March 15, 2020
To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus
COVID-19 Physician Information Update
March 15, 2020
A Message from Dr. Nicole Boutilier, Vice President of Medicine
NSHA is committed to keeping all physicians up to date with information from the provincial incident management team and all clinical information required to assist in our provincial response.

We are working on updating further support documents for primary care physicians and they will be available tomorrow.

Ongoing Primary Care in Family Practice
NSHA is rapidly adapting its service delivery to align with today’s direction of the Chief Medical Officer of Health, including a reduction in and/or interim suspension of ambulatory care services. During this time, it is of particular importance that our family physician community continue to provide ongoing delivery of primary health care services for Nova Scotians, and focus on providing your patients with access to timely care for their urgent health concerns in your offices.

Family physicians are encouraged to consider a continuity plan for your practice if you and/or your colleague(s) are unable to practice, or practice staff are unable to work (i.e. are feeling unwell or need to self-isolate for 14 days), including increased appointments by phone or other virtual means. You may want to consider connecting with another practice in your community to discuss how you can provide your collective patients with access to urgent primary care, and further coordinate as a group to support your regular community family medicine coverage (e.g. emergency department, inpatient, long term care, etc.).

A heartfelt thank you to everyone who are continuing to be patient as this response rapidly evolves. New information is being shared as quickly as possible, and I appreciate your efforts to focus on providing the best ongoing care for your patients.

Ambulatory/Outpatient Visits and Group Sessions – Direction of the EOC
This applies to Ambulatory and Outpatient visits only, this does not apply to Primary Care.

In response to the global pandemic declaration by the World Health Organization, all non-urgent ambulatory clinic visits and group sessions will be suspended in all Nova Scotia Health Authority (NSHA) facilities effective March 18, 2020. This also includes any community sponsored or hosted group sessions that use NSHA space.
  • All outpatient visits are to be limited to urgent care visits only. This excludes Mental Health and Addictions one-to-one outpatient clinic treatment appointments (Urgent and Non-urgent).
  • Transition to one-on-one visits as much as possible to minimize large number of people being in close proximity.
  • All group programs, including wellness programs, will be cancelled. Staff will be redirected to high priority activities as identified through business continuity plans.
  • Virtual care options should be considered. This would include telephone follow-up as appropriate. For additional virtual care options, program leaders should contact IMITProjectServices@nshealth.ca (The Incident Management Team are working Virtual Care options IM/IT, DHW, and PHC and will have further updates tomorrow or Tuesday.
 
Please work with the zone leadership to identify specific service changes and proceed with implementation.

As a health care organization, it is important that we take every measure to ensure the safety of our patients and to maintain our capacity to respond to community needs; focusing on the prevention of disease in our communities. To assist with containment of the disease, NSHA is encouraging social distancing and avoiding large gatherings which are known strategies that interrupt person to person spread. NSHA is committed to supporting all efforts to minimize the health impacts of COVID-19 in Nova Scotia.

Nova Scotia Department of Health and Wellness News Release--First Presumptive Cases of COVID-19 in Nova Scotia; New Prevention Measures

Nova Scotia Government held a press conference regarding three presumptive positive cases of COVID-19 in Nova Scotia and additional measures to support virus containment.  Full release is available here . Highlights include:
  • Nova Scotia announced the province’s first three presumptive cases of novel coronavirus (COVID-19), today, March 15. The province is also taking further measures to reduce the spread of COVID-19.
  • The cases are not connected and are travel related. The individuals followed all the proper procedures when they started to feel unwell.
  • Two individuals are in the Halifax Regional Municipality and one is in Kings County. All three are managing their symptoms at home in self-isolation. 
  • Public health has been in contact with these individuals and those who have come in close contact with them are also being directed to self-isolate at home, away from the public, for 14 days.

Additional prevention measures for Nova Scotians are in effect immediately under the authority of the Health Protection Act and include:
  • long-term care facilities closed to visitors effectively immediately
  • public schools closed for two weeks following March Break (weeks of March 23 and March 30) and then will be reassessed
  • regulated child care centres closed March 17 to April 3 and then will be reassessed
  • March break camps cancelled
  • casinos in Halifax and Sydney are closed as of 12 am March 16 and bar owners can no longer operating VLTs
  • anyone who travelled outside of Canada must self-isolate even if symptom-free
  • organizations and businesses must practice social distancing of two metres or six feet and keep gatherings below 150 or much smaller if possible. This applies to restaurants, bars, movie theatres and other gathering spots.

Supply of Scrubs / In Hospital Laundry Service
It is always good practice to exchange scrubs before leaving the facility. A scrub exchange program is now available for the Halifax Infirmary Emergency Department. Procurement is working to purchase more scrub supplies but notes that due to shortages this may take several weeks.

Currently, we ask that all health care workers follow the regular precaution of taking uniforms home to wash. Those areas that use scrubs will continue to launder them within their facility. If you have NSHA issued scrubs in your homes, please consider returning them to your site ASAP to enter circulation as demand for laundered scrubs is increasing.

Supplies and Personal Protection Equipment
Our supply departments have assured us that supplies are adequate within the facilities. Current in-hospital scarcity is related to bringing supplies back to inventory to ensure supply chain has a good view of availability of PPE. Additional reserve is available to access and orders are in the queue. Please do not remove supplies from our facilities. Please see this video from Dr. Brendan Carr , President and CEO on the issue .
A process is currently underway to explore our ability to purchase and distribute supplies to family physician offices across the province. More updates will follow. For those who do not have access to appropriate PPE or swabs, please use the physician referral pathway for Coronavirus Assessment Centres listed on the Physician Site .

New Video to Demonstrate Appropriate Application and Removal of PPE
Please view the video here .

Interim Site Leadership Change for Colchester East Hants Health Centre (CEHHC)

Dr. Steve Ellis will be stepping into the role of interim site lead effective immediately to allow Dr. Ryan Sommers to focus on his roles as Medical Officer of Health and Zone Medical Executive Director during this critical period. We thank both Drs. Ellis and Sommers for their ongoing commitment to the people of Nova Scotia.

Privileging and Credentialing Process
NSHA physicians seeking to help out by providing clinical services in a new zone must have their privileges appropriately updated to reflect the new zone before working.

The NSHA privileging and credentialing team will work to identify key groups of providers and preemptively adjust privileges to allow for provincial work.

All individual physicians volunteering to help out providing services at facilities outside of their regular zone, are being asked to connect with the department head of the receiving zone to arrange privileges through the typical processes.

Urgent credentialing requests should be sent to credentialing@nshealth.ca   and include “urgent covid19 related” in the subject line.

*Updated* Physician Referrals to Coronavirus Assessment Centres
Our incident management team has created Pre-Screening Guidelines for patients presenting in your offices. This provides a clear direction to physicians on referral to Coronavirus Assessment Centres using the fax form linked below. The fax form was updated today.

Please note that in the effort to get these crucial pieces of documentation and information out to you as quickly as possible, there is a likelihood of regular ongoing updates and new versions- for the most recent version, please check the website . We are carefully dating communications to ensure you can find the most up to date version.

All of these forms are available on the physician specific information site here .

* More updated documents coming tomorrow. Please check this site before downloading.
Update: Clarification on Travel Advisory for Physicians Returning From or Planning to Travel Outside Canada
Public Health Nova Scotia has issued a directive that all physicians currently returning from travel outside Canada or who are planning travel to outside Canada are asked to follow self-isolation for 14-days upon their return. This directive started at 12 pm on March 13. All physicians returning from travel after 12 noon on March 13 are required to self-isolate.
All physicians planning travel or who are returning from travel are asked to report these details to their local ZMED office through the following contacts.

Fit Testing for Physicians
Only physicians who are providing aerosol generating procedures (positive pressure ventilation (BiPAP and CPAP), endotracheal intubation, airway suction, high frequency oscillatory ventilation, tracheostomy, chest physiotherapy, nebulizer treatment, sputum induction, and bronchoscopy) should be participating in fit testing at this time. Staff members are working to reach all physicians in each zone to determine their fit testing status.
For information about fit testing in your area, contact your zone Occupational Health and Safety Lead:
Frequently Asked Questions
What is the difference between self-isolation and quarantine?
All NSHA staff and medical staff arriving from out of country travel after March 13, 12 noon, are required to self-isolate for 14 days.
Yesterday we posted definitions from Health Canada that were confusing and contradictory to the directive for health care providers and public servants who have traveled out of country. We apologize for that confusion.

A revised answer as it relates to our situation is below:

Isolation refers to an individual with symptoms and quarantine refers to exclusions in persons without symptoms. However, the mainstream use in the current context has meshed these two terms.

The goal of quarantine is to prevent any transmission if one becomes minimally symptomatic. The measures listed under self-isolation on the Public Health Agency of Canada website would be considered the ‘gold standard’ to prevent transmission. Practically, the full extent of these measures may be unrealistic for the asymptomatic returning traveler. The DHW resource is a more practical example, where the asymptomatic returning traveler would stay in their own home, avoid visitors, and avoid close contact with vulnerable people. https://novascotia.ca/coronavirus/#help

This can be further complicated for health providers who are returning from travel outside the country and have to consider their partners, spouses, or other housemates. The best advice would be to self-isolate from other members of the same home (or at a separate location if possible) or ask those members to self-isolate or work from home and avoid contact with others as much as possible during the 14 day period as well.

To appropriately self-isolate:
  • Avoid close contact with people with chronic conditions, compromised immune systems and older adults.
  • Don’t have visitors to your home.
  • Avoid situations like social gatherings, work, school, daycare, or visiting other people who are in a health care facility or long-term care residence.
  • Limit taking public transit, taxis and ride sharing.
  • Wash your hands often with soap and warm water, for at least 20 seconds. Use hand sanitizer if soap and water are not available.
  • Cover your mouth and nose with your arm when coughing or sneezing.
  • The Government of Canada has additional resources about how to self isolate and how to care for someone with COVID-19.
 
 
Why can’t physicians returning from travel just be swabbed/screened and then return to work sooner than the 14-day advisory?
This is a provincial guideline, similar to other jurisdictions in Canada. Although the incubation period is on average 5 days, there are cases that have presented later so swabbing on arrival cannot predict who might be incubating infection and present at a later date that could lead to exposure of others. We are taking all measures to prevent potential exposure to patients who may be a higher risk of complications and care providers who are crucial to our provincial response.

I’m a doctor and I’ve traveled outside Canada and am now symptomatic, what do I do?
Leave the workplace, self-isolate, and contact Occupational Health and Safety Line to discuss 1-833-750-0632.
We are asking all staff and physicians to not call 811 and to not present at Coronavirus Assessment Centres.