Minutes - April 21, 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 (joined at 7:18 p.m.)
Ms. Mariam Hamou
Ms. Maureen Cassidy
Ms. Aina DeViet
Ms. Tino Kasi 

Others Present:

Ms. Carolynne Gabriel, Executive Assistant to the Board of Health and Communications Coordinator (Recorder)
Dr. Alexander Summers, Medical Officer of Health
Ms. Emily Williams, Chief Executive Officer/Director, Health Organization
Ms. Stephanie Egelton, Executive Assistant, Medical Officer of Health and Associate Medical Officer of Health
Ms. Heather Lokko, Director, Healthy Start/Chief Nursing Officer
Ms. Maureen MacCormick, Director, Healthy Living
Ms. Cynthia Bos, Manager, Human Resources
Ms. Lilka Young, Health and Safety Advisor
Ms. Linda Stobo, Manager, Chronic Disease Prevention and Tobacco Control
Ms. Alison Locker, Manager, Public Health Assessment and Surveillance
Ms. Tracey Gordon, Manager, Vaccine Preventable Diseases
Mr. Dan Flaherty, Communications Manager
Mr. Alex Tyml, Online Communications Coordinator
Mr. Parthiv Panchal, Information Technology, End User Support Analyst

Chair Matt Reid called the meeting to order at 7:02 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. Maureen Cassidy, seconded by Ms. Aina DeViet, that the AGENDA for the April 21, 2022 Board of Health meeting be approved.
Carried

Minutes

It was moved by Ms. Kelly Elliott, seconded by Ms. Mariam Hamou, that the MINUTES of the March 17, 2022 Board of Health meeting be approved.
Carried

It was moved by Ms. Cassidy, seconded by Mr. John Brennan, that the MINUTES of the April 7, 2022 Finance & Facilities Committee meeting be received.
Carried

Reports and Agenda Items

Finance & Facilities Committee Meeting Summary from April 7, 2022 (Report No. 20-22)

Mr. Mike Steele, Chair, Finance and Facilities Committee provided a summary of the proceedings of the April 7, 2022 Finance and Facilities Committee meeting. The Finance and Facilities Committee received five (5) reports from staff.

It was moved by Mr. Steele, seconded by Ms. Cassidy, that the Board of Health:
1) Receive Report No. 06-22FFC, re: “Cyber Security Training” for information;
2) Receive Report No. 07-22FFC, re: “Financial Borrowing Update” for information;
3) Receive Report No. 08-22FFC, re: “2021 Vendor and VISA Payments” for information;
4) Receive Report No. 09-22FFC, re: “2021 Board of Health Remuneration” for information; and
5) Receive Report No. 10-22FFC, re: “Q4 Financial Update and Factual Certificate” for information.
Carried

Mr. Steele updated the Board of Health that the May Finance and Facilities Committee meeting has been cancelled. The next meeting of the Finance and Facilities Committee will occur the first Thursday in June.

Verbal Governance Committee Meeting Summary from April 21, 2022

Ms. Aina DeViet, Chair, Governance Committee provided a summary about the proceedings of the April 21, 2022 Governance Committee meeting, which had four (4) reports presented.

It was moved by Ms. DeViet, seconded by Ms. Cassidy, that the Board of Health receive Report No. 05-22GC, re: “2021 Occupational Health and Safety Report” for information.
Carried

It was noted that the Governance Committee moved to make the MOH and CEO Performance Review Committee a standing committee instead of an ad hoc committee.

It was moved by Ms. DeViet, seconded by Mr. Steele, that the Board of Health:
1) Receive Report No. 06-22GC, re: “Governance By-law and Policy Review” for information
2) Direct Staff to evenly distribute the governance by-laws and policies to be reviewed over a two-year period.
3) Approve the governance policies appended to Report No. 06-22GC.
Carried

It was moved by Ms. DeViet, seconded by Mr. Steele, that the Board of Health approve the MOH and CEO Performance Review Committee as a standing committee and direct staff to develop the Terms of Reference and reporting calendar for the committee.
Carried

It was moved by Ms. DeViet, seconded by Mr. Steele, that the Board of Health receive Report No. 07-22GC, re: “2021-22 Provisional Plan Update” for information.
Carried

It was moved by Ms. DeViet, seconded by Ms. Mariam Hamou, that the Board of Health:
1) Receive Report No. 08-22GC, re: “MLHU Q1 2022 Risk Register” for information.
2) Approve the Q1 2022 Risk Register (Appendix A to Report No. 08-22GC).
Carried

Canadian Public Health Week 2022 at Middlesex-London Health Unit (Report No. 21-22)
This report was introduced by Dr. Alexander Summers, Medical Officer of Health. Dr. Summers articulated that the report outlines a real highlight for the Health Unit with the inaugural Canadian Public Health Week happening this year. To celebrate, events were held for staff of MLHU and social media was used to promote the week to the public. A highlight of the week was a coffee break which occurred on the Friday and was in-person for staff as well as attended by some Board of Health members, the Mayor of London, and the Warden of Middlesex County.

The appendix to the report outlines initiatives and activities from across the organization. This information was used to inform staff trivia and social media posts, as well as highlight the work of the organization for the Board of Health.

Ms. Williams stated that, as someone who joined the organization during the COVID-19 pandemic, the coffee break was a chance to meet staff face-to-face and the week was truly a celebration of the work of public health.

It was moved by Ms. Cassidy, seconded by Ms. DeViet, that the Board of Health receive Report No. 21-22 re: “Canadian Public Health Week 2022 at Middlesex-London Health Unit” for information.
Carried

Feedback on Vaping-Related Provisions of the Tobacco and Vaping Products Act (Report No. 22-22)

This report was introduced by Ms. Maureen MacCormick, Director, Healthy Living who introduced Ms. Linda Stobo, Manager, Chronic Disease Prevention and Tobacco Control.

Discussion on this report included:

• At the time the Tobacco and Vaping Products Act (TVPA) was passed, evidence around vaping and its health effects was new. To address this, it was included in the legislation that a review would be conducted three years after the enactment of the Act and every two years thereafter. This provides an opportunity to review the evidence on an ongoing basis and determine any changes to ensure the protection of the population.
• Since the enactment of the legislation, a lot more evidence has become available which is concerning, including evidence of harms to respiratory and circulatory systems and significant concerns regarding dual use of vapour products and cigarettes.
• There is also evidence of confusion by the public with regards to the safety of vapour products. When vapour products first became widely available, it was thought they could be a cessation aid for those addicted to tobacco products; however, the way vapour products are regulated as a commodity and not as a cessation aid is not in alignment with the evidence on how vapour products could potentially help with cessation.
• The Middlesex-London Health Unit and the Southwest Tobacco Control Area Network have drafted submissions with recommendations for the Tobacco Control Directorate in response to their request for public input. These submissions on Appendix A and B.
• Since the drafting of these submissions, the Federal Government announced in the 2022 budget the enactment of a federal tax regime for vaping products, as well as a framework for provinces to follow suit which would complement the federal tax regime. This announcement addresses one of the recommendations in the submissions.
• There has been a rapid growth in the marketplace even beyond expectations from 2019-2020. The retail landscape has increased, especially online sales which are harder to enforce.
• Youth feedback to MLHU Enforcement Officers is that vapour products are very easy to obtain, and they believe vaping is safer than using cigarettes.
• Ms. Cassidy articulated that some tactics to sell vapour products seem predatory, similar to historical practices to promote cigarettes. Ms. Stobo noted that many large vapour companies are owned by the tobacco industries, and that records show that tobacco companies see vapour products as an opportunity to hook people on nicotine in a new way as tobacco use is declining. This will require public health to re-do some of the work done in the past to reduce the burdens of tobacco by reframing it as nicotine addiction.
• Ms. Hamou inquired if the Health Unit sees educating parents as a strategy for mitigating the use of vapour products in youth. Ms. Stobo indicated that the Middlesex-London Health Unit is working with School Board partners to work on vapour product use in schools. The Chronic Disease Prevention Team is working closely with the Child Health and Young Adult Teams working in schools. Work initiated in 2019 and early 2020 were interrupted due to the pandemic, but work is resuming. Possible activities are reaching parents through schools with information to have conversations with their children.
• Dr. Summers noted that the fight against the harms of tobacco have made the careers of many medical officers of health and public health staff, and this will continue with the emergence of vapour products. The work of public health to mitigate the burden of tobacco and vapour products will be upstream and a cornerstone of public health going forward.

It was moved by Ms. Elliott, seconded by Ms. Cassidy, that the Board of Health:
1) Receive Report No. 22-22 re: “Feedback on Vaping-Related Provisions of the Tobacco and Vaping Products Act” for information;
2) Endorse and submit feedback prepared by Middlesex-London Health Unit staff, attached as Appendix A, to the Tobacco Control Directorate of Health Canada, expressing its support and providing its perspective on the operation of the vaping-related provisions of the Tobacco and Vaping Products Act (TVPA); and,
3) Endorse and submit feedback prepared by the Southwest Tobacco Control Area Network, attached at Appendix B, to the Tobacco Control Directorate of Health Canada, on behalf of the seven public health units in southwestern Ontario.
Carried

Update of Urban and Rural Health Indicators within the Middlesex-London Region (Report No. 23-22)

This report was introduced by Dr. Summers who introduced Ms. Alison Locker, Manager, Population Health Assessment and Surveillance.

Dr. Summers shared a PowerPoint presentation.

Discussion on this report included:

• The Middlesex-London Health Unit has previously assessed population health outcomes across different strata of demographic variables, including urban versus rural settings as the risk and health outcomes can differ between regions.
• In February 2020, the Health Unit provided a comparison of health indicators between urban (City of London) and rural (Middlesex County) populations.
• The current report is intended to provide a brief update on this data. The data used for this report is also from 2020 and is from emergency department visits. No new mortality or behavioural risk factor data is available.
• The three indicators for which there is comparative data between the report in 2020 and the current report are emergency department visits for falls, motor vehicle collisions, and opioid poisonings.
• In the report from 2020, the rate of falls and motor vehicle collisions were higher in rural settings than in urban settings while the rate of opioid poisonings was higher in urban settings than rural.
• Using the most up-to-date data, there were not changes in the patterns.
• Regardless of the year, the rates of falls are significantly higher in rural settings than in urban. There was a decline in both rural and urban settings in 2020, likely due to pandemic public health measures which restricted movement.
• Motor vehicle collisions continued to be higher in rural settings than urban settings. Similar to falls, there was a sharp drop in 2020, likely due to pandemic public health restrictions
• The rate of opioid poisonings continued to be higher in urban settings as compared to rural settings. Unlike falls and motor vehicle collisions, the rates in both settings continued to increase year over year with no large decline due to the pandemic.
• Caution is necessary when interpreting data from one year as the trends seen in 2020 may or may not be sustained in the future.
• MLHU will continue to monitor, assess, and report on relevant indicators as they inform interventions and planning. While mortality data has not been updated since 2015, it is anticipated that there will be new data released. As the largest three mortality indicators (ischemic heart disease, dementia and Alzheimer disease, and lung cancer) are generational issues, is it not anticipated that rate will have changed drastically over five years. The Health Unit is currently providing ongoing interventions to reduce chronic disease indicators; however, the impact of these interventions may not be seen for years to come.
• Ms. DeViet inquired how changing community demographics (e.g. people moving from urban settings to more rural communities) is taken into consideration when analyzing and interpreting data trends and using the data to inform interventions. Dr. Summers noted this question speaks to the challenges of measuring health outcomes like lung disease where the exposures that result in the health outcome accumulate over a lifetime, regardless of any movement over the lifetime. It also speaks to the importance of collecting multiple sociodemographic data points to help with interpreting mortality data to help determine contributing factors. Additionally, the challenges with interpreting data speaks to the need to use both population health assessment and surveillance data but also community consultations and demographic forecasting.

It was moved by Ms. Elliott, seconded by Ms. DeViet, that the Board of Health:
1) Receive Report No. 23-22, re: “Update of Urban and Rural Health Indicators within the Middlesex-London Region” for information; and,
2) Direct staff to provide a summary of this report to Middlesex County Council.
Carried

MLHU 2022 Vaccine Preventable Diseases Operational Plan (Report No. 24-22)

This report was introduced by Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Diseases who introduced Ms. Tracey Gordon, Manager Vaccine Preventable Diseases.

Discussion on this report included:

• Prior to the COVID-19 pandemic, the Vaccine Preventable Diseases Team (VPD) was very busy, with the majority of the work focused on school-aged children receiving the mandated and recommended vaccines as indicated in the Ontario Publicly Funded Vaccine Schedule and Immunizations School Pupils Act, as well as managing programs prescribed under the Ontario Public Standards, including the distribution of the annual influenza vaccine and monitoring vaccine adverse effects.
• Due to the COVID-19 pandemic and the introduction of the COVID-19 vaccines, VPD has had to modify its operational plan in order to continue to offer the COVID-19 vaccine in addition to providing its already existing programs.
• The strategy within the Operational Plan is to maintain the COVID-19 vaccination clinics at their baseline levels while leveraging those resources to administer non-COVID-19 Ontario publicly funded vaccines to school-aged children.
• The focus on providing the COVID-19 vaccine during the pandemic has resulted in a decrease in the vaccination of school-aged children with all required and recommended publicly funded vaccines. The plan is to leverage additional resources through COVID-19 funding as well as periodic down time in the COVID-19 vaccination clinics to focus on screening school-aged children for overdue vaccines. By the end of 2022, the hope is to have screened all children from junior kindergarten to grade 12. After just over three weeks, the team has screened and sent letters to over 17 000 overdue grade 9 to grade 12 students as well as 6000 junior kindergarten students.
• MLHU will continue to offer two mass vaccination sites, one in the County at the Caradoc Community Centre, and one in the city of London at the Western Fair District Agriplex. In parallel with these clinics, mobile clinics will continue to be offered, focusing on areas with lower vaccination rates. The provincial GO-Vaxx bus is also being leveraged to assist in providing clinics both in the County and London. Another team is going to all schools to provide non-COVID-19 vaccines as part of the regular grade 7 vaccination program.
• Leaders and staff at mass vaccination clinics are being trained to administer all school-aged vaccines. Students will be able to book appointments for these vaccines at the Caradoc Community Centre clinic every Monday and at the Agriplex clinic every Wednesday, Friday, and Saturday starting May 2, 2022. Online bookings for the school-aged vaccines were opened over a week ago and over 220 students are booked in the first two weeks. COVID-19 vaccine will continue to be offered every day the mass vaccination clinics are open.
• Ms. Cassidy inquired if the clinic at the Western Fair District Agriplex will continue to be available, recognizing that the Western Fair is being planned for this fall. Ms. Gordon noted that recently in April, the mass vaccination clinic at the Agriplex moved from the larger space into the horse arena which is a smaller space. This will permit the clinic to continue to run even as other events are being held at the Agriplex.

It was moved by Ms. Hamou, seconded by Ms. Elliott, that the Board of Health receive Report No. 24-22, re: “MLHU 2022 Vaccine Preventable Diseases Operational Plan” for information.
Carried

Verbal COVID-19 Disease Spread and Vaccine Campaign Update

Dr. Summers provided a verbal update and shared a PowerPoint presentation.

Discussion on this update included:

• In Ontario, cases of COVID-19 continue to increase among those eligible for testing, but the rate is slowing. There has been some indication over the past four to five days that cases and transmission may be plateauing. Additionally, the percent-positivity also appears to be plateauing. Wave 6 hospitalization rates are trending upward; however, they are not nearly as high as first Omicron wave. Additionally, the proportion BA.2 subvariant COVID-19 cases identified continues to increase and this strain will quickly become the dominant strain in the province.
• Across the world, there continues to be substantial COVID-19 activity, but it is starting to decline.
• Ontario, Quebec, Manitoba, Alberta, and the USA are all seeing a plateauing of the Omicron wave. This may be due to populations reaching a temporary state of herd immunity, which means that enough of the population has either been infected with COVID-19 or vaccinated that the virus is unable to be transmitted to people who are easily infected. As a result of vaccination, there is a lower rate of mortality and even though there are higher cases than previous waves, cases are more are mild or asymptomatic
• Dr. Summers believes that Wave 6 has likely peaked or very nearly peaked, although the recent long weekend may cause an increase.
• The increase in cases and transmission of COVID-19 in Wave 6 was expected. As the province came out of Wave 5, there was a rolling back public health protections which meant there would be an increase in cases and transmission. What was unknown was how much the cases would increase, which would depend on previous infection rates and immunization. A notable bump in cases was experienced as, with protections lifted, there was increased mobility outside of homes. People are still moderating their out-of-home mobility, but it differs among people as everyone has different risk levels.
• Wastewater testing is suggesting a decline which is indicative of plateauing.
• Hospitalizations, ICU rates, and deaths are lagging indicators, and are not expected to plateau yet.
• The one major limit for the health care system during this sixth wave isn’t the case numbers, but the staffing with staff getting or being close contacts of COVID-19 cases. The rate of staff absenteeism due to COVID-19 is starting to plateau.
• Percent-positivity in Southwestern Ontario, including in Middlesex-London is also declining.
• A single vital sign doesn’t count for much when interpreting the data; however, when taking into consideration multiple indicators, it is suggestive that cases in Middlesex-London are truly plateauing.
• The COVID-19 vaccine allowed for tolerating rates as high as occurred in Wave 5. Without the vaccine the impact on human suffering, death, and health care capacity would have been profound.
• The risk to the community of transmitting or being exposed to COVID-19 continues to be high. Booster doses are encouraged.
• When making plans, individuals should consider their personal health and risk but also the vulnerabilities of those around them.
• Ms. Cassidy inquired how those who are vulnerable can be protected, especially when they are in the community and not a high-risk setting like long-term care homes where there are still some restrictions. Dr. Summers indicated that when considering the risk of severe outcomes from COVID-19 and any other infectious disease, it is considered how to optimize the immune protection of that individual and also how to reduce the risk of exposure. Those two domains have different strategies. To optimize the immune protection, individuals are vaccinated, for example the availability of fourth dose boosters for those 60 years of age or older. To reduce potential exposure, individuals can wear masks. Individuals and their families can also make decisions about what environments they will go into given the community risk, including those who are more vulnerable who may wish to avoid higher risk settings and activities.
• Mr. Steele inquired how effective wearing a mask is for protecting the person wearing the mask when in a larger group where others are not wearing masks. Dr. Summers indicated that wearing a mask may mitigate the risk of COVID-19 for the person wearing the mask by five to 20 per cent with an N95 respirator having a slightly larger reduction in risk than a cloth or medical mask because of the fit.

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

Medical Officer of Health Activity Report for March (Report No. 25-22)

Dr. Summers provided an overview of his activities since the March 17, 2022 Board of Health meeting.

It was moved by Ms. Hamou, seconded by Mr. Brennan, that the Board of Health receive Report No. 25-22 re: “Medical Officer of Health Activity Report for March” for information.
Carried

Chief Executive Officer Activity Report for March (Report No. 26-22)

Ms. Williams provided an overview of her activities since the March 17, 2022 Board of Health meeting.

It was moved by Ms. Cassidy, seconded by Ms. Hamou, that the Board of Health receive Report No. 26-22 re: “Chief Executive Officer Activity Report for March” for information.
Carried

Correspondence

It was moved by Ms. Cassidy, seconded by Ms. Tino Kasi, that the Board of Health receive items a) and c) for information and to endorse items b) and d).
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is a Special Meeting of the Board of Health on Thursday, April 28, 2022 at 6:00 p.m.

The next regular meeting of the Middlesex-London Board of Health is Thursday, May 19 at 7:00 p.m.

Confidential

At 8:35 p.m., it was moved by Ms. Elliott, seconded by Ms. Hamou, that the Board of Health will move in-camera to approve previous confidential Board of Health minutes and to consider matters regarding labour relations or employee negotiations and personal matters about identifiable individuals, including municipal or local board employees.
Carried

At 9:24 p.m., it was moved by Ms. Hamou, seconded by Mr. Steele, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 9:24 p.m., it was moved by Ms. Cassidy, seconded by Ms. Kasi, that the meeting be adjourned.
Carried

Matt Reid
Chair

Emily Williams
Secretary