% in staffing by June 1, 2021 with a total of 59 permanent and contract employees.
• CUPE group had approximately 123 staff at the beginning of March 2020 and saw an increase of 15.45% in staffing by June 1, 2021 with a total of 142 permanent and contract CUPE members.
• ONA group had approximately 82 staff at the beginning of March 2020 and saw an increase of 48.78% in staffing by June 1, 2021 with a total of 122 permanent and contract ONA members. WECHU continues to onboard a number of new graduate nurses which will add to this overall total of contract ONA members.

Overall, the Windsor-Essex County Health Unit’s staffing during the COVID-19 pandemic has been greatly increased due to community needs. The Windsor-Essex County Health Unit has been able to support the community with the increase of staff amongst case and contact management, COVID-19 vaccine roll-out, and the reopening of schools throughout the year. The staff of the Windsor-Essex County Health Unit have been able to adapt and pivot into new programs and services throughout the last 15 months in order to ensure that the residents of Windsor-Essex were able to access the education and resources required throughout the pandemic. The Windsor-Essex County Health Unit has strived to continue other programs that provide resources and services to the community outside of COVID-19.

DATE:

June 2021

SUBJECT:

Temporary Foreign Workers COVID-19 Vaccination Strategy

BACKGROUND

The agri-food sector in Windsor and Essex County has been impacted greatly by the COVID-19 pandemic. The congregate living arrangements that exist for many Temporary Foreign Workers (TFWs), similar to other congregate settings, create challenges for adhering to public health recommendations such as physical distancing and increase the risk for spread of COVID-19.  There are estimated to be between 8,000 -10,000 TFWs working and living in Windsor-Essex, majority in the Leamington and Kingsville area. There are approximately 255 farms operating in Windsor and Essex County with well over 1500 accommodations that are inspected annually by the health unit.  In 2020, there were nearly 50 COVID-19 outbreaks in agriculture settings.

In April 2021, the Ministry of Health released their Phase 2 guidance document for the prioritization of COVID-19 vaccination. Within the phase 2 guidance document, high risk congregate living settings were identified as a priority for vaccination including employer-provided living accommodations for temporary foreign agricultural workers.  

Current Initiatives

Between April 18 and May 6th, 2021, vaccine appointments were reserved for TFWs at the Nature Fresh Recreation Centre vaccination clinic in Leamington. During the 13 days of targeted clinics, 4,768 workers were scheduled for their first dose vaccination across 132 area farms.  As well the WECHU hosted two pop-up clinics the evening of May 20th and 21st in downtown Leamington providing additional opportunities to both documented and undocumented workers to be vaccinated. To date over 5200 temporary foreign workers in the region have received their first dose of COVID-19 vaccine. To achieve this the WECHU worked closely with partners at the Municipality of Leamington and partners of the Workplace Wellness for Agri-Food Workers Task Force to develop a comprehensive outreach and communication plan.  

Health Promotion Resources and outreach:

In order to promote COVID-19 vaccination, educate workplaces and workers and register temporary foreign workers for vaccination multiple health promotion strategies were used. The WECHU sent out an information memo to all farms via MailChimp that included vaccination information for employees and a link to a dedicated vaccine information page for temporary foreign workers (https://www.wechu.org/cv/covid-19-vaccine-information-temporary-foreign-workers). The website includes resources for workers developed by partnering organizations, Health Canada, the Ministry of Health and the WECHU and covers common vaccine concerns, myths and facts, accessibility, after care and frequently asked questions. Resources are available in multiple languages for viewing both in print and video. Resources were shared through the HUB Connect App, WhatsApp Groups, and social media. Health education videos in multiple languages were also shared and displayed at the vaccination site through TV monitors on site.

For mobile clinics the WECHU worked with key partners from the Workplace Wellness for Agri-Food Workers Task Force to identify outreach strategies, locations and timing of mobile clinics. Mobile clinics were supported on site with WECHU staff, staff from Essex-Windsor EMS and Erie Shores Health Care and staff and volunteers from the Migrant Worker Community Program.

Registration and Clinic logistics:

The WECHU created a dedicated pre-registration pathway for all farms with temporary foreign workers as well as a dedicated email for questions and inquiries. Farm operators were asked to identify the number of workers that were interested in receiving their vaccination, as well as provide information on mode of transportation to the site, cohorts and languages spoken by workers. The WECHU booked farms in blocks of time to ensure workers remained in their appropriate cohort.

Before vaccination day for each farm, the WECHU met with each farm operator to go over logistics for the day, including ensuring all workers had appropriate ID, completed consent (in their preferred language), FAQ documents and transportation arrangements.

On-site the WECHU utilized WE Speak centralized interpretation services to support on demand video interpretation at registration tables and within the vaccination clinic. Additionally the WECHU had support from local partners for in-person interpretation to ensure that individuals received care that was accessible and culturally appropriate. 

Farm Experience Evaluation

In order to better understand the effectiveness of this strategy, a feedback evaluation survey was sent to all farms at the end of the 3-week blitz.  There were 57 completed surveys, and the findings are as follows:

• Vaccination Registration Process:
  • 80% received the initial registration email in a timely manner
  • 70% Agreed that the WECHU provided them with the resources they needed to help the worker make an informed choice
  • 71% felt supported during the registration process
• Communication:
  • The following communication methods were rated as being very helpful and helpful:
    • Email – 93%
      WECHU Vaccine Webpage for TFWs* - 75% *Google Analytics report showed 1164 visits to the dedicated webpage, from 836 unique users during the 3-week time period (April 18 - May 6)
    • Phone call/Video meeting – 63%
    • Vaccine day logistics checklist – 73%
• Vaccination Day Logistics:
  • 80% of respondents felt their workers were well supported at the vaccination clinic
  • 75% said the vaccination clinic was well organized and our workers were able to flow through the process without issue (arrival, registration, vaccination, waiting and exiting).
• Feedback
  • Positive
    • Well organized
    • Process was quick at the vaccination centre
    • Very thankful
  • Suggestions for Improvement
    • Reduction in the number of spread sheets required
    • Increased flexibility with scheduling appointments
    • More information sharing directly with the workers
• Successes and Challenges
  • Successes
    • High uptake by farms
    • Well established clinic location
    • Safely and efficiently immunized several thousand TFWs
    • Excellent partnerships from community agencies
    • COVax information uploaded ahead of time helped make day-of registration fast
    • “What to Expect on Vaccination Day” information and consent forms provided ahead of time and in multiple languages helped to reduce day-of questions
  • Challenges
    • Complicated registration system – multiple forms and emails
    • Farms having to coordinate group transportation that kept work cohorts separated
    • Tight timelines for all tasks
    • Resource intensive for everyone involved (WECHU, Farms, Partners)
    • Translations required in multiple languages for every resource
    • Addressing vaccine hesitancy amongst workers and farm owners

Overall, the targeted clinics for Windsor-Essex TFWs were well received and highly successful.  The partnership between the municipality of Leamington, the farm owner/operators, several community organizations and the WECHU was a critical component of the process.

Future Plans

Moving forward, there will be ongoing promotion of the community vaccine clinics to late adopters and newly arriving workers who did not accept airport vaccination. Targeted “pop-up” clinics have been held on off hours in evenings to address access and hesitancy issues. There will also be continued engagement with our community partners to ensure that every worker who would like a vaccine is able to receive one.

Agencies who provided direct support to this vaccine project include:

• Municipality of Leamington
• C.A.R.E for International Workers (made up of 9 different organizations)
• Migrant Worker Community Program
• Consulate of Mexico in Leamington
• Occupational Health Clinics for Ontario Workers Inc. (OHCOW)
• Ontario Greenhouse Vegetable Growers (OGVG)
• Ontario Fruit and Vegetable Growers Association (OFVGA)
• Windsor-Essex Local Immigration Partnership (WE-LIP)
• Erie St. Clair LHIN
• The Neighbourhood Organization (TNO)
• Ontario Provincial Police
• Workplace Wellness for Agri-Food Workers Task Force

Reference:

1. National Collaborating Centre for Methods and Tools. (2020). Rapid Review: What factors increase the risk of COVID-19 outbreaks in congregate living settings? How do outcomes compare to outbreaks in community settings? https://www.nccmt.ca/knowledgerepositories/covid-19-rapid-evidence-service

Board Members Present:

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

Border Member Regrets:

Larry Snively

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Lorie Gregg, Nicole Dupuis, Felicia Lawal, Kristy McBeth, Dan Sibley, Lee Anne Damphouse

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

ISSUE

In October 2018, after a provincial review of existing Supervised Consumption Services (SCS) and Overdose Prevention Sites (OPS), the Government of Ontario announced its commitment to fund a re-purposed version of the Consumption and Treatments Services (CTS) Program. Consumption and Treatment Services sites provide wrap-around services that connect clients who use drugs to primary care, treatment, and other health and social services; including:

• Supervised consumption and overdose prevention services,
• Onsite or defined pathways to addictions treatment services,
• Onsite or defined pathways to wrap-around services, and
• Harm reduction services.

Opioid overdose and opioid related mortality has risen dramatically during the pandemic. Opioid overdose has risen considerably each year in Windsor-Essex from 197 in 2017 to 350 in 2020. As well, in 2020 Windsor-Essex saw the highest number of opioid related deaths since 2007. Of the deaths in 2020 (Jan-Sept), 97.9% were identified as accidental and 52.2% of those individuals were alone at the time of death.

BACKGROUND

In September of 2019, the WECHU Board of Health passed a resolution supporting the submission of a Consumption and Treatment Services (CTS) application for a site in the City of Windsor. The submission for a proposed site will be made to the Ministry of Health, including the submission of an Exemption for Medical Purposes under the Controlled Drugs and Substances Act for Activities at a Supervised Consumption Site Application required by Health Canada. 

In order to facilitate the site location process required for the application, a CTS Stakeholder Advisory Committee was established and site criteria determined, complimenting the mandatory requirements under the federal and provincial processes:

• Site must be 200m from a sensitive land use (e.g. parks, daycare centers, and schools) as well as 600m from other CTS sites OR If  located within 200m of a sensitive land use, application must include plans on how to address community concerns
• Site must be easily accessible by public transit
• Site must be within walking distance to areas known to be frequented by people who use drugs
• Space should be greater than 590ft2 (for six consumption booths) or 385ft2 (for three booths)

To complete the application process, a location and a comprehensive community consultation on the site are required. The WECHU has identified two potential sites for a CTS within the Downtown area of Windsor, prioritized through the Supervised Injection Services Community Consultations Report. The two sites are located at:

• 101 Wyandotte Street East, Windsor
• 628 Goyeau Street, Windsor

Each site was reviewed using a matrix scoring tool. Crime Prevention Through Environmental Design (CPTED) audits were completed on both sites by Windsor Police Services (WPS). The WECHU, with support from the CTS advisory committee is currently engaged in the consultation process on both sites. Consultation will follow similar processes and models conducted in other regions such as Barrie, Waterloo, Toronto. The consultation includes the following:

• Key informant interviews with stakeholders and businesses in proximity to the proposed sites,
• Focus groups with key stakeholder groups such as outreach workers, people with lived experience, and neighbourhood groups,
• An online community survey, and
• Live town halls held virtually, with special invitation to workplaces and residents within 300 metres of the each location.

PROPOSED MOTION

Whereas, Opioid overdose and opioid related mortality has been declared a public health crisis, and

Whereas, Opioid overdose and opioid related mortality is at an all time high in Windsor-Essex, and

Whereas, Consumption and Treatment Services have the potential to address opioid overdose and opioid related mortality, and

Whereas, the WECHU is required to submit an application for a CTS that includes a site location and an accompanying community consultation, and

Whereas, the CTS advisory committee has identified two potential sites and has engaged in the community consultation on the proposed sites

Now therefore be it resolved that the Windsor-Essex County Board of Health support the WECHU administration to finalize a site for the CTS, pending no concerns, based on the outcome of the community consultation, and

FURTHER THAT, the Board of Health support administration to continue with the next steps of the consultation process which includes seeking City of Windsor council approval for the proposed site, and

FURTHER THAT, administration enter into an agreement with the proposed landlord to secure the site for submission of an application.

DATE:

June 2021

SUBJECT:

CEO Transition

ISSUE

Theresa Marentette will officially retire from her role as Chief Executive Officer and Chief Nursing Officer of the Windsor-Essex County Health Unit effective June 30, 2021.

Upon Theresa Marentette’s departure, Nicole Dupuis, Director of Health Promotion, will transition to the position of Chief Executive Officer, effective July 1, 2021. In this role, Nicole Dupuis will have a direct reporting line to the Board of Health and have the ability to bind the Board of Health. 

PROPOSED MOTION

Whereas, that the Board of Health approve the appointment of Nicole Dupuis as Chief Executive Officer of the Windsor-Essex County Health Unit, effective July 1, 2021, with a direct reporting line to, and ability to bind, the Windsor-Essex County Board of Health.

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the CEO Transition to Nicole Dupuis take place effective July 1, 2021 as presented by Administration.

Meeting held via video.

DATE:

May 2021

SUBJECT: 

Beach Water Sampling

BACKGROUND

The Windsor-Essex County Health Unit conducts beach water sampling in accordance with Recreational Water Protocol, 2019 and following the Operational Approaches for Recreational Water Guideline, 2018. The 2020 season of beach water sampling was deferred prior to the season start due to reallocation of Environmental Health Department resources to respond to the COVID-19 pandemic. Beach Water Sampling will resume for the 2021 season. The Environmental Health Department conducts water sampling of all nine (9) public beaches in Windsor and Essex County from June to September. Public beaches that are part of the beach water quality monitoring program include: Cedar Beach; Cedar Island Beach; Colchester Beach; Holiday Beach; Mettawas Beach; Point Pelee North West Beach; Sandpoint Beach; Seacliff Beach; West Belle River Beach. Each week, bacteriological samples are collected across the beach front and tested for Escherichia coli (E. coli). E.Coli exposure can lead to severe stomach cramps, diarrhea, fever and vomiting. Water conditions, weather, and potential pollutants are also monitored and documented by Public Health Inspectors as these factors, among others, impact water sampling results.

CURRENT INITIATIVES

Pre-season Public Beach Assessments will be completed in early June, and beach assessments and sampling will be conducted weekly afterwards and continue until the season end in mid-September. All beach assessments and sampling will be done by 2 PHIs on Monday’s (or Tuesdays if Monday is a holiday).

Beaches with bacteria counts that exceed 1000 E. coli per 100 mLs will be posted with a sign indicating the beach is closed after the initial sampling, and re-sampled on Thursday to permit for re-opening of public beaches before the weekend if satisfactory results were returned. Beaches with bacteria counts exceeding 200 E.Coli per 100 mLs (but less than 1000 E. Coli per 100 mLs) will be posted with a warning sign, but will remain open and not be resampled.

The Environmental Health Department will update the Beach Hotline (519-258-2146 ext. H2O) and the Interactive Beach Map located on the Windsor-Essex County Health Unit website https://www.wechu.org/your-environment/beaches-pools-and-spas/beaches throughout the season once routine weekly sampling begins.  In addition, community agencies are emailed the results.

DATE:

May 2021

SUBJECT: 

Consumption and Treatment Services Site – Update 

BACKGROUND

In September of 2019, the WECHU Board of Health passed a resolution supporting the submission of a Consumption and Treatment Services (CTS) application for a site in the City of Windsor. Submission for a proposed site would be made to the Ministry of Health, including the submission of an Exemption for Medical Purposes under the Controlled Drugs and Substances Act for Activities at a Supervised Consumption Site Application required by Health and Canada. 

In Ontario, Consumption and Treatment Services sites provide wrap-around services that connect clients who use drugs to primary care, treatment, and other health and social services, including:

• Supervised consumption and overdose prevention services,
• Onsite or defined pathways to addictions treatment services,
• Onsite or defined pathways to wrap-around services, and
• Harm reduction services.

To complete the application process, the WECHU must identify a location and complete a comprehensive community consultation. In order to facilitate this process, a CTS Stakeholder Advisory Committee was established and site criteria estblished, complimenting the mandotory requriements under the federal and provinical processes:

• Site must be 200m from a sensitive land use (e.g. parks, daycare centers, and schools) as well as 600m from other CTS sites OR If  located within 200m of a sensitive land use, application must include plans on how to address community concerns
• Site must be easily accessible by public transit
• Site must be within walking distance to areas known to be frequented by people who use drugs
• Space should be greater than 590ft2 (for six consumption booths) or 385ft2 (for three booths)

In the fall of 2020, using these criteria, and in consultation with the WECHU legal representation and procurement procedures, the WECHU issued a Request for Expressions of Interest (RFEOI) through the MERX Online Public Tenders solicitation database for interested landlords and property owners. No submissions were received. The WECHU issued a second Request for Expressions of Interest (RFEOI) through the MERX Online Public Tenders solicitation database for interested Real Estate agencies to represent the WECHU in the idenfication of a location for a potential CTS. No submissions were received for the second tender.

CURRENT INITIATIVES

In February 2021, the WECHU Substance Use coordinator, utilizing the set criteria for site identification, worked through local real estate listings to identify potential locations for a CTS. Locations for rent or lease meeting the criteria were listed and scored using a matrix relative to the criteria.

Several locations have been identified for onsite review. Environmental audits will be completed by Windsor Police Services in order to determine the safety of the area and guide any mitigating interventions which can improve the safety of the areas surrounding the site and discourage criminal activity. Once sites have all been reviewed and audits complete, next steps to the process include formal recommendation to the board of health and community consultation.

DATE:

May 2021

SUBJECT: 

Syphilis and HIV in Windsor-Essex County

BACKGROUND

Syphilis and HIV are sexually transmitted and blood-borne infections (STBBIs) of public health significance. Although they are largely preventable, data for these infections in Windsor and Essex County (WEC) is showing cause for concern. Syphilis cases are steadily increasing at a significantly higher rate when compared to Ontario incidence rate. Between 2017 and 2019, there was a 134% increase in syphilis infection rate in WEC, compared to a 25.6% increase in Ontario. There has also been a recent increase in local HIV cases. From January 1st to March 31st, 2021, there were 9 cases of HIV reported in WEC. In comparison, there was an average of 4.6 cases in the first quarter of the previous 5 years, with a range of 2 to 7 cases.

The majority of syphilis and HIV cases have been found in men, although women are also at risk. Between 2010 and 2019, men comprised 81% of syphilis cases in WEC, and all cases of HIV in the first quarter of 2021 were men. Syphilis can also increase the risk of HIV infection. One-third of the HIV cases diagnosed in the first quarter were found to be co-infected with syphilis. Individuals at highest risk for syphilis and HIV infection share the same common risk factors. These factors include: engaging in unprotected sex (vaginal, anal, and oral), men having sex with men, and having sex with anonymous/multiple partners. Among the recent HIV cases, 78% reported having anonymous sex. This increasing trend of engaging in sex with anonymous partners found on the internet has created challenges in being able to notify contacts of exposure.  

CURRENT INITIATIVES

The Infectious Disease Prevention department is developing a sexual health strategy to address the increased prevalence of syphilis and HIV in WEC. One key part of this strategy was the creation of a Sexual Health Advisory Committee to increase stakeholder collaboration. Membership includes representatives from community partners such as the HIV Care Clinic, the Windsor-Essex Community Health Centre, Pozitive Pathways, as well as WECHU nurses who specialize in sexual health. A survey was recently conducted with the committee to identify factors that have contributed to the increased syphilis rates. Survey findings highlighted a significant lack of knowledge and awareness of syphilis among the general population and local health care providers. Specific barriers to testing, treatment, and safe sex practices were also identified. The data collected from the advisory committee, along with data previously collected from Clinical Services clients, is being used to further direct the sexual health strategy.

Moreover, interventions to increase public awareness are currently in progress. Strategic planning for a social media campaign is underway, and social media posts will soon be shared on the WECHU’s Facebook, Instagram, and Twitter accounts in order to engage our community.  The media campaign will focus on increasing knowledge and awareness regarding risk factors and infection prevention, as well as increasing testing and treatment. The WECHU will also be collaborating with Pozitive Pathways in an upcoming podcast and various webinars to target high-risk individuals. Targeted advertisements for high-risk populations will also be placed on Grindr, an online dating site for men who have sex with men. Furthermore, the Windsor-Essex Pride Fest is held in August and initiatives are underway to actively participate in the community event.  

Currently, all syphilis cases are referred to the WECHU for treatment and follow-up. The Clinical Services Nurse Practitioner will also be providing educational sessions for the testing, treatment, and follow-up of syphilis to key health care providers in the community in an effort to build capacity. Additional strategies to support health care providers and increase capacity in sexual health services are continuing to be explored.

DATE:

May 2021

SUBJECT: 

Vector-Borne Surveillance Report 

BACKGROUND

The Environmental Health Department conducts annual monitoring and testing of tick and mosquito populations in Windsor and Essex County (WEC) as part of the WECHU’s Zoonotic and Vector-borne Diseases Program. The program is required under the Health Protection and Promotion Act and provides the community with an early warning system for disease transmission through ticks and mosquitoes known as vector-borne diseases. Due to our geography and local climate, the WEC region is more susceptible to vector-borne diseases, as the ecological conditions influence transmission and distribution. 

Ticks and Lyme Disease

The Windsor Essex County Health Unit (WECHU) monitors tick-borne disease risk in our region. In the last three years, surveillance data indicated an increase in black-legged ticks (Ixodes scapularis) in WEC. The black-legged tick is the primary vector for Borrelia burgdorferi, the bacteria that causes Lyme Disease.

Environmental Health staff conduct active field surveillance at public parks and trails frequently used by community members and is done twice yearly to identify areas in WEC that have populations of black-legged ticks. In 2020, active field surveillance was not completed due to the COVID-19 pandemic, but it will resume this year in the following areas,

• Chrysler Greenway
• Ojibway Prairie Nature Reserve
• Gesstwood Camp
• Ruscom Shores Conservation Area

In 2020, the submission of ticks to the WECHU through passive surveillance was discontinued. The data collected from previous years has allowed the health unit to determine where and how the community have been exposed to ticks. The health unit will continue with suspending passive tick surveillance and will no longer accept tick specimens going forward.  Members of the public are recommended to submit a photograph to etick.ca, a free online service. The service will be promoted this year through WECHU’s website and social media channels.

Human Cases

In 2020, there were four cases of Lyme Disease in WEC.  All laboratory-confirmed cases are interviewed to determine where they may have encountered black-legged ticks. This information drives targeted tick awareness initiatives from the health unit.

Mosquito Surveillance and Testing

The WECHU, has one of Ontario’s most comprehensive mosquito surveillance programs. In 2020, mosquito surveillance began in May and ended in early October. Species-specific traps were deployed in various locations throughout WEC to capture mosquitoes for testing and identification to determine the presence of West Nile, Eastern Equine Encephalitis (EEE) Virus, and Zika Virus in our region. Invasive mosquito species Aedes aegypti (Yellow Fever Mosquito) and Aedes albopictus (Asian Tiger Mosquito) were also monitored through our Enhanced Mosquito Surveillance Program. These species are known carriers of diseases such as Zika, Malaria, Dengue, and Chikungunya. The health unit monitors mosquitoes at different stages in their life cycle to determine prevention and control initiatives for the program.

During this year’s season:

• Total number of traps deployed per week: 47
• Total number of mosquitoes trapped: 205,569
• Total number of pools tested: 2,052
• Number of positive pools for West Nile Virus : 30
• Number of positive pools for Zika Virus: 0
• Number of positive pools for EEE Virus: 0

The WECHU was the successful recipient for a grant from the Public Health Agency of Canada to study the effects of climate change and mosquito populations in our local communities. For the 2020 season, an additional 14 traps were strategically placed in Leamington to monitor mosquito populations. In addition to surveillance activities, key informant interviews were conducted to better understand the health care needs of the local community and within under-served populations (e.g., Temporary Foreign workers), identify gaps that exist in meeting those needs, and strengthen community involvement to improve health care access. All analysis of interview data has been completed, and an interview summary report will be released in June 2021.

Mosquito Control

Over 135,000 treatments of larvicide were applied to roadside catch basins and standing water sites last year to control mosquito populations. All municipalities in WEC have standing water by-laws that should be enforced due to the high number of positive West Nile Virus (WNV) pools in our region. Furthermore, property standards by-law enforcement is key to controlling invasive mosquito populations in our region, as these mosquitoes are container breeders.

Human Cases

The WECHU follows up on all human cases of WNV. Cases are investigated to assess if additional mosquito control activities are required. In 2020, there were two confirmed and one probable case of WNV in WEC. To date, there have been no human cases of Zika Virus identified in our community.

CURRENT INITIATIVES

The WECHU will begin surveillance and monitoring activities for ticks and mosquitoes in May 2021. In addition to these activities, the WECHU will be launching a Fight the Bite public awareness campaign in June 2021. The awareness campaign will focus on the prevention of mosquito breeding sites, information on tick removal, signs and symptoms of WNV and Lyme Disease, and personal protection. Messages and promotional materials will be developed to reach priority populations and inform the public of hot spots identified through previous monitoring efforts.

Please contact us if you require a different version of this report.

Board Members Present:

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

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Lorie Gregg, Nicole Dupuis, Dr. Felicia Lawal, Kristy McBeth, Dan Sibley, Lee Anne Damphouse 

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

Board Members Present:

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

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Lorie Gregg, Nicole Dupuis, Dr. Felicia Lawal, Kristy McBeth, Dan Sibley, Lee Anne Damphouse

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

ISSUE

The Healthy Babies Healthy Children program is a mandated program under the Ontario Public Health Standards (OPHS), and is funded 100% through the Ministry of Children Community and Social Services (MCCSS). In 2020, due to the COVID-19 pandemic, HBHC program services were significantly altered across the province as staffing resources were redeployed to support the COVID response.

The HBHC program is an evidence based early intervention home visiting program designed to improve outcomes for children at risk of poor growth and development. The HBHC program aims to support the most vulnerable and marginalized families in our community through blended home visiting including nursing, social work and peer support. Entry into the HBHC programs occurs through screening and referral at three stages: Prenatal; Postpartum; and Early Identification. The HBHC screen identifies a family experiencing a need, issue or risk that may compromise healthy child development; and/or parenting ability; and who may benefit from a more thorough evaluation and receipt of HBHC program services or other community services. HBHC staff utilize standardized assessments and evidence-based interventions to work on family centred goals and develop a Family Service Plan that monitors the progress and achievement of those goals. The HBHC program staff support families with:

• healthy pregnancy and prenatal care
• developing a positive relationship with their child
• promoting child’s growth and development
• connecting families to resources and programs within their community
• working together with families to help give their child the best start in life

BACKGROUND

In March 2021, the WECHU received communication from the MCCSS requesting the restoration of HBHC services for the 2021-2022 fiscal year. Health Units were asked to submit their service delivery plans and financial forecast to MCCSS by April 14, 2021 for review and consideration. Where staff were redeployed to other services supporting the pandemic, health units were asked to consider alternative staffing models including the use of social workers and other professional staff to support program delivery and identified service goals.

The WECHU’s service delivery plan recognizes the continued redeployment of nursing staff to support COVID-19 vaccination and case and contact management well into the 2021 calendar year. As such an alternate model of blended home visiting will be implemented utilizing social workers as the family case coordinators supporting all family service plans and goals. Limited nursing staff, including a registered lactation consultant will be incorporated into blended home visiting related to: prenatal health, healthy attachment, optimal growth and development, and breast feeding goals and will consult as an expert related to screening and assessment. Other supports for blended home visiting include a registered dietician to support nutrition and food security and family home visitors.

The WECHU has retained minimum service levels for HBHC over the course of the pandemic. Key priorities for families in Windsor-Essex remain as mental health, substance use and housing stability. HBHC staff have reported an increase in mental health complexity among clients and increased severity for those with pre-existing anxiety and depression. This may be attributed, at least in part, to the financial strain, isolation, and general uncertainty caused by the pandemic, as reported by some clients. This interim model will allow the WECHU the opportunity to meet full program implementation while maintaining program fidelity and support increased risks associated with substance use and poor mental health.

2021/2022 Budget

The MCCSS funds not only the Healthy Babies Healthy Children Program Initiative but also the Nurse Practitioner Program Initiative.  The MCCSS has combined the budget for these program initiatives for purposes of reporting.  As such, the WECHU will adopt a consistent approach.

To address the continued need to have the WECHU nurses more focused on the COVID-19 case and contact management and vaccination efforts, the FTE composition of the Healthy Babies Healthy Children Program Initiative will change throughout the fiscal year.  Initially, the Program will be more heavily supported by social workers.  This support will shift as nursing support can be reintegrated in the latter part of 2021.

*FTE estimates are approximate and subject to change based on program needs and pressures throughout the year.

Regarding the Nurse Practitioner Program Initiative, one (1) nurse practitioner FTE will be retained throughout the entire year.  This FTE will provide limited support to COVID-19 vaccination efforts.  Quarterly reporting will reflect the reallocation of applicable salaries and benefits for time expended on Ministry of Health Programs.

For the 2021/22 fiscal year, the fluent staffing complement results in a change in the salaries and benefits financial statement caption of $83,559.  Offsetting this are is an increase in the operating budget, most notably the following financial statement captions:

• Professional development of $14,600 – Increase in professional development to address the needs of FTEs that are new to the Healthy Babies Healthy Children Program Initiative as well as the needs of those returning to this program in the latter part of 2021.
• Program supplies of $66,159 – Increases in program supplies for the Healthy Babies Healthy Children Program Initiative to address the need to review and refresh resources and revitalize the program.  Additionally, there will be an augment in information technology hardware and software to address increased FTEs.  The program area will also continue to review equipment requirements for work-from-home as well as ensuring field staff are more mobile, in that they can document client interactions in the field.

PROPOSED MOTION

Whereas, the Windsor-Essex County Health Unit receives grants from the Ministry of Children, Community and Social Services to fund the Healthy Babies Healthy Children and Nurse Practitioner Program Initiatives, and

Whereas, the total budget for the Healthy Babies Healthy Children Program Initiative and the Nurse Practitioner Program Initiative combined is $2,894,841 for the period April 1, 2021 to March 31, 2022,

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the budget as presented by Administration for the period April 1, 2021 to March 31, 2022.

Meeting held via video.

Board Members Present:

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

Board Member Regrets:

Judy Lund

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Lorie Gregg, Nicole Dupuis, Dr. Felicia Lawal, Kristy McBeth, Dan Sibley, Lee Anne Damphouse

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

Board Members Present:

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

Board Member Regrets:

Judy Lund

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Lorie Gregg, Nicole Dupuis, Dr. Felicia Lawal, Kristy McBeth, Dan Sibley, Lee Anne Damphouse

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

1. Period covered by this report:  January 1, 2021 to March 31, 2021
2. For the period covered by this CEO Quarterly Compliance Report:
   
   1. The undersigned has personal knowledge of the matters herein reported or has made due inquiry with respect to the same.
   2. Except as reported in any previous CEO Quarterly Compliance Report, the undersigned reports as follows:
      
      1. that the Health Unit has been in material compliance with all laws, regulations, orders, judgments or decrees applicable to it.  Without limiting the generality of the foregoing the Health Unit is current in respect of all tax and related withholding and remittances required by law;
      2. the Health Unit has been in material compliance with its By-laws;
      3. the Health Unit has been in material compliance with all other Board resolutions;
      4. the Health Unit has been in material compliance with all contracts and commitments to which the Health Unit is a party including without limitation all funding and accountability agreements;
      5. the Health Unit is current with respect to the payment of all remuneration (including salary and benefits) to its employees;
      6. there are no material variances between what is contemplated by the Operational Plan and what in fact transpired or appears likely to transpire
      7. more specifically, no material changes are required in respect of financial resource allocation plans to address shifts in need and capacity
      8. no material adverse change has occurred in the operations of the Health Unit or its assets and liabilities taken as a whole
      9. there have been no material breaches of the Ethics Code of Conduct by anyone who is subject to it;
      10. there have been no unplanned terminations of any Health Unit employees;
      11. there have been no claims made pursuant to any insurance policies maintained by the Health unit; and,
      12. nothing has come to the attention of the undersigned which would materially adversely change any previous CEO Quarterly Compliance Report, except as detailed below:

Items (vi), (vii), and (viii) have been revised due to the COVID -19 pandemic as follows:

On March 17, 2020, the Province of Ontario enacted the Emergency Management and Civil Protection Act, R.S.O. 1990, c. E.9. (“the Act”), to support efforts to contain the spread of COVID-19, in our communities.  The Act supports public health units to, regardless of their collective bargaining agreements, suspend services, redeploy staff as deemed appropriate, modify hours of work, cancel and or defer vacations, utilize part-time/contract staff to perform the duties and responsibilities of bargaining unit staff and suspend the grievance process. 

The WECHU, in its response to COVID-19 within the communities of Windsor and Essex County has:

• Redeployed staff as considered appropriate to facilitate our response to the pandemic;

Date:   April 15, 2021

Theresa Marentette, CEO

Meeting held virtually.