Minutes - May 19, 2022 - Board of Health Meeting

Members Present: 

Mr. Matt Reid (Chair)
Mr. John Brennan
Mr. Mike Steele
Ms. Mariam Hamou
Ms. Maureen Cassidy
Ms. Aina DeViet

Regrets:

Ms. Kelly Elliott
Mr. Selomon Menghsha
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. Heather Lokko, Director, Healthy Start/Chief Nursing Officer
Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Diseases
Ms. Shaya Dhinsa, Manager, Sexual Health
Mr. Jordan Banninga, Manager, Infectious Disease Control
Ms. Anita Cramp, Manager, Young Adult
Ms. Rhonda Brittan, Manager, Healthy Communities and Injury Prevention
Ms. Jennifer Proulx, Manager, Best Beginnings NFP
Mr. David Jansseune, Assistant Director, Finance
Ms. Lindsay Croswell, Community Health Nursing Specialist
Mr. Dan Flaherty, Communications Manager
Mr. Jason Micallef, Marketing Coordinator
Mr. Parthiv Panchal, Information Technology, End User Support Analyst

Chair Matt Reid called the meeting to order at 7:01 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 Mr. Michael Steele, seconded by Ms. Mariam Hamou, that the AGENDA for the May 19, 2022 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by Ms. Aina DeViet, seconded by Ms. Hamou, that:
1) the MINUTES of the April 21, 2022 Board of Health meeting be approved, and
2) the MINUTES of the April 28, 2022 Board of Health meeting be approved.
Carried

It was moved by Ms. Maureen Cassidy, seconded by Ms. DeViet, that the MINUTES of the April 21, 2022 Governance Committee meeting be received.
Carried

Reports and Agenda Items

Nurse-Family Partnership Annual Report (Report No. 28-22)

This report was introduced by Ms. Heather Lokko, Director, Healthy Start/Chief Nursing Officer who introduced Ms. Lindsay Croswell, Nurse Family Partnership Practice Lead.

Highlights of this report included:

• The Middlesex-London Health Unit is the provincial license holder for five health units providing the Nurse Family Partnership (NFP). As the license holder, MLHU is required to issue an annual report to the international licensing organization outlining implementation successes and challenges in maintaining fidelity to the program’s 14 core model elements. MLHU’s annual report was submitted on February 28, 2022 and the annual review meeting with the international organization was held March 11, 2022 to go through the report.
• Highlights of the report included:
• 388 unique clients participated in the program
• 4228 visits were completed
• Of the 182 discharges from the program, 42% graduated, 38% were un-addressable attrition, 14% were addressable attrition, and the remaining 4% were transferred to another NFP site or discontinued the program after child apprehension
• Ontario had the highest rate internationally of enrollments generated from referrals at 88%
• Of the collected intake demographics, 42% disclosed they experienced challenges with mental health and 55% had current or recent experiences with intimate partner violence
• Accomplishments celebrated included:
• 100% compliance was almost achieved for all eligibility criteria, with two out of five sites achieving less than 100% for gestational age at first visit
• A 3% improvement in early enrollment rate
• The establishment of a SharePoint site for consistent and efficient data reporting
• Planning and co-facilitating virtual NFP education for new staff with colleagues in British Columbia
• The international team provided their annual feedback for priority planning on April 21, 2022.

Ms. Cassidy inquired if the 388 unique clients were supported just by MLHU or if the number was combined from all five Ontario sites. Ms. Croswell indicated the number was for all Ontario sites. Ms. Cassidy requested a break down by health unit in future reports on this program.

Ms. Cassidy requested clarification on the differences between un-addressable attrition and addressable attrition. Ms. Croswell explained that un-addressable attrition includes clients lost to follow-up which results in staff not knowing the client’s reason for leaving the program prior to graduating. Examples of addressable attrition could be the client saying they are leaving the program because they have accomplished what they wanted from the program, they have the support they need, or they do not have the time with school.

Ms. DeViet commented that it seems like a lot of the reasons for clients leaving the program are outside the control of the program staff and, if so, what improvements can be made by staff and the health units. Ms. Lokko responded that while there are aspects outside of the control of program staff, there are areas for improvement within the 14 core model elements, for example, improving enrollment prior to 16 weeks gestation of pregnancy.

Ms. Cassidy noted the 88% enrollment rate from referrals and inquired from where referrals are received and what are the other ways clients enter the programs if not through referrals. Ms. Croswell indicated that the international benchmark for enrollment is 75% and the NFP program in Ontario, over its lifetime, has an enrollment rate of 89%. She explained that this high rate has a lot to do with strong central referral intake processes and the talent of the nurses turning referrals into actual clients. With regards to referrals, Ms. Croswell explained that referrals come in from primary health care (e.g. physicians, midwives), other health unit programs (e.g. prenatal, school health, and sexual health teams and programs), and community partners who may have stronger relationships with services like maternity residence homes and child protection teams. Self-referral is also possible.

It was moved by Ms. Cassidy, seconded by Mr. John Brennan, that the Board of Health receive Report No. 28-22 re: “Nurse-Family Partnership Annual Report” for information.
Carried

MLHU 2022 Infectious Disease Control Operational Update (Report No. 29-22)

Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Diseases, introduced this report.
She outlined that since the first case of COVID-19 in Middlesex-London in January 2020, MLHU has reported 37,763 confirmed cases of COVID-19 and 385 deaths. Currently, the Health Unit is seeing a decline in the daily number of COVID-19 cases and the seven-day incidence rate. While this is good news, the Infectious Disease Control (IDC) Team does need to make operational adjustments with the direction from the ministry to not proceed with individual case management, but to focus on high-risk settings such as long-term care and retirement homes. She introduced Mr. Jordan Banninga, Manager, Infectious Disease Control.

Highlights of this report included:

• The Infectious Disease Control Team is charged with reducing the burden of infectious diseases in the community which has been challenging during the pandemic while continuing to respond to all other reportable diseases.
• The IDC’s approach has changed considerably since the start of the pandemic. During 2020 and 2021, the transmissibility of the COVID-19 variance allowed for testing and contact tracing fast enough to prevent spread in the community. This changed with the Omicron variant which has a rate of transmissibility which did not allow for contact tracing every case. Due to high community immunity from vaccination, there was a decoupling of severity from the rate of cases. In response, the COVID-19 response has shifted to outbreak investigation with a focus preventing and managing outbreaks in high-risk settings where severe outcomes remained likely.
• With the current decrease in daily cases, the IDC team is in the process of reorganizing to provide services and different interventions than case and contact management and outbreak investigation to focus on enhanced infection prevention and control (IPAC) in high-risk settings providing more hands-on, involved support which the team was unable to do during the Omicron wave.
• The team has begun to reduce the capacity of the contact tracers as there is less of a need to screen all cases coming in the door. There is a casual pool of contact tracers deployed to meet the community need should cases counts rise once again.
• Another key component of the IDC program which continued during the pandemic is case and contact management for other infectious reportable diseases like tuberculosis, gastrointestinal illnesses, and preparing for new and emerging pathogens, like monkeypox.
• Inspections which were slowed down or put on hold during the pandemic are starting again. With the decline in COVID-19 cases and outbreaks, the team is rapidly pivoting capacity to provide inspections in personal service settings, institutional food kitchens, and day cares.
• The team has a FoodNet Canada program, funded by the Public Health Agency of Canada, which is responsible for sampling in local supermarkets for food-borne pathogens. There is also a water sampling component.
• A key challenge for the program includes responding to substantial variations in COVID-19 associated work and ensuring appropriate deployment of staff. There were also a lot of changes to team membership, including onboarding over 100 new staff.

It was moved by Mr. Steele, seconded by Ms. Hamou, that the Board of Health receive Report No. 29-22, re: “MLHU 2022 Infectious Disease Control Operational Update” for information.

Carried

Opioid Crisis Update (Report No. 30-22)

Ms. Albanese introduced this report and Ms. Shaya Dhinsa, Manager, Sexual Health.

Highlights of this report included:

• Since the start of the COVID-19 pandemic, opioid toxicity and its impacts have greatly increased. Looking only at the naloxone program, there was a 60% or more increase in 2020 and 2021 in distribution of naloxone.
• There have been increased emergency department visits and opioid toxicity, and about a 45% increase in deaths.
• There is an opioid overdose report received weekly. For the week of May 2 to May 8, 2022, there were 139 emergency department visits throughout hospitals which report this information, 23 of which were visits by Middlesex-London residents.
• Opioid use and poisonings in the community is a very important issue and work began in 2017 to mitigate the issue. An Opioid Crisis Working Group was formed previously which looked at what local interventions were currently in place and how they could be enhanced as well as what other interventions could be implemented.
• Local interventions include:
• Needle Syringe Exchange Program: this program has been in place for many years and has been made more accessible through increasing to around 20 locations as well as a mobile van. These sites and mobile vans also distribute naloxone.
• Naloxone Distribution Program: as of May 19, this program has increased to 38 participating community organizations who provide and administer naloxone.
• The Consumption and Treatment Services Site: this was introduced in 2017 as the Temporary Overdose Prevention Site and is now the Consumption and Treatment Site. There was a slight decrease in visits through the pandemic, likely influenced by the fear of contracting COVID-19. This isolated many individuals which could increase the risk of overdose if alone while using opioids. For the individuals who did attend the Consumption and Treatment Site, there was an increase in referrals and support services requested, including primary care, housing, addiction services, mental health, access to food, and wound care and testing.
• Local drug alerts: these alerts were put in place several years ago to notify all community partners of toxicity risks of drugs circulating in the community. The number of alerts has increased slightly as the toxicity of the local drug supply has increased.
• Safer Supply: this program was implemented in 2016 by the London Intercommunity Health Centre. This program has been gaining momentum and is currently up to 280 individuals in the program. Some of the observed outcomes include a 35% reduction in injection drug use, 32% reduction in emergency department visits, 30% reduction in survival sex work, 36% reduction in criminal justice system involvement, and improved food and income security.
• Community Drug and Alcohol Strategy: this was launched in 2018 and many of the individuals who sit on the Opioid Crisis Working Group were involved in the development of this strategy. The strategy uses the four pillars approach (prevention, treatment, harm reduction, enforcement) and is focused on all substances.

Ms. Hamou inquired about the development of the permanent supervised consumption site and if more than one site will eventually be available. Dr. Summers, Medical Officer of Health, indicated that during the preliminary and consultative stages of the process, multiple sites were considered as well as mobile options; however, a single site was approved and hopefully there will be updates soon on the permanent site. As the site becomes operational, ongoing evaluations will be required to provide a better understanding of what the needs of the community are, including the need in suburban and rural populations. Presently there are no plans for additional sites.

Ms. Hamou inquired about the Safer Supply Program and whether it will be implemented in other cities. Dr. Summers indicated that the program is run by the London Intercommunity Health Centre and not the MLHU and as such, he does not have that information. The growing evidence around the impact of programs like the Safer Supply is being seen in other parts of the province and he believes they will be implemented through the health care system side of the sector in varying ways depending on the success of the program.

Ms. Cassidy reflected on the work which occurred in 2017 in planning for the permanent supervised consumption facility, including the work at City Council for issues such as zoning. There had been a second site proposed but it had been decided against, possibly due to zoning issues. She stated she thought the Health Unit had done a good job in bringing the community along and addressing community concerns through the public consultation process with regards to the second site. She expressed support in Ms. Albanese, Ms. Dhinsa, Dr. Summers, and the MLHU having a second site for a supervised consumption facility “on the radar.” There have been a couple announcements prior to the provincial election being called for other communities to set up mental health and supervised consumption and treatment facilities.

Ms. Cassidy inquired if the number of needles and syringes being handed out has decreased from previous years and how the number distributed in Middlesex-London compares to other major cities. Ms. Dhinsa indicated that there has been an increase in the utilization of syringes over previous years, in part probably due to easier access as a result of satellite settings like pharmacies and the mobile clinic. She also said that she does not currently know the comparison of local distribution numbers to cities like Toronto or Montreal but could look up that information.

Ms. Cassidy inquired if Middlesex-London and the Health Unit have lost ground in the progress which had been made against the opioid pandemic. Dr. Summers replied that the COVID-19 pandemic has distracted from the opioid pandemic. As was seen in the population health assessment and surveillance data presented at the last Board of Health meeting, while there has been a reduction in other disease outcomes as a result of people staying home through the pandemic, there has been a constant increase in opioid toxicity outcomes. Efforts against the opioid pandemic likely have lost some momentum as a result of the COVID-19 pandemic; the goal of this report is to jump-start efforts again.

It was moved by Ms. Hamou, seconded by Mr. Steele, that the Board of Health receive Report No. 30-22, re: “Opioid Crisis Update” for information.
Carried

MLHU School Team’s Return to School Health Work (Report No. 31-22)

Dr. Summers introduced this report and introduced Ms. Anita Cramp, Manager, Young Adult Team.

Highlights of this report included:

• The School Health Team, which consists of the Young Adult Team and Child Health Team, are back working in schools. For two years, team members had been redeployed to COVID-19 work but the full team has been repatriated back to the School Health Team and are working along-side School Board and School partners.
• Middlesex-London Health Unit is one of the first Ontario health units to have their full team back working in schools.
• School Health Team members received a warm welcome back at schools.
• School Health Team staff had touch-bases with all principals to determine school-related health issues and concerns. The number one issue expressed was mental health. In secondary schools, sexual health was also a big concern. Vaping also continues to be a concern. Eating disorders has grown as a concern over the pandemic in the region as well as provincially.

Ms. Cassidy inquired with other school programs, such as the Active and Safe Routes to School program, are operating. Ms. Cramp indicated that a lot of those initiatives in neighbourhoods are operating. The Active and Safe Routes to School is a truly comprehensive program that requires many partners around the table and works to change attitudes, behaviours, and the physical environment.

Ms. Hamou inquired if the reasons for the increase in eating disorders is known. Ms. Cramp indicated that she is aware of two possibly contributing factors: increased isolation during the pandemic and being on camera more frequently as a result of virtual learning.

It was moved by Ms. DeViet, seconded by Mr. Brennan, that the Board of Health receive Report No. 31-22, re: “MLHU School Team’s Return to School Health Work” for information.
Carried

County of Middlesex Official Plan Review Submission (Report No. 32-22)

Dr. Summers introduced this report and Ms. Rhonda Brittan, Manager, Healthy Communities and Injury Prevention.

Highlights of this report included:

• Ontario Public Health Standards mandate public health units to inform local healthy public policy. It is not new that the health unit works with its municipal partners to participate in reviews to land use planning documents including official plans; however, during the COVID-19 pandemic the ability to do so has been greatly reduced.
• The Healthy Living and Environmental Health and Infectious Disease divisions reviewed and provided input on the County of Middlesex Official Plan Amendment Consultation Draft to ensure it conforms with the revised Provincial Policy Statement.
• Built environment is integrally interwoven with health, for example providing opportunities for physical activity, mental health and social interconnectedness, safety on streets and roads, access to healthy, affordable food, and additional aspects that make the healthy choice the easy choice.
• There is a really strong connection between the ecosystem, climate change, and human health and wellbeing.
• The submission to the County of Middlesex (Appendix A) included suggestions for enhancements related to high quality, functioning public spaces, protection from health hazards, mobility options, and affordable housing.

Ms. Cassidy noted that Middlesex County and the entire region is growing. She commented that as a city councillor, she works with decisions made 50 to 60 years ago that do not necessarily improve health. For example, communities were built without sidewalks or purpose-built for cars, and that trying to “backtrack” is difficult. She hopes that Middlesex County takes the recommendations of the Health Unit and prevent decisions made by the city that now are trying to be changed.

It was moved by Ms. Hamou, seconded by Ms. Cassidy, that the Board of Health receive Report No. 32-22, re: “County of Middlesex Official Plan Review Submission” for information.
Carried

Verbal Funding Update

Mr. David Jansseune, Assistant Director, Finance provided this update and shared a PowerPoint slide.

Highlights of this verbal update included:

• Base funding:
• The Health Unit’s provincial budget is around $20 million and a 1% increase was budgeted. This 1% increase has been approved, which was $198,065.
• The Ontario Seniors Dental Care funding was increased from $1,861,400 to $2,191,500 which is about a 18% increase. These funds will be helpful for opening up additional dental operations, specifically in Strathroy.
• Projects/Initiatives:
• The School Focused Nurses Initiative was extended to December 2022 from July 31, 2022, for $1,642,700.
• The Temporary Retention Incentive for qualified nurses was funded at $793,400 which allows for qualified nurses to receive a maximum of $5000, split evenly between the spring and the fall.
• On May 2, 2022 the Health Unit received the funding letter from the province, confirming 50% of its requested funding for COVID-19 case and contact management and vaccine clinics with plans to review the funding requirements as the year progressed. This is similar to the process in 2021.
• COVID-19 recovery funding, budgeted at around $1.6 million and 18 FTE, was not approved.
• Funding for the Electronic Medical Records special project, at 2 FTE, was not approved.
• Capital:
• Capital for the Strathroy Dental project was approved with incremental funding of $350,100 to bring the total to $1,050,100. This funding can only be used for capital expenses and not operating.

Ms. DeViet inquired, with respect to the capital budgeting increase, is it allocated or going into a reserved fund. Mr. Jansseune indicated that the money is earmarked specifically for expanding the senior dental operations in Strathroy to better serve the County of Middlesex.

Dr. Summers provided some history for the seniors dental program which was announced in 2018-2019 and resulted in a significant expansion in the dental services provided by the Health Unit. When the program was announced, funding was announced to build out the services; however, it did not include sufficient capital to build enough operatories; this has resulted in a substantial wait list in Middlesex-London. These additional funds are required to increase capacity to meet the demands of the program. An increase in operational costs are also necessary as the initial funding did not correspond with the breadth of the eligibility for the program. Even with these funding announcements, there is a way to go in order to fulfill the requirements of this mandatory program.

It was moved by Mr. Steele, seconded by Ms. DeViet, that the Board of Health receive the “Verbal Funding Update” for information.

Verbal COVID-19 Disease Spread and Vaccine Campaign Update

Dr. Summers presented this verbal update and shared some PowerPoint slides.

Highlights of this report include:

• The Health Unit continues to see a notable ongoing and sustained decrease in COVID-19 cases. Daily case numbers are only gathered from those who are eligible for testing, which is only a subsection of the population. This means that the absolute number of cases is an underestimation; however, the trend of declining cases is real.
• Globally as well as provincially, the sixth wave is declining.
• The 14-day trend across all health units in Ontario, MLHU is third lowest in the province and showing ongoing decline. Much of the province is in a similar space except for some parts of Northern Ontario which have had significant incidence case rates, but which are also seeing a decline.
• From April 1, 2022 onwards, the sixth wave has peaked in inpatient admissions, but ICU admissions have barely changed. This highlights the positive impact of the booster dose coverage of the COVID-19 vaccine which has severely reduced the risk of severe outcomes, ICU admissions, and death.
• Operationally, the Health Unit continues to modify its operations in anticipation of increase COVID-19 cases in the fall.
• Vaccine coverage will be critical to continue decoupling severity from incidence of COVID-19. The vaccine infrastructure is in place for school catch-up clinics while also getting prepared for large increases in booster dose eligibility in the fall when there will be increased urgency for vaccination.
• The plan for the summer is to prepare, hold the pandemic steady, and support people to get vaccinated in their own time and in their own way.
• The Health Unit continues to acutely recommend masking in indoor environments and will continue to review this recommendation month by month. Potentially, masks will be more optional during the summer but will probably resume their importance in the fall.

Mr. Steele inquired if there are any new variants of concern on the horizon. Dr. Summers replied that while a few variants have been on the radar, not of them have yet to demonstrate immune escape or increased transmission which would indicate their ability to out-compete the Omicron B.A.2 subvariant.

Ms. Cassidy asked if every wave in the COVID-19 pandemic was caused by a different variant. Dr. Summers replied that waves one through four were each caused largely by a new variant as well as changes in restrictions, but wave five and six were both driven by the Omicron variant, partially due to the subvariant but also due to the easing of restrictions. The success story was the wave caused by the Delta variant which was blunted due to the vaccination effort.

Ms. Cassidy inquired if there is a shift in focus to, or greater emphasis on, therapeutics, especially for high-risk individuals. Dr. Summers responded that the provincial infrastructure to prescribe and access therapeutics like Paxlovid has been rapidly built and exists. The impact of therapeutics at the population level is likely marginal and instead would have impact on preventing severe outcomes among those for whom vaccination either was not effective or was not utilized. At this point there is not a full understanding on the impact therapeutics have made on the decoupling of the severity from the incidence. He believes the vaccination coverage and immunity from previous exposure are the biggest contributors to that decoupling. Going into the next year, the infrastructure to distribute therapeutics will be essential; however, relying on post-infection therapeutics in order to limit the impact of infectious disease is always the last resort and nothing substitutes for vaccination.

It was moved by Ms. Cassidy, seconded by Mr. Steele, 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 April (Report No. 33-22)

It was moved by Mr. Brennan, seconded by Ms. DeViet, that the Board of Health receive Report No. 33-22 re: “Medical Officer of Health Activity Report for April” for information.
Carried

Chief Executive Officer Activity Report for April (Report No. 34-22)

It was moved by Ms. Cassidy, seconded by Ms. Hamou, that the Board of Health receive Report No. 34-22 re: “Chief Executive Officer Activity Report for April” for information.
Carried

Correspondence

It was moved by Ms. Cassidy, seconded by Ms. Hamou, that the Board of Health receive item a) for information.
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, June 16 at 7:00 p.m.

Confidential

At 8:33 p.m., it was moved by Ms. DeViet, seconded by Mr. Steele, 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 9:19 p.m., it was moved by Ms. Hamou, seconded by Ms. DeViet, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 9:19 p.m., it was moved by Ms. Cassidy, seconded by Ms. Hamou, that the meeting be adjourned.
Carried

Matt Reid
Chair

Emily Williams
Secretary