COVID-19 Update from the Department of Medicine
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As of May 8, 2020 in Nova Scotia
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1,008
positive tests
(861 in Central Zone)
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3
currently in hospital (non-ICU)
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2
currently in hospital (ICU)
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I hope everyone is staying well. This week marked a significant decrease in new cases and communities with cluster activity; which means all that we are doing is making a difference. We are now shifting our focus to how we are going to resume our non-COVID services again and how we are going to be able to be flexible in the coming months to increase and decrease those services in response to COVID activity in our communities. I would like to thank Dr. Simon Jackson (Division of Cardiology and QEII medical site lead) for his work on this initiative. As the numbers of cases decrease and we get to catch our breath, at least for a short time, I would like to recognize all of the work our department has done and continues to do to support the health system. I want to thank everyone from our administrative staff who have added responsibilities and challenges working from home and assuming duties for those colleagues redeployed to Northwood and primary and secondary assessment centres, to our physicians working at Northwood to support primary care physicians and our physicians working in the COVID IMCU and inpatient COVID units at the QEII and Dartmouth General. I have to thank our Infectious Diseases Division who has been at the helm of clinical planning and Infection Prevention and Control. They have spent countless hours including weekends to keep on top of COVID management and no one could have done this without them. Many of you are doing clinical and administrative activities you don’t traditionally do or have not done before; thank you.
Our Researchers are standing up trials and projects faster than one could ever believe and this week were successful in securing almost $500,000 in funding from the Nova Scotia Research Coalition Grant competition. Thank you to them for creating the new knowledge that will help us beat COVID.
The theme of our strategic planning that we have been doing over the last 18 months or so has been how we come together to support each other and make our department an even stronger one. As tough as the COVID-19 pandemic has been and as much as it has turned the system and the work we do upside down, it has certainly shone a light on how strong and great we are as a department when we come together.
Keep well,
Christine
Christine Short, MD, FRCP(C), FACP
Associate Professor & Head/Chief, Department of Medicine
Dalhousie University/Central Zone, Nova Scotia Health Authority
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Undergraduate Medical Education
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- Current Med 3 clerks (Class of 2021) - Tentative aim is to restart clerkship on June 8 with two 8-week units to allow all remaining core objectives to be met.
- Virtual graduation ceremony for entire Class of 2020 on May 21.
Excerpts from:
Faculty of Medicine: COVID-19 Update #12 (emailed May 1)
Office of the Dean
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Postgraduate Medical Education
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- Self-Isolation Measures Adjusted - Dr. Robert Strang, Chief Medical Officer of Health for Nova Scotia, advised that residents returning from rotations elsewhere in the Maritimes must now adhere to ''work isolation'' protocols, as defined by the NSHA, rather than strict self-isolation for 14 days.
- Electives - Dalhousie electives will re-open on July 1, 2020. (Public Health rules may still require a period of self-isolation upon arrival in a new province, so residents and Program Directors are asked to use their best judgement about the relative value of individual electives, depending on the specific Public Health requirements of the individual province.)
Excerpts from:
Faculty of Medicine: COVID-19 Update #12 (emailed May 1)
Office of the Dean
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From the Division of General Internal Medicine
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GIM Inpatient Consults - ON HOLD
Effective
Wednesday, May 6, the Division of General Internal Medicine will no longer be offering inpatient consultation services at the QEII (both HI and VG sites) to generate additional staff capacity to cover inpatient medicine services in response to COVID-19.
- All inpatient internal medicine consults should be redirected to the most appropriate medicine subspecialty to address the consult question.
- This change will be re-evaluated on Wednesday, June 3.
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GIM Outpatient Rapid Access Clinic - ON HOLD
Effective
Friday, May 1, the General Internal Medicine Rapid Access Clinic will be unavailable.
- Any urgent internal medicine referrals in the emergency department should be directed to the Senior Internist team to complete the assessment in the ED prior to discharge home. If the Senior Internist determines that the patient can go home with need for urgent internal medicine follow-up then the Senior Internist can discuss arranging that follow-up directly with Dr. David Simpson or Dr. Rosario Rebello who are covering our ambulatory program at this time.
- This change will be re-evaluated as the COVID-19 situation evolves and communication will be released once the clinic is accepting referrals again.
Excerpts from announcement by:
Nabha Shetty and Ashley Miller
Interim Co-Division Heads
Division of General Internal Medicine
Department of Medicine, Dalhousie University
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Nova Scotia COVID-19 Health Research Coalition
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The Nova Scotia COVID-19 Health Research Coalition is comprised of eight organizations:
- Dalhousie University
- Dalhousie Medical Research Foundation
- Nova Scotia Health Authority
- QEII Foundation
- Dartmouth General Foundation
- Research Nova Scotia
- IWK Foundation
- IWK Health Centre
The Coalition worked in collaboration to raise $1.5 million in support of COVID-19 research. There were 262 applications and 40 projects were awarded funding on April 30. Congratulations to the following DoM recipients (9 projects):
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Project:
Cellular immune phenotype in patients with severe COVID disease before and after COVID-19 treatment
Dr. Lisa Barrett, Division of Infectious Diseases
$ 75,000
This study aims to better understand COVID-19 immune disruption and reversibility by examining global and SARS-CoV-2 specific immune dysregulation before, during and after therapy.
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Project:
Understanding how grades of frailty affect the evolution of COVID
Dr. Kenneth Rockwood, Division of Geriatric Medicine
$ 73,000
This study will investigate how differences in frailty and fitness among people being assessed for COVID-19 are related to the development, progression, and outcomes of the disease.
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Health System Improve
ment
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Project:
Internists Crisis Support for PCPs in LTC: making connections during COVID19
Dr. Nabha Shetty, Division of General Internal Medicine &
Dr. Paige Moorhouse, Division of Geriatric Medicine
$ 47,531.25
This study will develop and implement a “one stop shop” for medical specialist consultation by primary care providers working with long-term care residents to manage COVID-19 outbreaks ,with real-time evaluation of feasibility and effectiveness using an implementation science methodology.
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Project:
Physical Distancing and Medical Distancing: Reducing the Cardiac and Neurovascular Impact of COVID‐19
Dr. Ratika Parkash, Division of Cardiology
$ 73,750
This study will investigate the degree to which Nova Scotia’s COVID-19 pandemic response has affected morbidity and mortality in patients with known or new onset cardiovascular or neurovascular disease.
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Project:
Prevalence and clinical characteristics of COVID-19 among hemodialysis patients
Dr. Karthik Tennankore, Division of Nephrology
$ 43,103.36
This study will describe and compare clinical characteristics of hemodialysis patients with known or suspected exposure to COVID-19 with those of hemodialysis patients with no known or suspected exposure to COVID-19, and describe the clinical outcomes of hemodialysis patients who develop COVID-19 with those who do not.
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Project:
Right care, right time, right place: Leveraging a virtual care solution in the delivery of community-based care for COVID-19 patients
Dr. Ashley P. Miller, Division of General Internal Medicine
$ 73,000
This study will evaluate, refine, and implement a virtual patient-centered platform to guide COVID-19 patient care in the community, and examine clinical predictors of COVID disease progression.
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Project:
COVID-19 viral shedding study
Dr. Glenn Patriquin [affiliated with Division of Infectious Diseases]
$ 25,000
This study will determine the optimal upper respiratory tract specimen for detecting virus in COVID-19 patients, the point at which the virus is no longer detected in infected individuals’ upper respiratory tracts, the point at which recovered patients are no longer infectious, and how antibody titres correlate with viral shedding and disease severity.
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Project:
A Multiplex Platform for Higher Sensitivity Detection of SARS-CoV2
Dr. Todd Hatchette [cross appointment with DoM - major appointment in Pathology]
$ 44,000
This study will develop a new, digital droplet polymerase chain reaction (ddPCR) COVID-19 test and determine whether it is more sensitive than the existing real-time PCR test.
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Project:
Canadian Longitudinal Study on Aging (CLSA):Building a COVID-19 Platform for Research in Canada
Dr. Susan Kirkland [cross appointment with DoM - major appointment in Community Health & Epidemiology]
$ 35,000
As part of the existing Canadian Longitudinal Study on Aging (CLSA), this study will determine individual factors that increase risk of COVID-19 symptoms and severity, understand the impact of pre-COVID factors such as socioeconomic status on health outcomes, and assess the long-term health and social consequences of COVID-19 and associated mitigation strategies on older adults.
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Changes to COVID-19 Community Cluster Process
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Changes start May 7 at 0800
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Currently Nova Scotia Public Health is identifying geographic areas where there is sustained and persistent transmission of COVID-19 within communities. These community clusters are noted within the NS Public Health Epidemiology report which is published daily. Nova Scotia Public Health is concerned that there is an increased risk of asymptomatic infection and risk of transmission from patients residing within these communities. As we have done throughout the pandemic, a precautionary approach is being taken to keep both healthcare workers and patients safe while they are within NSHA. Additional precautions are recommended when caring for patients from these clusters.
In collaboration with Public Health and the IWK, we have refined the methodology to identify Community Clusters by using the 6 characters of the postal codes rather than using only the first 3 characters of the included postal codes as this methodology captures not only the Community Cluster but potentially the surrounding area. Using 6 digit postal codes allows us to include only addresses that fall within the Community Cluster. The Community and Facility clusters are identified daily within the Nova Scotia Public Health Epidemiology report. We will then take the clusters, assign postal codes using the most recently available postal code data from a Nova Scotia postal code ‘look up’ program.
We have created a searchable excel file COVID Community Cluster Postal Code Search, that will be used by healthcare workers to search the postal code of the patient. The healthcare worker will enter the 6 digits of the patient’s postal code and the program will indicate “YES” if the postal code is part of a community cluster or “NO” if the postal code is not part of a community cluster. The healthcare worker will only see the searchable box. All postal codes will be hidden and locked, making it less accessible. The COVID Community Cluster Postal Code Search will be a link from the current landing page for Community and Facility Cluster information on the COVID HUB. The landing page is located on the intranet and requires a NSHA or IWK account to access. Clinical Medical Advisory Committee will continue update the list daily to ensure the most current data is available for healthcare teams.
Health Information Services staff will pull the lists of booked appointment (1 to 2 days in advanced of scheduled appointments) and use COVID-19 Community Cluster Postal Code Search to identify if the patient resides within a cluster, if so they will put a droplet/contact flag to the patient chart using the patient flag (PHS) or staff flag (Meditech) process.
In addition healthcare workers are completing the COVID Risk Assessment Form for all patients with their initial interaction (ambulatory/surgical) visit and admissions. As part of the COVID Risk Assessment, one of the questions is Does the patient reside in a community or facility cluster? The healthcare worker will then go to the HUB, use COVID Community Cluster Postal Code Search, using the patient’s postal code, search the postal code and it will indicate if the postal code is in a community cluster; as well the facilities with COVID will be listed.
From
NSHA Leadership
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Screening patients prior to surgery / procedure
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Patients who reside within a COVID community or facility cluster and
have booked surgeries or procedures in the near future should be swabbed prior to surgery / procedure.
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from the Clinical Medical Advisory Committee, May 2
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Your mental health needs during a pandemic
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Statistics Canada wants to hear about your mental health and well-being.
Results will be used by governments and other organizations to evaluate the need for services and assistance programs to support individuals, families, and communities during and after the pandemic.
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Survey open until Monday, May 11.
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How are Canadians coping with the COVID-19 situation?
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View the results of the recent March / April survey by Statistics Canada.
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Weekly update and mini grand rounds
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COVID-19 Weekly Update for DoM
8 - 8:15 a.m.
(adjusted)
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DoM Grand Rounds
8:15 - 9 a.m.
(adjusted start time)
"What's in the Air with COVID-19?"
Dr. Lynn Johnston
Division of Infectious Diseases
Complete your evaluation:
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Featuring Cape Breton Regional Hospital Staff and Physicians with special guest, Heather Rankin
"Meaghan Grant-Bennett and Michelle Wheelhouse, medical social workers, looked for a way to acknowledge the fear and anxiety yet bring hope and optimism to co-workers, family, friends and neighbours. They reached out to various departments, units and services at the hospital to take part in the We Rise Again video project. The video features staff and physicians (and a special guest) singing “Rise Again,” composed by Leon Dubinsky and recorded by the iconic Rankin Family."
NSHA Vimeo
Uploaded: Thursday, May 7, 2020
Video: 5 min 36 secs
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Cuban doctors battling COVID-19 around the globe
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"Cuban doctors and nurses have been working in some of the most challenging emergencies around the globe for many years including the Ebola crisis in West Africa and the aftermath of Chernobyl. Now they are working to treat patients with COVID-19 in
22 countries
including Italy and South Africa."
Interview between:
- Jonathan Green, Australian Broadcasting Corporation
- John Kirk, Professor, Department of Spanish and Latin American Studies, Dalhousie University
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Time
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15 min 30 sec
Uploaded:
May 6, 2020
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NSHA / Dr. Lynn Johnston
Uploaded: March 13, 2020
Video: 10 min
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NSHA / Dr. Glenn Patriquin
Uploaded: April 3, 2020
Video: 3 min
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COVID IMCU, MTU, SI-ED Schedule
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My Personal Directive
(Legal Information Society of Nova Scotia)
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Once completed online, it can be downloaded or emailed. Once signed and witnessed, it is valid.
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Spectrum MD
(Antimicrobial Stewardship)
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A list of some neighbourly businesses offering convenient, discounted or free services.
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NSHA healthcare workers experiencing COVID-19 symptoms, contact: 1-833-750-0632
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Nova Scotia Health Authority
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Government of Nova Scotia
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When you take care of yourself, you take care of others.
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