March 27, 2020
To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus
COVID-19 Physician Information Update
March 27, 2020
A Message from Dr. Nicole Boutilier, Vice President of Medicine
Updated Clinical Documents
Order Sets and Clinical Guidelines

Coronavirus Care Pathways

Virtual Care

New Laboratory Requisitions
Note: Requisition forms shared yesterday referred to Emergency/Ambulatory but apply to Emergency/Acute Care


Occupational Health, Safety & Wellness

Continuing Care
Redeployment of Physicians
For those that have been impacted by system changes, services winding down or variations in service delivery, we are asking you to participate in physician redeployment opportunities.

We are looking for experience or skill sets that would lend to the following areas:

  • Long Term Care
  • Emergency Medicine
  • ICU/Critical Care
  • Inpatient Care
  • Secondary Assessment Center
  • Access Clinic (Primary Care)

More detailed descriptions of these opportunities can be found here:

  • Long Term Care - standard scope of practice for general practitioner.

  • Emergency Medicine - family physicians working within emergency departments must work to the scope defined here. 

  • ICU/ Critical Care – providers sought to cover ICU patients during pandemic surge. Skills required for non-intensivists (i.e. Anesthesia, Family Medicine – ED, Surgery) to fulfill this role can be found here. 

  • Inpatient Care – inpatient skills set required to support care of COVID and non-COVID patients across NSHA inpatient units. The ideal care provider will be dependent on patient acuity and the facility resources (i.e. Hospitalist, Internist, GP, NP with acute care experience, Emergency physicians, or Surgeon) 

  • Secondary Assessment Centre – physicians working in the Secondary Assessment Centre (SAC) are expected to see patients who screen positive for the current case definition of COVID.  

  • Access Clinics – standard scope of practice for general practitioner. 

Do you have other specific skills that could assist to support the pandemic response? Tell us how you can support the pandemic response during this time. Please complete the following short survey, so that we may collect your information and match your skills with areas of need. Medical Affairs team members are collecting this information to assist the redeployment opportunities.  

Should you have any questions please contact physicianrecruit@nshealth.ca.
Swab Processing Prioritization
and Swab Results and Admissions
Swab Processing Prioritization
  • COVID swabs from inpatients and those submitted from Occupational Health will be placed first in the queue for testing as they arrive to the laboratory. 

  • However, due to increasing volumes, swabs from any other individual patient CANNOT be prioritized by the microbiology laboratory; they will be processed as received.

  • Please do not call the lab to request that an individual patient’s swab be prioritized. Also, please do not call the lab to track down results as it will slow the entire process and increase turnaround time for testing. Once completed, all results will be available in Millennium, the Clinical Portal and Share portal. If you do not have access you can call central reporting 902-473-2266.

Swab Results and Admissions
  • Clinicians who are deciding upon a patient’s disposition, should not be waiting for COVID-19 test results. If the patient requires admission and meets the COVID admission criteria please contact the COVID-19 inpatient unit.

  • If the patient does not meet the COVID-19 inpatient admission criteria but requires admission, the patient can be placed on droplet and contact precautions on the appropriate unit until the COVID swab is processed and results are known.
Changes to Northern Zone Medical
Executive Director Roles
Dr. Ryan Sommers, Interim Zone Medical Director for Northern Zone has been increasingly pulled towards his responsibilities as Zone Medical Officer of Health during this COVID-19 pandemic. As a result, he will be stepping down from his Interim role as ZMED effective immediately, a little earlier than his previously announced timeline to April 30. I want to thank Dr. Sommers (and his entire family) for the exceptional support to the zone and his continued work with COVID-19. 

Dr. Aaron Smith and Dr. Tanya Munroe have stepped in to support the zone medical leadership as we work through the challenges of this pandemic. They will support the zone in a co-leadership role and divide the work between them. Dr. Smith will support Pictou, Tatamagouche, Pugwash, Springhill and Aberdeen site issues; Dr. Munroe will support Colchester East Hants Health Centre and Cumberland Regional Hospital. They both will provide support to Northern Zone Medical Advisory Committee and Northern Zone Incident Management Team.

I would like to extend gratitude to both interim physician leaders who are providing this support in addition to busy practice obligations. We will all get through these times by working together!
Social Media Use
With widespread concern in the public about COVID-19, there is a lot of inaccurate and misleading information circulating on social media. It is important to remember that we are in a position to reassure people and direct them to accurate and up-to-date information. We ask you to use caution when posting or sharing information.

The situation is changing rapidly so please visit: https://novascotia.ca/coronavirus ,
https://canada.ca/coronavirus and www.nshealth.ca , regularly for updates.

There are also regular media briefings livestreamed on the goverrnment's web site, You Tube and Facebook pages, where Premier Stephen McNeil and Nova Scotia’s Chief Medical Officer of Health, Dr. Robert Strang, provide updates on the COVID-19 situation.
DNS Virtual Care Webinar
Tips for Getting the Most out of Virtual Care
Join Doctors Nova Scotia April 1, 2020, 6-8 p.m. for another in the COVID-19 webinar series on virtual care. Doctors John Ross, Ajantha Jayabarathan (AJ), David LaPierre and others will share their tips for success followed by a Q&A session.  Register here
PPE Supply Status
Some staff and physicians have expressed concern about whether there is enough personal protective equipment (PPE) in Nova Scotia to last through the COVID-19 pandemic.

Yesterday, president and CEO Dr. Brendan Carr shared a video message on this topic, reassuring staff and physicians that we have a healthy supply to meet our current need. He reminded staff and physicians that we need to ensure we are using this supply appropriately so that we can continue to meet the need for the duration of the pandemic.

As Brendan stated, “It’s important that all of us continue to focus on meeting not only the demands of today, but the demands of a surge we know is coming.”

Today we’re sharing a photo of our PPE stockpile to help reassure staff and physicians that we have a robust supply. We are also working to boost our stockpile, following both traditional and innovative procurement streams. 
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. If you receive unsolicited offers of N95 respirators, please forward these to: PPEOffer@nshealth.ca (Note: Email updated from March 26 update).
Perioperative (Surgical) Services
Resources and Webcast
Three new/updated resources have been shared today related to surgical care. These include updated triage recommendations, a new screening tool for emergency/urgent waitlist surgeries, as well as a resource developed to support the management of surgical cases in the Halifax Infirmary ORs. 

Other sites may find this resource helpful and are encouraged to email plans they adapt based off this model to Dr. Greg Hirsch, Senior Medical Director, Perioperative (Surgical) services and Dr. Marcy Saxe-Braithwaite, Senior Director, Perioperative (Surgical) Services. This will help ensure consistency with broad principals and standards. 
 
You can also download the recording of our March 25 DNS Webcast - Perioperative Care During COVID-19.
 
A Show of Appreciation
Aberdeen Hospital Site leads Dr. Chris Elliott and Kerry Heather distribute 80 bouquets of flowers to front line staff, that were donated by McKean’s Flowers in New Glasgow.
NSHA Operational Update
Nova Scotia Health Authority continues to plan and prepare at an organizational level, across the province, for service delivery during the COVID-19 pandemic.

Today, NSHA released our latest operational update. In addition to changes communicated yesterday, regarding collaborative emergency centres (CECs) in Cumberland County and the temporary Closure of the Women’s and Children’s unit at Cumberland Regional Health Care Centre, we are temporarily suspending the Colon Cancer Prevention Program. We have also updated visitor restriction information pertaining to cancer patients

Temporary suspension of the Colon Cancer Prevention Program
As NSHA focuses its efforts on managing the COVID-19 pandemic, we are suspending the Colon Cancer Prevention Program until further notice. This means:
  • Home screening kits will not be mailed out.
  • Home screening kits already at the lab and those that are already in the mail will be processed and the results will be mailed to participants.
  • Participants who test positive for trace amounts of blood in the stool will not be contacted for an appointment until the screening program has restarted; screening nurses will, however, contact them to answer questions/ease their concerns.
  • All screening colonoscopies which are currently booked will be cancelled until further notice.
  • NSHA is contacting scheduled patients and clients directly to notify them of cancellations
  • Nova Scotians who have received, but have not yet done the home screening test, should wait until the screening program resumes operations.
  • Nova Scotians who have worrying symptoms of colon cancer will be directed to speak with their primary care provider.
 
Updated visitor restriction information pertaining to cancer patients
 **In addition to the below information specific to cancer patients, strict visitor limits remain in place across all NSHA sites. 
 
Recognizing the fine balance between the real needs for emotional support and the implications of spreading COVID-19 in our treatment areas to vulnerable patients, the following visitor/companion policy is now in place.
  • Except under exceptional circumstances (e.g. mobility concerns, substitute decision maker in place, etc.) patients must attend appointments alone as per NSHA guidelines
  • Inpatients - We are encouraging the family members of cancer patients to adhere to the no-visitor restriction. If a patient has unique physical, emotional or cognitive complexity we will make an exception and allow one visitor to be present. 
  • Treatment - We are not permitting companions in the treatment venues, as the physical layout makes social distancing difficult and the vast majority of patients are immunocompromised.
  • Ambulatory clinics - In keeping with cancer centres across Canada, the NSHA cancer care program will permit patients who are having their first appointment to bring one companion with them. 
  • We will also be giving the option to join in via phone/Facetime should companions not wish to enter the facility. For subsequent clinic visits, we are asking patients to respect the no visitor restriction but will make exceptions if the patient has unique physical, emotional or cognitive complexity impacting their ability to attend alone.
 
For an overview of NSHA’s phased COVID-19 response plan, click here .
Provincial COVID-19 Status Update
As of today, March 27, Nova Scotia has 90 confirmed cases of COVID-19. 

Seventeen new cases were identified Thursday, March 26. Most are connected to travel or a known case. None of the new cases are connected to the St. Patrick's Day gathering in Lake Echo, Halifax Regional Municipality. All attendees at the event are being contacted and are being tested. Case investigations are ongoing. At this point, public health cannot confirm a link to community spread. 

It is imperative that anyone who has travelled outside Nova Scotia self-isolate for 14 days and for everyone to adhere to the five-person social gathering limit. As always, any Nova Scotian who develops symptoms of acute respiratory illness should limit their contact with others until they feel better. If they are concerned about COVID-19 they can go to https://811.novascotia.ca/ and use the online assessment tool. Anyone referred to an assessment site by 811 will be tested. 

The 90 individuals affected range in age from under ten to mid-70's. Two individuals are currently in hospital. Three individuals have recovered and their cases of COVID-19 are considered resolved. Cases have been identified in all parts of the province. 

Public health is working to identify people who may have come in close contact with the confirmed cases. Those individuals who have been confirmed are being directed to self-isolate at home, away from the public, for 14 days. 

To date, Nova Scotia has 3,649 negative test results and 90 confirmed cases. 

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 .

Quick Facts:
  • testing numbers are updated daily at https://novascotia.ca/coronavirus 
  • Nova Scotia's Health Protection Act gives the chief medical officer of health the authority to give advice to protect public health and decrease risk to public health presented by communicable diseases such as COVID-19
  • a state of emergency was declared under the Emergency Management Act on March 22 and remains in effect until noon, April 5
  • under the state of emergency government can control or prohibit assembly as well as travel to and from areas. It can also coordinate commerce activity and emergency responders.

A new virus like COVID-19 can cause fear. Nova Scotians are encouraged to support each other and use technology to stay connected.

Additional Resources:
  • Government of Canada: https://canada.ca/coronavirus
  • Government of Canada toll-free information line: 1-833-784-4397
  • The Mental Health Provincial Crisis Line is available 24/7 to anyone experiencing a mental health or addictions crisis, or someone concerned about them, by calling 1-888-429-8167 (toll free)
  • Kids Help Phone is available 24/7, by calling 1-800-668-6868 (toll-free)