COVID-19 Physician Specific Information Update

March 12, 2020

To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus

COVID-19 Physician Information Update

March 12, 2020

A Message from Dr. Nicole Boutilier, Vice President of Medicine

NSHA is committed to updating physicians on all relevant information as we work to operationalize our provincial response to COVID-19.

I would like to thank physician leaders and medical staff who have participated in the many different working groups to mount a provincial response. We acknowledge that there are many communication updates from different stakeholder groups and we are doing our best to provide accurate and timely response to questions and concerns. NSHA is using a multi-channel approach that involves an email contact list that we use to send my newsletter updates, and a website for physicians to keep track of updates here . This site does not require a login for access. This site also has a link to subscribe to email updates and we encourage those who are receiving this message from a colleague to use this link to subscribe .

There is a communications subcommittee for the organization’s work on COVID-19. We are asking all communications be managed through this structure. There are regular daily briefings scheduled where information is shared with the public and media through designated organization spokespersons. If you have a key message or direction that needs to be communicated, please forward to Krista Grant ( kristal.grant@nshealth.ca ), Chief Public Engagement and Communications and Tamara Gilley ( tamara.gilley@nshealth.ca ), Director Corporate Affairs. Messages will be compiled and included in regular status updates.

As leaders in the health system, we are asking that physicians be mindful of their role of modeling appropriate response to their peers, allied health providers, and the public.

NSHA Incident Management Team (IMT) & Working Groups

NSHA’s IMT is designed to ensure a clear establishment of command and control during an incident or event. Our priorities focus on life safety, incident stabilization, property preservation and continuity of operations. This multi-disciplinary team is working very hard with Zone IMTs as well as our external provincial partners on a daily basis.

IMT increased their capacity by activating working groups to address the processes and support required to plan and respond to the needs of the organization. Working group memberships should be firm within the next few days. Physician engagement is key and physician names are being collected and submitted through the ZMED offices.

The co-leads of the IMT are: Bethany McCormick ( Bethany.mccormick@nsheatlh.ca ) and Dr. Todd Hatchette ( todd.hatchette@nshealth.ca ) .

Working Groups & Co-leads

Infection Prevention and Control: Tammy MacDonald (tammy.macdonald@nshealth.ca), Dr. Ian Davis (ian.davis@nshealth.ca)
Occupational Health Safety and Wellness: Tracey Ungar (tracey.ungar@nsheatlh.ca), Tom MacNeil (toma.macneil@nshealth.ca)
Supplies: Evan Cheung (evan.cheung@nshealth.ca), JP Kent (jean.kent@nshealth.ca)
Communications: Krista Grant (kristal.grant@nshealth.ca) and Tamara Gilley (tamara.gilley@nshealth.ca)
Medical Affairs: Nicole Boutilier (nicole.boutilier@nsheatlh.ca)
Medical and Clinical Advisory: Cindy McQuarrie (cindy.mcquarrie@nshealth.ca), Dr. Shelly McNeil (shelly.mcneil@nshealth.ca)
Laboratory: Shauna Thompson(shauna.thompson@nshealth.ca), Dr. Todd Hatchette (todd.hatchette@nshealth.ca)
Logistics and Operations: Pascal Rodier (Pascal.Rodier@nshealth.ca)
Public Health: James Broesch (James.Broesch@nshealth.ca), Dr. Ryan Sommers (ryan.sommers@nshealth.ca)

Inpatient Care Working Group, Patient Flow Working Group, and Critical Care Working Group co-leads will be announced soon.

Zone Incident Management Teams and Co-leads

Western Zone IMT: Wanda Matthews(wanda.matthews@nshealth.ca), Dennis Oxner (dennis.oxner@nshealth.ca)
Eastern Zone IMT: Brett MacDougall (brett.macdougall@nshealth.ca), Bruce MacDonald (bruce.macdonald@nshealth.ca)
Central Zone IMT: Vickie Sullivan (vickie.sullivan@nshealth.ca), Delwin Ferguson (delwin.ferguson@nshealth.ca)
Northern Zone IMT: Cheryl Northcott cheryl.northcott@nshealth.ca) and Scott Brumwell (scott.brumwell@nshealth.ca)

Physician Information about Coronavirus Assessment Centres

NSHA has stood up local coronavirus assessment centres across the province. To view the list click here . The centres operate in a medical oversight model with physicians providing support using virtual care. This model was developed with HAMAC approval and will continue to be revised as feedback is received. Patients are asked to call 811 where they will be pre-screened and referred to an appointment for further screening by nurses and allied health care providers. Physicians will provide virtual oversight via phone and later telehealth to the clinics as required.

Recruitment of physicians to support Coronavirus Assessment Centres

NSHA medical leadership are securing resources to provide support to the clinics. Further into our planning, the team will be seeking expanded participation from GPs and ERPs who feel comfortable assessing undifferentiated respiratory symptoms, are confident in clinical decision making in uncertainty, and understand the provincial emergency program of care and EMS systems.

Physician Referrals to Coronavirus Assessment Centres from Primary and Ambulatory Care Settings

We are aware that physicians are having challenges with referring patients (who have screened positive for testing) to assessment centres from their office or ambulatory care settings. We are working to ensure one single point of entry to the assessment clinics: this is currently 811. Work is underway to address staffing 811 to meet high call volumes and higher than normal wait times. The Incident Management Team are also working to create a referral pathway for direct physician referrals via phone and fax. This information is coming together imminently and we expect to be able to provide further updates as soon as possible.

Physician and Medical Learner Self-Screening

Please see the Occupational Health and Safety tool below for screening and their Q&A document here

Physician Payment

There are several questions around payment that our teams are working to address.

Emergency Department and ICU Surge Funding

These requests are with Department of Health and Wellness and we will update departments when we receive the status.

Remuneration for Coronavirus Assessment Centres

Physicians participating in the medical oversight for Coronavirus Assessment Centres will receive a sessional rate at $154 for general practitioners and $177.10 for specialists who meet a minimum criteria. This payment will be levied using a distinct claim form that is sent directly to DHW and Medavie. Shadow billing is not required for this service.

Payment in the event of Suspended Services and Quarantined Physicians

NSHA has submitted this request to the Department of Health and Wellness. We are not able to update further at this time.

Personal Protective Equipment

The current evidence suggests the virus causing COVID-19 is transmitted by droplets similar to influenza. Contact and droplet precautions including a surgical mask with eye protection, gloves and a gown are the PPE that will protect our workforce.

N95 masks are only required when doing aerosol generating medical procedures, such as intubation. There is a worldwide shortage of N95 masks that has begun to impact NSHA. While we have enough stock to ensure we can support the management of patients on airborne precautions based on historical needs, over the past few weeks usage of N95 masks has been 2-3 times the normal rates, which is not sustainable. N95 masks are not needed for infections like COVID-19, which is transmitted by droplets and any use of N95 masks for non-aerosol based protection will result in a critical shortage of our supply.

NSHA Supply Chain Operations will be monitoring orders, and surveying departments to identify surplus. Departments that do not have a clear use for N95 masks will no longer be supplied. It is vital that N95 masks be conserved for use in only the required and appropriate circumstances. These measures are necessary to ensure that masks are available for patients, staff and learners when and where they are needed.

Patient Requested Employer Notes

Some employers are asking employees who have traveled to impacted areas to obtain a physician’s note or screening before returning to work. Public Health has provided a general form letter for physicians to use for these requests. It can be downloaded here.

Updated Travel Advisory

Effective March 12, 2020 and in light of the global pandemic declaration, all travel outside of the Maritimes for health authority work-related purposes is not permitted until further notice. This means no new travel outside the Maritimes can be booked for NSHA related work. This decision will be re-evaluated on a bi-weekly basis as the situation evolves. Those who have pre-booked work-related travel and are scheduled to travel must cancel. Guidelines on travel cancellation and reimbursement are posted to the coronavirus page ( www.cdha.nshealth.ca/coronavirus ) and attached to the Travel Policy available on http://policy.nshealth.ca

This applies to all NSHA employees, physicians and researchers.

For personal travel, employees are encouraged to be mindful of travel to countries with active advisories. The decision to book or cancel personal travel rests with the employee. Employees, in this case, are responsible for costs associated with the change or cancellation of personal travel plans. Current travel advisories are issued by the Federal Government of Canada and are being updated daily. Upon returning to Canada from personal travel, all travelers should monitor their health for fever, cough and difficulty breathing for 14 days after arrival in Canada. If you have these symptoms, contact the public health authority in the province or territory you are in. All travelers returning from locations where increased health notices exist should consult with their local public health authority (811 in Nova Scotia) immediately and self-isolate for 14 days upon return to Canada.

All physician recruitment team travel is suspended until further notice. We are working on a process for out of province physicians that may be travelling for site visits and locums.

Physician Meetings

As an important part of our response to COVID-19, we are asking that all planned large group meetings for physicians be postponed or a virtual option be considered. HAMAC will proceed with Skype as well as other zone level and departmental meetings. We are working with leaders to ensure access using these platforms. If you need support for these platforms, please reply to this email.

Up to Date Open Access for Physicians

Coronavirus information is available on UpToDate with open access for anyone seeking the latest evidence-based updates.

Wolters Kluwer Coronavirus Resources & Tools page provides resources across our Health solutions.

Frequently Asked Questions

What is the NSHA's incident response structure? And, how can physicians be involved?

NSHA has mounted a province wide incident management response to COVID-19 with a co-leadership model where physician engagement is key. The committees are being filled and physician names have been submitted through the Zone Medical Executive offices. Click for diagram of committee structure and IMT model.

Where is the full list of assessment centres and why are they located within the sites?

Assessment centres are being stood up in response to need and new sites are opening regularly. If you are trying to support patient access to the centre, or support office staff with patient questions, direct all patients to 811 for pre-screening and an appointment for the nearest assessment centre in their area.

Will physicians be asked to self-isolate after travel? Will they be able to return to work after traveling?

Please see the FAQ for Health Care Providers here

Will family practices be provided appropriate PPE equipment?

Appropriate PPE at this time are standard droplet precautions (for patients not requiring aerosol generating procedu res is a regular face mask. Practices are asked to provide a face mask to any symptomatic patient.

Should immunocompromised doctors be concerned or limit work frequency and location?

Please see the Occupational Health and Safety tool below for screening and their Q&A document here .

If you have a patient exhibiting symptoms, and who has traveled to an impacted area, refer them to 811 to be screened in for corona virus assessment appointment. Isolate the patient and ask them to wear a mask. Initiate droplet and contact precautions, donning gloves and a long sleeved gown. Don a mask and eye protection/face shield or mask with visor when within 2 meters of patient suspected or confirmed. In addition to gloves, gowns and eye protection a respirator mask (N95) is required by all health care workers in rooms when performing aerosol-generating medical procedures (e.g. suctioning, BiPap, trach care, aerosol or nebulized medications, nasopharyngeal aspirate (pediatrics), bronchoscopy or inducing sputum). Perform aerosol-generating medical procedures in an airborne isolation room and only when medically necessary. Use single-use devices when possible. Dedicate reusable non-critical equipment to this patient when possible and clean and disinfect prior to use on another patient.

Perform frequent hand hygiene with alcohol-based hand rub or soap and water if hands are visibly soiled. REMINDER- Perform hand hygiene after removing gloves and gown and before removing face protection and upon exiting patient room and removing N-95 (if used).

Will physicians required to self-isolate be compensated for loss of income? Will there be opportunity to provide virtual care for physicians in isolation?

This question has been raised to the Department of Health and Wellness and we will update as soon as we are aware. There may be an opportunity for physicians in isolation to participate in the virtual care schedule if they meet the criteria for participation.