Minutes - October 19, 2023 - Board of Health Meeting

Members Present: 

Matthew Newton-Reid (Chair)
Michael Steele (Vice-Chair)
Selomon Menghsha
Skylar Franke
Michelle Smibert
Aina DeViet
Peter Cuddy (arrived at 7:15 p.m.)
Tino Kasi
Michael McGuire
Emily Williams, Chief Executive Officer (ex-officio)
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Others Present:

Stephanie Egelton, Executive Assistant to the Board of Health (recorder)
Sarah Maaten, Director, Public Health Foundations
Mary Lou Albanese, Director, Environmental Health and Infectious Disease
Jennifer Proulx, Acting Director, Healthy Start and Chief Nursing Officer
Dr. Joanne Kearon, Associate Medical Officer of Health
Cynthia Bos, Manager, Human Resources
Tracey Gordon, Manager, Vaccine Preventable Disease
Jordan Banninga, Manager, Infectious Disease Control
Alison Locker, Manager, Population, Health, Assessment and Surveillance
Shaya Dhinsa, Manager, Sexual Health
Alex Tyml, Online Communications Coordinator, Communications
Parthiv Panchal, End User Support Analyst, Information Technology

Chair Matthew Newton-Reid called the meeting to order at 7 p.m.

Disclosure of Conflict of Interest

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

Approval of Agenda

It was moved by A. DeViet, seconded by M. Smibert, that the AGENDA of the October 19, 2023 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by M. Steele, seconded by M. McGuire, that the MINUTES of the September 21, 2023 Board of Health meeting be approved.
Carried

It was moved by M. Smibert, seconded by T. Kasi, that the MINUTES of the September 21, 2023 Performance Appraisal Committee meeting be received.
Carried

It was moved by M. Smibert, seconded by T. Kasi, that the MINUTES of the September 21, 2023 Governance Committee meeting be received.
Carried

New Business

Opioid Crisis Update – 2023 (Report No. 58-23)

Mary Lou Albanese, Director, Environmental Health and Infectious Disease introduced Shaya Dhinsa, Manager, Sexual Health and Alison Locker, Manager, Population Health Assessment and Surveillance to provide an update on the opioid crisis in Middlesex-London.

S. Dhinsa provided an overview of activities within the Health Unit regarding the opioid crisis. Opioid poisonings and opioid toxicity deaths in Middlesex-London have continued to escalate from 2017 to 2022. A new report from Public Health Ontario shows that since the start of the pandemic, increasingly individuals are dying from multiple toxic substances.

A. Locker provided epidemiological data regarding opioid use in the community. Before the pandemic, the rate of opioid related hospital visits and deaths was increasing in the region and Ontario. Throughout the pandemic, opioid related hospital visits increased by 92%, from 37 in January 2020 to 71 in December 2022, and 121 visits in July 2021. In 2020, there was an average of 9 opioid-toxicity deaths reported each month, further increasing by 29% in 2021.

A. Locker noted that since mid-2017, the rates of opioid related hospital visits in the Middlesex-London region have consistently exceeded the Ontario rate. Through 2022, local rates ranged from 110 to 150 hospital visits per month per 100,000 population. During the first 9 months of 2022, the rate of opioid-related deaths in the Middlesex-London region ranged from 14 to 30 deaths per 100,000 population and exceeded the provincial rate.

The local Opioid Working Group, and many community partners (including the Health Unit) continue to work together to help minimize the adverse effects of the opioid crisis, including opioid toxicity, other negative outcomes, and death. Current interventions include:
• Needle Syringe Program
• Naloxone Distribution Program
• International Overdose Awareness Day
• Consumption and Treatment Services
• Local Drug Alerts
• The Safer Opioid Supply Program
• The Community Drug and Alcohol Strategy

In response, MLHU, the local Opioid Working Group, and community partners have continued to work together to offer a variety of interventions to minimize adverse effects. Final reflections included:
• Opioid poisonings and deaths have continued to escalate beyond the COVID-19 pandemic.
• The use of multiple substances combined with the adulteration of the drug supply is complicating the treatment of overdoses, contributing to increased fatalities.
• There is a continued need for community-based treatment and harm reduction interventions, community collaboration, and upstream prevention to reduce opioid poisonings in the Middlesex-London region.
• There is also a need to expand healthcare and community-based interventions to address multiple concurrent substance use disorders.

Chair Newton-Reid asked for clarification on if the term “benzos” was the technical term for fentanyl or if it was a different substance that is causing the rise in deaths and hospitalizations. S. Dhinsa explained that “benzos” (benzodiazepines) and fentanyl are separate substances. Benzodiazepines are depressants and related overdoses cannot be reversed using naloxone, as they remain in the system for longer and do not respond to treatment as quickly. S. Dhinsa noted that due to mixing of these substances, calling 911 is necessary to treat an individual in crisis.

Dr. Summers noted that the 6-7-year trend in opioid related deaths in Middlesex-London is not dramatic compared to the province and is consistent across the province and Canada. The number of emergency department visits is higher because of data time frame difference; there are opioid related visits coded at the emergency rooms but reflects the region’s ongoing role as a service center for mental health and addiction. The intersection of homelessness and lack of economic opportunity is contributing to greater substance use risk and associated opioid use.

Board Member Mike Steele noted that the Needle Syringe Program had distributed 1.7 million syringes in 2022, and inquired if this was expected and relatively the same number throughout the province. S. Dhinsa noted that the distribution number of syringes has not increased dramatically but has been higher. The program ensures there are ample supplies for safety reasons and clients take as much as they need or for their friends in the community. Dr. Summers added the use of safe supplies decreases the risk of blood borne infection.

M. Steele inquired if the Health Unit or the Regional HIV/AIDS Connection tracks the number of clients using the Needle Syringe Program. S. Dhinsa noted that there were 200 visits (to the program for safe supplies) in 2020, 742 in 2021, 388 in 2022, and 3596 from January-September 2023. The larger portion of visits have occurred at the permanent safe injection site on 446 York Street, and the Middlesex-London Health Unit’s location at 355 Wellington (Clarence Street) is now the only safe supply location in the downtown core.

Board Member Skylar Franke inquired on the response of public health regarding the narrative that providing safer drug supply to those who use drugs increases addiction. Dr. Summers noted that further assessment is needed both of those clients who use drugs who have not gone to the safe supply or safe injection sites and in the surrounding community of these sites. For clients who have used safe injection sites, the program has given them safety in the supplies used and as a result, lessen strains on primary care with a harm reduction approach. Dr. Summers added that illicit drugs are causing overdoses and deaths, and there was a growing challenge before safer supply programs were introduced. Dr. Summers concluded that the safe supply location has demonstrated to be positive to those using drugs who would seek treatment or recovery and has not demonstrated to start drug use in those who were not previously using.

It was moved by M. Smibert, seconded by S. Franke, that the Board of Health receive Report No. 58-23 re: “Opioid Crisis Update-2023” for information.
Carried

2023-2024 Respiratory Season Review and Update (Report No. 59-23)

Dr. Joanne Kearon, Associate Medical Officer of Health introduced Jordan Banninga, Manager, Infectious Disease Control and A. Locker to provide an update on this respiratory season.

A. Locker provided an overview of the current season of respiratory illness:
• COVID-19 cases and outbreaks dominated the 2022-2023 respiratory season, as has been the case since the 2019-2020 season. There have been approximately 7800 COVID-19 cases and 177 institutional COVID-19 outbreaks since 2022.
• After several seasons of no or low influenza cases and outbreaks, activity in the 2022-2023 season was more comparable to pre-pandemic levels.
• Other respiratory pathogens also circulated in the 2022-2023 and were identified in outbreaks.
• For a few respiratory seasons after 2020, illness reports were almost exclusively COVID-19. After the pandemic, there are pathogens such as Influenza A, RSV and Rhinovirus being detected.
• Summer months see respiratory pathogens, but not as evident as the winter and fall months.
• After a 2022-2023 season that extended into the summer months, respiratory trends from September and early October justified declaring the start to the 2023-2024 season on October 5, 2023.

J. Banninga reviewed public health interventions used to respond to 2023-2024 Respiratory Season. These included vaccine distribution, mass vaccination clinics, mobile vaccination clinics, infection prevention and control, and outbreak investigation and management. J. Banninga also highlighted that the Health Unit participated in two respiratory preparedness exercises on August 16 and September 25. The local exercise held on September 25 included 37 participants from the health system, and provided a review of what to know, and what to expect for the 2023-24 Respiratory Season.

Chair Newton-Reid inquired when COVID-19 vaccine eligibility would be expanded to the general population. Dr. Summers noted that the vaccine eligibility expansion date would be on or around October 30 for the general population to receive their COVID-19 vaccine. Dr. Summers also noted that the Health Unit would strive to provide the Board of Health an annual report on respiratory season for awareness.

It was moved by S. Menghsha, seconded by S. Franke, that the Board of Health receive Report No. 59-23 re: “2023-2024 Respiratory Season Review and Update” for information.
Carried

Compliance with the Immunization of School Pupils Act in Middlesex-London Update (Report No. 60-23)

M. Albanese introduced Tracey Gordon, Manager, Vaccine Preventable Disease and A. Locker to provide an update on the compliance of immunization of students in the Middlesex-London region.

T. Gordon reminded the Board of Health that the Immunization of Student Pupils Act (ISPA) requires students attending elementary and secondary school to have proof of up-to-date immunization or provide a valid exemption. In 2022 and 2023, the Health Unit launched an initiative to increase immunization coverage through enforcement of the ISPA.

T. Gordon noted that strategies to support vaccination for students in the region included suspension letters noting reminders of required vaccinations and exemption information, and catch up clinics at the Health Unit offices in London, Strathroy and the Western Fair Vaccination Clinic. The Vaccine Preventable Disease team mailed 32,591 letters, sent suspension notices to 21,869 students, and suspended 5805 students spread out over 6 months. There were 312 clinics at Health Unit locations, with 13,250 students vaccinated from November 2021 – May 2022. Regarding impacts, the Health Unit data is still pending from Public Health Ontario, but preliminary local data is positive.

A. Locker provided a brief overview of the data associated with student vaccination uptake, noting that school year vaccination data is captured from September 1 – August 31.

In the 7-17-year old cohort, between the 2021-22 and 2022-23 school years, coverage estimates for ISPA reportable diseases (diphtheria, measles, meningococcal disease, mumps, pertussis, poliomyelitis, rubella, and tetanus) all increased between 8% and 22%. Coverage estimates for diphtheria, pertussis, and tetanus were approximately 65%. In the 2022-23 school year, the preliminary coverage estimates for the same diseases were approximately 87%. Coverage estimates for measles, meningococcal disease, mumps, poliomyelitis, and rubella were 81%-90%. Preliminary coverage estimates for these diseases increased to 91%-95%.

It was moved by M. McGuire, seconded by M. Smibert, that the Board of Health receive Report No. 60-23 re: “Compliance with the Immunization of School Pupils Act in Middlesex-London” for information.
Carried

Current Public Health Issues (Verbal)

This report was presented by A. Summers who provided a verbal update on current public health issues in the region.

Highlights included the topics of:

Respiratory Season

COVID-19 laboratory confirmed cases and outbreaks have decreased from the previous week, but the Middlesex-London region is still entering the 2023-2024 respiratory season. Wastewater positivity testing for COVID-19 has slightly increased since August. On October 5, the Health Unit issued a media release advising the start of respiratory season.

Recommendations from Middlesex-London Health Unit include:
• Get fall respiratory vaccines (COVID-19 and influenza) when eligible
• Masking in public indoor environments
• Washing hands often
• Staying home when unwell
• The Health Unit is now requiring masking in all its clinical settings

The XBB.1.5 monovalent COVID-19 vaccine became available in the mass vaccination clinic at the Western Fair on October 6, with approximately 350 appointments each day. Pharmacies are now beginning to receive and administer the XBB1.5. COVID-19 vaccine and the influenza vaccine.

Health and Homelessness

On October 5, City of London Council approved the first 5 Hub locations and lead agencies:
• Atlohsa Family Healing Services Hub: 550 Wellington Road (open December 2023)
• Youth Opportunities Unlimited (2 sites):
o 800 Commissioners Rd. E (open May 2024)
o Joan’s Place, 329 Richmond St. (open December 2023)
• Canadian Mental Health Association (CMHA) and CMHA Thames Valley (2 sites):
o 556 Dundas St. (open December 2023)
o 705 Fanshawe Park Rd. (open May 2024, pending rezoning)

The Middlesex-London Health Unit continues to be part of conversations with other community partners regarding this matter.

MLHU in the News

Media for the Middlesex-London Health Unit was focused on vaccination for COVID-19, with the opening of the fall vaccination season and the start of respiratory season.

It was moved by S. Franke, seconded by P. Cuddy, that the Board of Health receive the verbal report re: “Current Public Health Issues” for information.
Carried

Medical Officer of Health Activity Report for September (Report No. 61-23)

Dr. Summers presented his activity report for September. There was no discussion on this report.

It was moved by S. Franke, seconded by M. McGuire, that the Board of Health receive Report No. 61-23 re: “Medical Officer of Health Activity Report for September” for information.
Carried

Chief Executive Officer Activity Report for September (Report No. 62-23)

Emily Williams, Chief Executive Officer presented her activity report for September. There was no discussion on this report.

It was moved by A. DeViet, seconded by P. Cuddy, that the Board of Health receive Report No. 62-23 re: “Chief Executive Officer Activity Report for September” for information.
Carried

Correspondence

It was moved by M. McGuire, seconded by P. Cuddy, that the Board of Health receive the following items for information:
a) Middlesex County re: Middlesex-London Health Unit 2024 Budget
b) Huron Perth Public Health re: Support for Healthy Public Policy Regarding Alcohol Marketplace
and Product Sales
c) Huron Perth Public Health re: Bill 93, Joshua's Law, Lifejackets for Life, 2023
e) Timiskaming Health Unit re: Universal, No-cost Coverage for all Prescription Contraceptive
Options for all Ontarians
f) Peterborough Public Health re: Section 50 Agreements
g) Middlesex-London Board of Health External Landscape for October
Carried

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health endorse item d) re: Windsor-Essex County Health Unit re: Investing in a Sustainable Federal School Food Policy.
Carried

Other Business

The next meetings of the Middlesex-London Board of Health are Thursday, November 9, 2023 at 1 p.m. (Special Board of Health) and Thursday, November 16, 2023 at 7 p.m. (Regular Board of Health).

Closed Session

At 8:11 p.m., it was moved by S. Franke, seconded by M. McGuire that the Board of Health will move into a closed session to consider matters regarding labour relations or employee negotiations, personal matters about an identifiable individual, including Board employees, litigation or potential litigation, including matters before administrative tribunals, affecting the municipality or local board, advice that is subject to solicitor-client privilege, including communications necessary for that purpose, and to approve previous confidential Board of Health minutes.
Carried

At 9:56 p.m., it was moved by A. DeViet, seconded by S. Franke, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 9:56 p.m., it was moved by P. Cuddy, seconded by S. Menghsha, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary