March 25, 2020
To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus
COVID-19 Physician Information Update
March 25, 2020
A Message from Dr. Nicole Boutilier, Vice President of Medicine
Updated Clinical Documents
New Screening Protocol for Patients with Influenza Like Illness
Guideline from Infection Prevention and Control

Infection Prevention and Control strategies to prevent or limit transmission of COVID-19 in healthcare settings include prompt identification of all persons with signs and symptoms of acute respiratory infection (e.g. fever and/or cough) with the immediate application of Droplet and Contact Precautions (in addition to Routine Practices). 

A primary objective for managing the COVID-19 outbreak is the early detection of cases and slowing the spread of COVID-19 in order to flatten the epidemiological curve. With the increasing number of COVID-19 cases reported in Nova Scotia, active screening of patients, residents, and clients in our acute care hospitals and long term care facilities is imperative to ensure early identification of COVID-19. 

Effective immediately, all patients, residents, and clients located in NSHA hospital or long term care/residential facilities will be assessed two times per day for fever, respiratory symptoms, and change in health, which could reflect an infection. This assessment must be documented on the attached form that will be placed on each patient/resident/client’s chart.

Immediate management of patient/resident with symptoms is to include:
  • Implement Droplet and Contact Precautions 
  • Report the suspect case to Infection Prevention and Control
  • Test patient for viral respiratory infection ie. send flu swab
Laboratory Services Reminder
Physicians and nurse practitioners are reminded to restrict laboratory orders to urgent or testing required for immediate diagnosis, management chronic illness and time sensitive prenatal screening. If a patient in self-isolation requires out-patient blood work, physicians and nurse practitioners are asked to direct them to contact the laboratory to book an appointment for blood collection and indicate that they are self-isolating. This will ensure staff are prepared to take the extra precautions necessary to protect themselves and other members of the public.

Information about NSHA Blood Collection clinics, including hours of operation and contact information, can be found on the NSHA website: http://www.nshealth.ca/blood-collection.

Updated Naming of Health Services to Support COVID-19
The Medical and Clinical Advisory Group of the provincial Incident Management Team have refined the terms to be used in the documentation of guidelines, communications, and any NSHA related material.

Here are terms to ensure common language:
  1. Primary Assessment Centres (PAC): These are the centres within (or near) our facilities that receive 811-referred patients for assessment and testing for COVID-19. 
  2. Community Primary Assessment Centres (CPAC): These are centres in the community that receive 811-referred patients for assessment and testing for COVID-19. 
  3. Secondary Assessment Centres (SAC): These are units, centres or wards for further assessment of patients who were tested for COVID-19 and referred for further follow up and assessment before being referred to convalesce at home. 
  4. COVID Inpatient Units: these are units to support COVID-19 patients who require admission to hospital for stabilization and treatment. 
Health Canada Mandatory Reporting for Adverse Drug Reactions and Medical Device Incidents
Health Canada has clarified expectations regarding the requirement for hospitals to report medical device incidents (MDIs) and serious adverse drug reactions (ADRs) during the COVID-19 pandemic.
During the COVID-19 pandemic, reporting expectations and timelines will not change for some high priority products or those that may be used in a pandemic. These include antivirals, vaccines, medicines for outbreak symptom management, medical devices related to the diagnosis and management of patients with COVID-19, blood and blood components, cells, tissues and organs (CTOs) and drug identification number-assigned (DIN) manufactured blood products. Furthermore, reports with death as an outcome should also be treated as priority.

Full details are included here.
PPE Update
Independent offers of /solicitation for donations of PPE - NSHA has been approached by a number of individuals and groups interested in donating items or equipment during the pandemic, including personal protective equipment (PPE). Although we have enough PPE to meet the current need, NSHA is following up on offers for N95 respirators to help boost our stockpile for the coming weeks and months, when we expect to see a surge in cases. The organization is also working to source additional PPE using a streamlined approach. NSHA is keeping a list of offers received for reference and possible follow-up if/as appropriate. Staff are asked NOT to solicit donations of PPE from individuals or groups – it’s important that any efforts to source additional PPE be coordinated. We will provide information tomorrow about how to direct/forward on unsolicited offers of N95 respirators, if received.
MAiD Policy Change
The NSHA policy on Medical Assistance in Dying (MAiD) [ NSHA CL-AP-010 Medical Assistance in Dying (MAiD)] has been revised due to the current situation involving COVID19.

Effective immediately, the Executive Leadership Team has approved a temporary change to the policy that prohibits NSHA staff from acting as an independent witness for MAiD Request and Consent forms. As such, an NSHA staff member can now be an independent witness, provided that the staff member qualifies as an independent witness.  

To qualify as an independent witness the person must: 
  • be 18 years of age
  • understands the nature of the request for medical assistance in dying
  • is not directly involved in providing health care services to the person making the request
  • does not know of or believe that they are a beneficiary under the will of the person making the request, or a recipient, in any other way, of financial or other material benefit resulting from that person’s death

If you have questions about this policy, please ask your manager or John McCarthy, Medical Affairs Advisor, MAiD John.McCarthy@nshealth.ca 902-220-2968 (Mobile)

Seeking Physician for Occupational Health, Pandemic Support
Expressions of interest are being sought for an NSHA physician to serve as NSHA’s COVID-19 Occupational Health, Safety and Wellness physician.

The Occupational Health, Safety and Wellness Physician will provide operational surveillance, screening and management of healthcare workers who are off work due to travel-related isolation requirements or potential exposure.

All interested parties to apply by way of resume submission and expression of interest to Katrina Philopoulos, Director Physician Recruitment at physicianrecruit@nshealth.ca. Application Deadline: March 26, 2020 (posting will be removed when filled, if sooner).
Health Worker Accommodations
NSHA has been receiving offers from different organizations looking to support health care workers who may want to isolate away from family while supporting work with COVID-19. Some space has been made available through Atlantic Suites (at a discount) and Dalhousie University Residences. 

At this point, we are trying to gauge interest from those who may want to avail of these services. If you are interested in seeking alternate accommodation, you can reply to physiciancomms@nshealth.ca with your name, location and need. We can’t promise all requests will be accommodated but we can collect this information to share when offers come in.
Physician Parking at Victoria General Site
Physicians working at the VG site during the COVID-19 response have an additional reserved parking area. Ten additional spaces for physicians will be located at the entrance to the Victoria Building. These spots are best described as 'on the roof' of the VG cafeteria (in the back of this section).  
 
There will be a parking attendant onsite to allow physicians into this reserved section. Physicians will be required to enter the parking lot through the Dickson or Centennial Main Entrances as the Victoria Entrance is closed.

We are experiencing high volumes in our parking lots so we ask that you leave additional time.
Examination Update
The College of Physicians and Surgeons of Nova Scotia has been advised that the Medical Council of Canada, the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada have all postponed their examinations due to the COVID-19 pandemic.

  • If you have registered for an examination, rest assured that this will not negatively affect your medical licensure
  • If you are provisionally licensed at present, your provisional licensure will be extended
  • If you are at the end of training and contemplating independent practice, you will be considered eligible for provisional licensure

If you have any questions, please contact the College’s registration department at registration@cpsns.ns.ca.
Phishing Opportunities on the Rise during COVID-19
Please remember that cyberattacks like Phishing are on the rise with the COVID-19 pandemic. NEVER enter your user name and password into a link that comes through an email. These phishing attempts are convincing and often have familiar names and even familiar email addresses. Sometimes they ask you to login to receive updates to Outlook or Microsoft programs. Our IT updates will never ask you to enter information to register for updates, they will contact you to push them out.

If you receive an email with a link that seems suspicious, it most likely is. Please send all questionable emails to reportphishing@nshealth.ca.
Beware of COVID-19 Fraud
There are situations where misinformation about COVID-19 cases is being reported in communities and to businesses, as well as fraudulent calls from people claiming to be Public Health and asking for credit card/financial information. 
  • Any notification of potential exposures to COVID-19 that need to be shared with individuals, businesses, organizations or communities will be shared officially by Public Health. 
  • When Public Health calls people to discuss COVID-19 test results or to follow-up through our investigations, financial information is NEVER asked for. If you receive a call like this asking for financial information, please do not provide your financial or personal information. 
New Occupational Health and Safety Guidelines for Staff and Physicians
Updated March 25

This document provides instruction and guidance for physicians who are symptomatic and looking for screening or return to work advice.

View the document here
DNS Webinar for Family Practices
Recommendations for running an office-based practice in response to COVID-19
This webinar will provide an overview of the new virtual care fee codes and virtual care tools. Drs. Maria Alexiadis and Joanna Zed will present recommendations for office-based practices in response to COVID-19. Dr. Gus Grant will outline the College of Physicians and Surgeons of Nova Scotia's expectations for practice in a COVID-19 environment. Join us for ideas and information sharing and an opportunity to ask your questions related to these topics.

Thursday, March 26, 2020
6:00 p.m. to 8:00 p.m.
New Site Medical Lead - QEII
We are very pleased to announce that Dr. Simon Jackson has been appointed as the interim QEII Site Medical Lead effective Wednesday March 25th. Simon will work closely in a co-leadership relationship with Jill Flinn, VG Site Lead and Kitty Connell, HI Site Lead to coordinate Clinical Care at the QEII during the Covid-19 pandemic. They will connect QEII based teams who are already working hard on our Covid-19 response so as to ensure that a coherent QEII site based approach exists. Like other site based co-leadership teams (DGH/Hants) reporting structure will be through to zone leadership – Vickie Sullivan, Todd Howlett, and Paula Bond.
 
The decision to create this position is supported by the ELT at NSHA and the senior leadership in Central Zone. 
 
Please join us in welcoming Simon. He, Jill and Kitty will need your support as we work together to provide the excellent care we are known for during this pandemic.
 
Dr. Todd Howlett, Interim Executive Medical Director Central Zone
Paula Bond, VP Central Zone
Vickie Sullivan, Executive Operation Director, Central Zone
Provincial COVID-19 Status Update
As of today, March 25, Nova Scotia has 68 confirmed cases of COVID-19. 

Seventeen new cases were identified Tuesday, March 24. The cases are travel-related or connected to earlier reported cases. Several of the new cases are connected to groups or families who have returned to Nova Scotia following travel outside of Canada. None of these cases are from spread within the community. 

The 68 individuals affected range in age from under ten to mid-70's. Cases have been identified in all parts of the province. One individual remains in hospital. Two individuals have recovered and their cases of COVID-19 are considered resolved.

Public health has been in contact with these individuals and is working to identify others who may have come in close contact with them. Those individuals are also being directed to self-isolate at home, away from the public, for 14 days. 

To date, Nova Scotia has 2,772 negative test results and 68 confirmed cases. 

Anyone who has travelled outside of Nova Scotia must self-isolate for 14 days. If you have travelled outside of Nova Scotia or been in close contact with someone who has travelled and are experiencing fever or new cough you should complete the online questionnaire before calling 811. The online questionnaire can be found at: https://811.novascotia.ca/

Nova Scotians can find accurate, up-to-date information, handwashing posters and fact sheets at https://novascotia.ca/coronavirus .

Message from College of
Family Physicians of Canada
The COVID-19 pandemic is an enormous challenge for our country and its family doctors. Many of us are looking for answers to questions and for support as we adapt to this rapidly evolving health crisis. 
The College of Family Physicians of Canada (CFPC) would like to offer you access to our national, secure online networking space for all member family doctors, called MiGroups, to connect you with colleagues from coast to coast who are facing similar challenges.

MiGroups is a secure, private online platform hosted by TimedRight. Since the 2018 launch, over 2,500 members have joined. MiGroups is restricted to CFPC members only. MiGroups has a virtual hub focused on the pandemic where family doctors who are part of one or more of our 19 Member Interest Groups (MIGs) are already active.

We are now inviting all CFPC members to join and share your questions, updates, documents, and support with your family physician colleagues about the COVID-19 pandemic. MiGroups is accessible on your desktop, on a great iOS app, and, very soon, on Android.

You can register today at cfpc.timedright.com by creating an online profile.

Please don’t hesitate to contact us at migs@cfpc.ca if you have any questions or feedback.

Thank you for taking care of your patients and communities during these difficult times and
keep safe.

Webinar Tomorrow

On Thursday, March 26, 2020, at 12:00 p.m. (ET), join us for our live-stream webinar “The COVID-19 Pivot: Adapting family practice to virtual care.” Please use either of these links to join the live-stream event:
YouTube
Facebook
COVID-19 is uppermost on all our minds, and family doctors are doing their best to provide virtual care to patients where possible. For some physicians virtual care involves telephone visits, while for others it may include video visits, secure email and chat options, and electronic access to reports. Two of Canada’s family physician leaders in virtual care, Dr. Mark Dermer (Ontario) and Dr. John Pawlovich (British Columbia), will participate in our webinar and discussion with Dr. Jeff Sisler of the College of Family Physicians of Canada (CFPC). 

They will address the challenges this pivot to virtual care presents, with a focus on how family physicians need to think and act differently in this context. This session will include time for your questions and will be useful for all family doctors adapting to virtual care.
This session will be available in English only.
This one-credit-per-hour Group Learning activity has been certified by the CFPC for one Mainpro+ ® credit. For more information about our upcoming webinars, please visit our web page .

If you miss a live-stream webinar you can access recordings of the session online . Recorded live-stream webinars are eligible for non-certified credits in the Self-Learning category. Mainpro+ participants may also earn certified credits by completing a Linking Learning Exercise.
Questions about this webinar can be sent to practicesupport@cfpc.ca .