Minutes - February 17, 2022 - Board of Health Meeting

Members Present: 

Mr. Matt Reid (Chair)
Ms. Kelly Elliott (Vice-Chair)
Mr. John Brennan
Mr. Mike Steele
Mr. Selomon Menghsha
Ms. Mariam Hamou
Ms. Maureen Cassidy
Ms. Aina DeViet

Regrets:

Ms. Tino Kasi

Others Present:

Ms. Carolynne Gabriel, Executive Assistant to the Board of Health and Communications Coordinator (Recorder)
Dr. Alexander Summers, Acting Medical Officer of Health
Ms. Emily Williams, Chief Executive Officer/Director, Health Organization
Ms. Stephanie Egelton, Senior Executive Assistant to the Medical Officer of Health/Associate Medical Officer of Health
Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Disease
Ms. Maureen MacCormick, Director, Healthy Living
Mr. Dan Flaherty, Communications Manager
Ms. Shaya Dhinsa, Manager, Sexual Health
Mr. Christian Daboud, Manager, Health Equity
Ms. Isabel Resendes, Manager, Healthy Families Home Visiting
Mr. Parthiv Panchal, Information Technology, End User Support Analyst

Chair Matt Reid called the meeting to order at 7:00 p.m.

Disclosure of Conflict of Interest

Chair Reid inquired if there were any disclosures of conflicts of interest. None were declared.

Approval of Agenda

It was moved by Ms. Aina DeViet, seconded by Ms. Mariam Hamou, that the AGENDA for the February 17, 2022 Board of Health meeting be approved.
Carried

Minutes

IIt was moved by Ms. Kelly Elliott, seconded by Ms. Maureen Cassidy, that the MINUTES of the January 20, 2022 Board of Health meeting be approved.
Carried

It was moved by Mr. Mike Steele, seconded by Ms. Elliott, that the MINUTES of the February 3, 2022 Finance & Facilities Committee meeting be received.
Carried

Reports and Agenda Items

Finance & Facilities Committee Meeting Summary from February 3, 2022 (Report No. 06-22)

Mr. Mike Steele, Chair, Finance and Facilities Committee provided a summary of the proceedings of the February 3, 2022 Finance and Facilities Committee meeting.

It was moved by Mr. Steele, seconded by Ms. Cassidy, that the Board of Health receive Report No. 01-22FFC re: “Finance & Facilities Committee –2022 Reporting Calendar” for information.
Carried

It was moved by Mr. Steele, seconded by Ms. DeViet, that the Board of Health approve the renewal of the group insurance rates administered by Canada Life as described in Report No. 02-22FFC re: “Canada Life Benefits – Renewal Rates”.
Carried

It was moved by Mr. Steele, seconded by Mr. John Brennan, that the Board of Health receive Report No. 03-22FFC: “Employee and Family Assistance Program (EFAP) Services Contract Extension” for information.
Carried

It was moved by Mr. Steele, seconded by Ms. Cassidy, that the Board of Health receive Report No. 04-22FFC re: “2022 Budget Process Update” for information.
Carried

Governance Committee Meeting Summary from February 17, 2022 (Verbal update)

Ms. Aina DeViet, Chair, Governance Committee provided a summary of the proceedings of the February 17, 2022 Governance Committee meeting.

It was moved by Ms. DeViet, seconded by Mr. Steele, that the Board of Health approve the 2022 Governance Committee Report Calendar
Carried

It was moved by Ms. DeViet, seconded by Ms. Elliott, that the Board of Health:
1) Receive Report No. 02-22GC re: “Governance By-law and Policy Review” for information; and
2) Approve the governance policies as appended to this report.
Carried

It was moved by Ms. DeViet, seconded by Ms. Cassidy, that the Board of Health receive Report No. 03-22GC re: “Annual Privacy Program Update” for information.
Carried

It was moved by Ms. DeViet, seconded by Mr. Brennan, that the Board of Health:
1) Receive Report No. 04-22GC re: “MLHU Risk Management Plan” for information; and
2) Approve the new Middlesex-London Health Unit Risk Management Plan and Risk Register.
Carried

Presentation on Black History Month

Dr. Alexander Summers, Acting Medical Officer of Health, acknowledged that February is Black History Month and that, under the leadership of Ms. Heather Lokko, Director, Healthy Start/Chief Nursing Officer and Mr. Christian Daboud, Manager, Health Equity, MLHU has been internally celebrating. Dr. Summers then introduced Mr. Daboud who provided a slideshow presentation articulating how the Health Unit has internally been observing and celebrating Black History Month, including:

• Weekly emails sent to all staff to advise staff about a variety of options for how to engage in Black History Month, including upcoming events, videos, biographies of Black leaders and artists in the community, weekly educational topics, and music playlists highlighting Afrocentric music.
• Weekly presentations at the Health Unit staff townhall meetings.
• Weekly activities through “virtual coffee breaks” in collaboration with the Be Well Committee, for example “The Privilege Game.”
• Two educational events titled “Black History is World History” presented by Shifting Perspectives, a local training organization.

It was moved by Ms. Hamou, seconded by Ms. Elliott, to receive the verbal presentation on Black History Month for information.
Carried

Update to MLHU Policy on Child Abuse and/or Neglect and Duty to Report (Report No. 07-22)

Dr. Summers introduced this report and highlighted that this policy is a foundational component of the Health Unit’s operations and that the Health Unit leadership team wants to ensure that the Board of Health is aware that the Health Unit is discharging its responsibilities with regards to child safety.

Dr. Summers introduced Ms. Isabel Resendes, Manager, Healthy Families Home Visiting who spoke to the report.

Discussion on this report included:

• Everyone including members of the public and Health Unit staff has the responsibility to report suspected child abuse and/or neglect.
• Prior to COVID-19 child abuse and/or neglect issues were seen as significant concerns in Canada.
• The evidence of the impact of the pandemic on child abuse and/or neglect is still being collected but it is clear that the risk factors such as financial insecurity, lack of informal supports, use of alcohol, and mental health concerns have increased.
• MLHU policy has been updated to reflect legislative responsibilities and to have clear processes in place.
• Policy now aligns with legislation, so all staff are aware that the age of protection has been raised from 16 to 18 years old.
• After submitting a verbal report to Children Ais Society (CAS), all staff must follow up with an approved print or electronic letter within two days to CAS. A copy will also be included in the client file and copied to Ms. Resendes.
• Oral Health Team’s procedure for reporting potential dental neglect has been incorporated into the policy.
• It is not necessary that employees, or anyone, be certain that abuse and/or neglect is occurring to make a report. If there is any concern, staff should reach out to their manager.
• It is the preferred practice to notify the parent that a report has been made to CAS unless there is reason to believe that doing so might jeopardize an investigation or endanger a child or employee.
• Under Canadian law a fetus is not considered a legal person; therefore, employees are not permitted to refer a fetus to CAS unless there is express concern by the pregnant individual.
• Staff at MLHU often have access to information that give them the legal and ethical duty to report to CAS if there is reasonable ground to believe a child needs protection.

It was moved by Ms. DeViet, seconded by Ms. Cassidy, that the Board of Health receive Report No. 07-22 re: “Update to MLHU Policy on Child Abuse and/or Neglect and Duty to Report” for information.
Carried

Know Your Status – Increased HIV Testing in Emergency Departments (Report No. 08-22)

This report was introduced by Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Disease, who introduced Ms. Shaya Dhinsa, Manager, Sexual Health.

Discussion on this report included:

• In 2016, there was an HIV crisis in Middlesex-London. The Health Unit observed that local rates were usually around 20-24 cases a year, but in 2016 it was over 60 cases and primarily among people who inject drugs (PWID) which was different than the rest of Ontario.
• The Health Unit focused on UNAIDs 90-90-90 campaign: 90% of individuals with HIV know their status, of those individuals, 90% are on treatment, and of those individuals, 90% have undetectable viral loads.
• Many initiatives have been implemented since 2017 including: the safe injection site, which has connections to services and education; increased access to harm reduction supplies; and 20 locations to access supplies and 24 safe needle disposal sites.
• The Outreach Team was another initiative implemented around the end of 2017 and they were instrumental in connecting individuals to care who are hard to reach. The Outreach Team’s case load started at 25 and is now 150 individuals.
• The Middlesex-London Health Unit was the first in Ontario to launch “Cook your wash” campaign to decrease bacteria and viruses in drug “cookers” through boiling them.
• Initiatives to increase HIV testing in emergency departments had not yet been implemented. Many who are very sick get tested in the emergency department and find out they have HIV or leave and cannot be reached afterwards.
• Funding was secured for this initiative: “Know Your Status” with the support of Regional HIV/AIDS Connection. This funding is temporary to at least December 31, 2022.
• The initiative’s first phase included promotional materials distributed in emergency departments, including materials to inform patients why they are being asked and other locations where they can get tested if they are not yet ready to be tested onsite. The second phase, starting February 28, 2022, is to have a nurse in the emergency department educating and promoting testing. There is an continuing education credit for nurses and physicians. The premise of the initiative is that emergency physicians already test for HIV; this initiative will increase the rate of testing through education and awareness. The Health Unit already has all the supports in place for individuals who test positive for HIV, but if physicians to not know this, they may be reluctant to test as much.
• Risk factors for HIV have changed locally with more cases in men who have sex with men (MSM) and as a result of a decrease in condom use, which has increased in 2021. Many people will not disclose their risk factors due to stigma. Increasing testing in a broader population of people has proven successful in Vancouver for early identification of people who have HIV. The sooner infection can be detected, the sooner individuals can get on treatment.
• Data from London Intercommunity Health, which has the My Cares program, and the HIV care program provided through St. Joseph’s, shows that engagement in care cannot be verified for 16% of the 242 clients. It is possible that these individuals have passed away or moved locations. That is a smaller number than it was years ago, but it is important to track this information to determine the importance and success of these initiatives.

It was moved by Ms. Cassidy, seconded by Ms. Hamou, that the Board of Health receive Report No. 08-22 re: “Know Your Status - Increasing HIV Testing in Emergency Departments” for information.
Carried

Verbal COVID-19 Disease Spread and Vaccine Campaign Update

Dr. Summers provided an update on the COVID-19 disease spread and vaccine campaign in the Middlesex-London region and shared a slideshow presentation.

Discussion included:

• Updated provincial data from Feb 17, 2022, highlighting the number of people in hospital is 1342 and in the ICU is 356. Furthermore, the third dose coverage across the province is around 6.7 million people.
• Highlighting these numbers helps to interpret the models which came out of the Science Advisory Table at the beginning of February, which looked at hospital occupancy over time. The challenge with modelling this time was that there was decreased testing and so an accurate sense of the prevalence of COVID-19 in the community was lacking; however, it is possible to have a sense of the trends. Scenarios explored by the Scientific Advisory Table were low, moderate, and high severity following public health protections implemented in January. The Table also looked at vaccination coverage and the number of people who were infected at the beginning of the omicron wave. As restrictions ease, the probability exists that cases will increase in mid-February into March; however, so far the province seems to be in a better place than was projected with the low severity scenario.
• The current trajectory for ICU rates is favourable as a province.
• There has been increased thinking about COVID-19 into the future. Reaching a critical population immunity threshold to limit COVID-19 transmission is unlikely to occur, so instead, there is a need to manage COVID-19 in community through vaccination in order to avoid surges that overwhelm the healthcare system. It is likely that continued vaccination of the population at regular intervals will be needed to avoid the surges already seen with COVID-19.
• Operationally, the Health Unit continues to plan for case and outbreak management capacity for the remainder of 2022 and continues to plan the vaccination campaign as there is likely be a fourth dose push in 2022.
• The Province is easing public health protections as of today including: increasing social gathering limits, removing capacity limits in most settings where proof of vaccination is required, and raising capacity limits to 50% in large arenas. As of March 1, 2022, the Province is lifting capacity limits in all indoor settings and lifting proof of vaccination requirements. As a result of this, it is expected that COVID-19 cases will increase; however, it is unknown how it will affect hospitalizations. As restrictions are eased, the Health Unit will continue to track what it can track and respond to outbreaks in highest-risk settings as well as communicate the importance of mask use and vaccination.
• Booster dose coverage in the Middlesex-London region has slowed. The highest rates of booster doses are among the older age groups and decline as populations get younger. The Health Unit will continue to try to increase coverage through promotional campaigns and providing access through mobile clinics.
• The Health Unit is starting to see a plateau in vaccine uptake in children.
• Youth 12 to 17 years of age will become eligible for a booster dose starting tomorrow. Booster doses are critical against the Omicron variant for preventing symptoms, hospitalization, and death.
• The Health Unit is initiating new ways to increase vaccination coverage. This will include, for example, the celebration of Superhero Day on Family Day, February 21, with superheroes attending clinics and staff encouraged to dress up.
• Public health is continuing to learn how immunity wanes following the COVID-19 vaccination; however, what is important is completing a primary series of the vaccine and having a recent booster dose. Immunity will wane after six months which will result in increased vulnerability to symptomatic illness; however, its affect on the risk of hospitalization and severe outcomes is still unknown.
• Motivating people to get vaccinated will continue to be the work of public health. Most people get vaccinated because they trust the science and want to protect themselves and their community. We see more uptake among older people because their individual risk is higher so their incentive to get vaccinated is higher. As there is a decrease in personal risk, there is a need to find the individual levers that motivate people. For example, getting sick may be enough of an incentive for some to get vaccinated, but for others, the inconvenience of getting vaccinated is enough to deter them.
• There has been a very small increase in the rate of pediatric hospitalizations during the Omicron wave compared to the other waves. Earlier this week there was a spike in pediatric cases, but it’s beginning to decrease; time is needed to determine the trend.
• The backlog in surgeries both provincially and locally is significant. Plans are in place across the healthcare sector to reduce the backlog, but the major limitation remains health human resources.
• Youth now eligible to receive a booster dose can either walk into a clinic or book an appointment; however, the Health Unit is encouraging them to book in order to better manage volumes.

It was moved by Ms. Elliott, seconded by Mr. Selomon Menghsha, that the Board of Health receive the “Verbal COVID-19 Disease Spread and Vaccine Campaign Update” for information.
Carried

Acting Medical Officer of Health Activity Report for January (Report No. 09-22)

It was moved by Ms. Cassidy, seconded by Mr. Steele, that the Board of Health receive Report No. 09-22 re: “Acting Medical Officer of Health Activity Report for January” for information.
Carried

Chief Executive Officer Activity Report for January (Report No. 10-22)

It was moved by Ms. Hamou, seconded by Ms. Elliott, that the Board of Health receive Report No. 10-22 re: “Chief Executive Officer Activity Report for January” for information.
Carried

Correspondence

No correspondence was received.

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, March 17 at 7:00 p.m.

Confidential

At 8:11 p.m., it was moved by Ms. DeViet, seconded by Mr. Menghsha, that the Board of Health will move in-camera to consider matters regarding identifiable individuals, including Board employees and to approve previous confidential Board of Health minutes
Carried

At 8:24 p.m., it was moved by Ms. Hamou, seconded by Ms. Cassidy, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 8:25 p.m., it was moved by Ms. Elliott, seconded by Ms. DeViet, that the meeting be adjourned.
Carried

Matt Reid
Chair

Emily Williams
Secretary