COVID-19 Physician Information Update
May 8, 2020
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Updated Clinical Documents
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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies
COVID Assessment and Treatment
Infection Prevention and Control
Cancer Care
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Message from Dr. Nicole Boutilier
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As we start to plan for our service reintroduction as outlined by Dr. Carr in his messages today, I hope everyone can take a bit of a mental break this weekend to relax, re-energize and reward yourselves for the incredible teamwork and focus over the past two months. It’s been a remarkable time and we are definitely still in the middle of this COVID marathon. We need all of you for the next leg of this journey!
I want to also wish everyone a weekend of celebration or remembrance of mothers. While we may not be able to visit or hug our mothers or our children at this time, I know we carry them in our heart.
Happy Mother’s Day!
Nicole
P.S. Most of the clinical working groups are taking a well deserved break this weekend. We are not anticipating new documents, and will not publish a newsletter on Saturday and Sunday. As always, if there is information you need, we will adjust this plan.
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Message from Dr. Brendan Carr:
Health Service Reintroduction
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Dear colleagues,
In my recent message to you I referenced the fact that we have reached the peak of the COVID-19 pandemic. That is true. We are seeing the signs through the decreased number of people testing positive, limited community spread and low numbers of COVID inpatients in our hospitals.
Many of you are asking and wondering, “When will we get back to normal?” The simple answer – it’s going to take months and there will be a ‘new’ normal in terms of how our organization will deliver health services. Having said that, there are services that we know we need to reintroduce in the near future in a safe manner, keeping in mind our need to maintain a level of COVID-19 response.
I understand you are concerned about patients who are awaiting care and treatment. We are too. Our first priority will be to address the health needs of those people whose care was interrupted due to our efforts to create capacity within our system to respond to COVID-19. Ensuring their care needs are seen to is an important first step before we can look to resuming normal operations. That initial step as to how we reintroduce services will mostly likely look different across the regional zones and we need to consider three key elements: COVID service requirements; surge capacity and planning; and, support to long-term care.
Preparing to reintroduce services over the long-term is going to feel more like the changing of the season than the turn of one day to the next. It will be driven by epidemiology and we are going to advance a very careful plan developed in consultation with Dr. Robert Strang, the Chief Medical Officer of Health.
Teams have been mobilized across the organization to develop the short- and long-term plans and many of you will be asked for your input into those plans. One of the benefits of COVID-19 is that we have developed very effective structures and approaches through our emergency operation system at both provincial and zone levels that we can use to our advantage to streamline how we stage the reintroduction of services. In the coming days and weeks you will be provided with updates as to how that work is progressing.
And while that work is underway, our response to COVID-19 will also continue. The virus is still present and we do not have immunity. Unfortunately it could rise at any time and as such we also have to maintain capacity to respond to future surges or potential outbreaks.
You have all done great work over these past few months. I have complete confidence that you will all answer the call again as we move forward on the reintroduction of services.
Brendan
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We were notified by Nova Scotia Public Health that based on available epidemiological data, all current Community Clusters (Fairview, Dartmouth North and Preston/Lake Echo/ Lawrencetown) have been resolved.
Starting today, May 8, 2020, patients from those three Community Clusters who are asymptomatic and have no other identified COVID risk factors will no longer require additional precautions.
The COVID Risk Assessment Form must continue to be completed with every face to face visit and admission and appropriate precautions taken for both staff and patients when COVID-19 risk factors are identified.
As new community clusters are identified by Nova Scotia Public Health, we will notify staff and clinicians and the affected postal codes will be found in the
COVID community cluster postal code search.
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This 2.5-minute animated
PPE explainer video focuses on the theme of
Right PPE + Right Time = Healthy Providers.
Check it out for tips on how staff and physicians can best protect themselves against COVID-19.
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N95 Respirators and Fit Testing
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If you have been FIT tested for alternative models please use them and not the 1870+
In mid-April, NSHA introduced an expanded FIT testing model for N95 respirators to ensure that staff who are working with COVID-suspect or confirmed cases and who may need to perform aerosol-generating procedures are FIT tested to a variety of N95 respirators.
We made this change to ensure that those staff and physicians who need N95s will be able to receive and start using their supply without delay.
Many respirators are manufactured overseas. We’re well aware that global markets could shift and change; many countries are limiting exports. As a result, we launched an expanded FIT testing model to ensure staff are FIT tested to all procured models. In addition, we are adding to our stockpile of N95s to ensure we have the supply we need to enable our frontline workers to safely care for patients.
With ongoing consumption, our supply of 1870+ models has been reduced. These models will now only be provided to areas that have not undergone FIT testing on alternative models.
Knowing that a significant number of health care workers have been FIT tested to this model, we expanded FIT testing to include 3M 1870 and 1860, 1860s and 8210 models, as well as Pleats Plus. If you have been FIT tested to an alternative N95 model, you must select and don an alternative N95.
Many high-consumption areas such as COVID units, Critical Care, Respiratory Therapy, Anesthesia, Emergency, Perioperative and Airway teams have completed alternative FIT testing. Occupational Health, Safety and Wellness will be working with leadership in other units/areas to coordinate alternative FIT testing. It is important that staff participate in these FIT testing sessions to ensure they are properly FIT tested to a variety of models as noted above.
We want to assure you that our supply of all PPE, including N95s, can meet our current needs and we are working to ensure our supply meets future demand. Your safety and protection are our priority.
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NSHA enacted a process to forgive rent for physician experiencing a financial loss for the month of April.
NSHA has developed guidelines to forgive physician rents and will continue to evaluate these criteria for up to three months as we enter the height of COVID-19. Physicians who qualify for income stabilization can apply but this information will be reviewed with your application.
Eligibility
- Only physicians seeing a measurable decrease in revenue from MSI (defined as either FFS or other forms of alternative funding) are eligible to apply for this program.
- Individuals who are primarily remunerated through APP or AFPs are not eligible to participate in this program.
- Physicians who have received a portion of their income, typically less than 50%, through AFP or APP are eligible for this program.
- Eligibility is subject to NSHA verification of MSI billings.
Rent Suspension Application Process for May
We have noted that the online form previously provided, was not working as intended.
Eligible physicians can apply for deferral or suspension by downloading and completing the
application form and submitting to Medical Affairs at
PhysicianContracts@nshealth.ca. NSHA will review and communicate approval back in writing to all eligible physicians within 5 business days of the receipt of a completed application.
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Northern Zone Operations Executive Director
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Please be advised that Cheryl Northcott has resigned from her position as Operations Executive Director for the Northern Zone.
On behalf of the Nova Scotia Health Authority, I thank Cheryl for her many years of service to the administration and delivery of health services at the community and zone levels. I wish her all the best in her future endeavours.
On an interim basis, Debbie Burris, Senior Director, Acute Medicine Services, will fill the position of Operations Executive Director for the Northern Zone. This change is effective today, Friday, May 8, 2020.
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Online Learning Sessions from Library Services
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With COVID-19 evidence rapidly emerging, staff responsible for investigating, analyzing and synthesizing info can get continued support with essential skills through Library Services.
From May through June, Library Services will be offering practical and short online sessions (in 30 mins or less) that feature tips, tools and resources for consuming and creating content during the current pandemic and beyond. Register today for sessions in the
30 Minutes or Less series.
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Northern Zone Influenza Like
Illness Access Clinics
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In Northern Zone, the several assessment clinics have been stood up to assess and treat patients with influenza-like illness (ILI).
For Family Practices:
Locations and Hours
Amherst
11:00 am to 7:00 pm, 7 days a week
Hours that Physician or Nurse Practitioner Are On Site: 12:00 pm to 6:00 pm
New Glasgow
9:00 am to 7:00 pm, 7 days a week
Hours that Physician or Nurse Practitioner Are On Site: 12:00 pm to 5:00 pm
Truro
11:00 am to 7:00 pm 7 days a week
Hours that Physician or Nurse Practitioner Are On Site: 11:00 am to 5:00 pm Monday to Friday
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Priority COVID-19 Testing Update
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Priority COVID 19 testing on the GeneXpert platform is now available but with very limited availability. Instruments are in place in Aberdeen, CBRH, IWK, QEII, VRH, YRH and now at Colchester East Hants Health Centre. Although the assay can provide testing results within 1 hour, total turnaround time involves collection, transport and reporting of results which is closer to 2-4 hours.
NP swabs must be used however, the number of swabs are very limited and the decision to order priority testing must be carefully considered using the criteria below. The alternate throat/nares swab (Aptima) is 100 times less sensitive. GeneXpert is not validated for sputum testing.
Due to the limited availability of tests, the decision to use these tests will be managed locally and should only be used when results are required within a 6 hour time frame and cannot wait for the results from the QEII (whose TAT is < 24 hours once it arrives in the laboratory). The guidelines for test usage below will be updated when greater numbers of tests are available. There is no backlog for the routine COVID test.
GeneXpert testing should focus on:
- Intensive care settings – discuss with IPAC before removing patients from precautions. Patients with lower respiratory tract COVID 19 infection can have negative NP results. Lower respiratory tract specimens (ET secretions, BAL) are more sensitive in this setting.
- Residents in LTC (maximum of 3) – the remainder can be tested using the routine process
- Results required by Occ. Health to make decisions regarding management of HCW (requests must be requested directly to the laboratory by the Occ. Health physician)
- Pre-transplant donor or recipient screening
Decisions will be made on a case by case basis. Once our supply chain has improved we can revisit this guidance.
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Yarmouth Regional Hospital received dozens of ice-cream cupcakes from a small local business, Honey Bee’s Ice Cream shop. Staff and physicians were thrilled to get a chance to enjoy Honey Bee’s cupcakes – from a safe distance apart - with friends, family and co-workers.
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Provincial COVID-19 Status Update
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Today, May 8, Nova Scotia is reporting two additional deaths related to COVID-19, bringing the total to 46. The deaths occurred at the Northwood long-term care home in Halifax Regional Municipality.
"All Nova Scotians continue to hold Northwood residents and staff in their thoughts. I hope the families grieving today know their province is with them," said Premier Stephen McNeil. "Health system partners stand side-by-side with Northwood and our mobilization of efforts to support them will continue for as long as necessary."
As of today, Nova Scotia has 1,008 confirmed cases of COVID-19. One new case was identified Thursday, May 7.
The QEII Health Sciences Centre's microbiology lab completed 840 Nova Scotia tests on May 7 and is operating 24-hours.
There are two licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with active cases of COVID-19. Northwood in Halifax currently has 156 residents and 38 staff with active cases. One other facility has one staff member with an active case of COVID-19.
If you have two or more of the following symptoms, visit
https://811.novascotia.ca to determine if you should call 811 for further assessment:
- fever
- new or worsening cough
- sore throat
- runny nose
- headache
To date, Nova Scotia has 32,835 negative test results, 1,008 positive COVID-19 test results and 46 deaths. Confirmed cases range in age from under 10 to over 90. Five individuals are currently in hospital, two of those in ICU. Seven-hundred and twenty-two individuals have now recovered and their cases of COVID-19 are considered resolved. Cases have been identified in all parts of the province. A map and graphic presentation of the case data is available at
https://novascotia.ca/coronavirus/data .
Public health is working to identify and test 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.
Anyone who has travelled outside Nova Scotia must self-isolate for 14 days. As always, any Nova Scotian who develops symptoms of acute respiratory illness should limit their contact with others until they feel better.
It is now more important than ever for Nova Scotians to strictly adhere to the public health orders and directives - practise good hygiene, maintain a physical distance of two metres or six feet from others, limit essential gatherings to no more than five people and stay at home as much as possible.
Quick Facts:
- testing numbers are updated daily at https://novascotia.ca/coronavirus
- a state of emergency was declared under the Emergency Management Act on March 22 and extended to May 1
Additional Resources:
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Students Finish School June 5, Plan for Reopening Nova Scotia Under Development
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Premier Stephen McNeil and Dr. Robert Strang, chief medical officer of health, provided an update on COVID-19 today, May 8, announcing that the school year for students will end June 5 and licensed daycares will remain closed until at least June 5. They also outlined how government will determine the best way to reopen Nova Scotia.
Teachers will continue to work until the end of June to complete assessments and other tasks.
"I have been hearing amazing reports about how students, parents and teachers have been doing with at-home learning," said Premier McNeil. "I want to thank the parents and family members who have done their best to support their children's learning. And I want to thank the education workers who balanced home and work, too. You will have to do this for a little bit longer, but I believe in you and I know you've got this."
The goal is for daycares to reopen by June 8 but the timeline for them to resume operating will be determined in consultation with the sector. Those consultations are underway and will help inform Nova Scotia's reopening plan.
Nova Scotia's reopening plan is under development. It will be based on the following:
- advice from the Public Health Agency of Canada's recommendations and guidelines to lift public health measures
- status of COVID-19 in the province
- consultation with sectors
- the ability for people and businesses to continue to follow public health measures
"We must take a slow and methodical approach if we are to safely bring Nova Scotia back to normal," said Dr. Strang. "No decisions have been made. We are working on a reopening plan that balances public safety with the need to increase economic and social activity. The first phase is still some weeks away."
Reopening will be done in phases, over time. Each phase could last a minimum of 28 days. Readiness to reopen - and to move onto the next phase - will be assessed weekly.
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This section of our update is a list of helpful resources updated daily for physicians.
Please reach out to
Shawn Jolemore with your suggestions for additional content.
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Leadership and Wellness Poster
Updated for Week of May 4 - May 10
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Individual Executive Coaching for Physician Leaders with Executive Coach Lorie Campbell
Are you struggling to lead yourself or your team(s) well during this pandemic?
Take advantage of 30 or 60-minute focused, one-to-one virtual executive coaching sessions for formal physician leaders only. Email
Lorie Campbell to book a time for this free service, provided by NSHA Medical Affairs Leadership Development.
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Friend in Need: How to Support Your Peers
With Dr. Danya Lee-Baggley
Monday May 11, 4-5 p.m.
Please sign in with your full name and write your location of work after your name.
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Charge your Battery Series: Self-care Skills Training for Healthcare Providers During COVID-19
These sessions review empirically based skills that healthcare providers can use to be more fulfilled at work and home, and more engaged in consistent self-care behaviours, even during these times of crisis.
- Session 1: Building and sticking to a daytime routine that includes self-care
- Session 2: Emotion-focused coping for difficult emotions
- Session 3: Present moment awareness
- Session 4: Self-compassion to respond kindly to ourselves and others
- Session 5: Building and sticking to an evening routine to promote sleep
- Session 6: Emotion-focused coping for change and loss
- Session 7: Mindfulness
- Session 8: Compassionate responding to self and others
Sessions begin the week of May 11
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Physicians
Thursdays 4-5 pm
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Residents
Tuesdays 4-5 pm
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Managers/Leaders
Thursdays 2-3 pm
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CPSL Special Session - Everyday Resiliency
Dr. Robyne Hanley-Dafoe is a multi-award-winning psychology and education instructor who specializes in resiliency, navigating stress and change, and personal wellness in the workplace.
Described as transformational, engaging, and thought-provoking, Hanley-Dafoe provides practical strategies, grounded in global research and case studies, that help foster resiliency within ourselves and others.
With over 13 years of teaching and research experience at Trent University, her work connects research-informed practices with everyday applications that are realistic, universal, and sustainable.
Individuals must join via the link to have both audio and video. Understand that this is a sharing video so please be dressed and ready to go.
May 13, 2020 / 4:00 pm
Mind Body Skills Group:Learn Three Different Practices That Calm Your Mind, Relax Your Body and Life Your Spirits
With Dr. Zenovia Ursuliak, Wednesday, May 13, 4-5 p.m.
Please sign in with your full name and write your location of work after your name.
Mindfulness for Physicians: Emotion Regulation
With Dr. Nicole Herschenhous, Friday, May 15, 4-5 p.m.
Please sign in with your full name and write your location of work after your name.
Balint Support Group
Drs. Nicole Herschenhous and Ali Manning are starting a six-week virtual Balint group for physicians. Balint groups help reduce burnout and improve communication skills and empathy. Physicians will use case-based discussion for support around emotions and ethical dilemmas. More info
here. Email
Dr. Ali Manning to register!
Daily Physician Wellness Check In - COVID-19 What's Normal?
Join Drs. Jaqueline Kinley and John Chiasson for daily online meetings to chat about coping strategies and mental health concerns. Meetings are daily M-F at 12 NOON. and are open to all physicians. Click here for the
*updated* Zoom -
Join Zoom Meeting Link
DNS Professional Support Program
Feeling overwhelmed or need to talk to someone?
As we try to wrap our heads around the weekend’s tragic events and the senseless loss of so many innocent lives, I want to remind you that help is available. Whether you were directly connected to it or not, the tragedy intensifies the stress of the pandemic and the pressure on our lives due to the measures we are all following.
Contact the Doctors Nova Scotia (DNS)
Professional Support Program at 902-468-8215 or 1-855-275-8215 (toll-free) mail or via
email. LifeWorks by Morneau Shepell is also available to members and their families affected by the events in Portapique and surrounding communities. The crisis support line is open 24-7. Call 1-844-751-2133.
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Physician Screening for COVID-19
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Call 1-833-750-0632 to speak to Occupational Health and Safety for your screening options.
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