Minutes - September 19, 2024 - Board of Health Meeting

Thursday, September 19, 2024, 7 p.m.
MLHU Board Room – Citi Plaza
355 Wellington Street, London ON

Members Present: 

Matthew Newton-Reid (Chair)
Michael Steele (Vice-Chair)
Michelle Smibert
Michael McGuire
Selomon Menghsha (attended virtually)
Aina DeViet
Dr. Joanne Kearon, Acting Medical Officer of Health (ex-officio)
Emily Williams, Chief Executive Officer (ex-officio)

Regrets:

Howard Shears
Skylar Franke
Peter Cuddy
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Others Present:

Stephanie Egelton, Executive Assistant to the Board of Health (recorder)
Mary Lou Albanese, Director, Environmental Health, Infectious Diseases and Clinical Services
Jennifer Proulx, Director, Family and Community Health
Darrell Jutzi, Manager, Municipal and Community Health Promotion
Ryan Fawcett, Manager, Privacy, Risk and Client Relations
Marc Resendes, Acting Manager, Strategy, Planning and Performance
Cynthia Bos, Associate Director, Human Resources and Labour Relations
Abha Solanki, End User Support Analyst, Information Technology
Andrew Powell, Acting Manager, Infectious Disease Control
David Pavletic, Manager, Food Safety and Health Hazards
Melissa Thompson, Manager, Vaccine Preventable Disease
Donna Kosmack, Oral Health and Clinical Support Services

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.

At 7:01 p.m., it was noted that Board Member Michael (Mike) Steele declared a conflict of interest related to Report No. 12-24FFC, within the Finance and Facilities Committee Meeting Summary. Within this report, the Board will be receiving information related to the Health Unit’s new benefits provider (Manulife) effective January 1, 2025. This declaration was made due to Board Member Steele’s employment and active shareholding with Manulife but noted that he does not work within the Manulife Group Benefits department.

Approval of Agenda

Chair Newton-Reid noted that Report No. 58-24 re: 2023 Audited Financial Statements – Draft will be deferred to the October Board of Health meeting.
It was moved by M. Steele, seconded by M. Smibert, that Report No. 59-24 re: “2023 Audited Financial Statements – Draft” be deferred to the October Board of Health meeting.
Carried

Chair Newton-Reid noted that with Report 58-24 being removed from the agenda and deferred, there is also a change to the order of the closed session to the end of the meeting instead of the beginning of the meeting.

It was moved by A. DeViet, seconded by M. McGuire, that the AGENDA for the September 19, 2024 Board of Health meeting be approved as amended.
Carried

Approval of Minutes

It was moved by M. Smibert, seconded by M. Steele, that the MINUTES of the July 18, 2024 Board of Health meeting be approved.
Carried

Correspondence

It was moved by M. Smibert, seconded by M. McGuire, that the Board of Health receive items a) through c) for information:
a) Middlesex-London Board of Health External Landscape for September 2024
b) Healthcare Coalition re: Healthcare Coalition Urges Caution as Ontario Prepares for Alcohol Expansion
c) Health Canada re: reply to correspondence from March 22, 2024
Carried

New Business

Policy Position on Maximum Indoor Air Temperature (Report No. 59-24)

Jennifer Proulx, Director, Family and Community Health noted that this report on the policy position on maximum indoor temperature was a collaboration between two (2) program areas and introduced Darrell Jutzi, Manager, Municipal and Community Health Promotion and David Pavletic, Manager, Food Safety and Health Hazards.

D. Pavletic noted that the Health Unit has provided feedback on the proposed changes to the National Building Code of Canada that aim to establish a maximum indoor temperature in new housing units.
Exposure to extreme heat can have effects such as heat rash, muscle cramps, dizziness, nausea, vomiting, confusion, loss of consciousness and in some circumstances death. D. Pavletic reflected on the 2021 “Heat Dome” heat wave in British Columbia that resulted in 619 deaths with 98% of deaths occurring indoors. D. Pavletic added that everyone is at risk in the community, especially children, pregnant persons, older adults, those living with medical conditions (including mental health) and those experiencing social and material deprivation. The risk of negative health impacts from extreme heat can be reduced. For example, thermal insulation, housing location, building materials and house orientation, window shades, green spaces and ventilation (including use of cooler nighttime air) and air conditioning can help to mitigate high indoor temperatures.

D. Pavletic explained that under the National Building Code, there is a requirement to have heating equipment in residential buildings, but there is no code for maximum indoor temperature regarding cooling. From the 2021 heat wave, the Province of British Columbia updated their building codes to mandate new dwelling units in both large and small residential buildings to maintain temperatures at no more than 26 degrees in a single living space. This legislative change in British Columbia resulted in proposed changes (named Proposal Change 2061) to deal with overheating in new dwelling units. The amendment put forward aims to address the gap in overheating indoors and the proposal included setting a maximum indoor temperature of no more than 26 degrees in new units.

D. Jutzi noted that the Health Unit submitted feedback for the amendment to the National Building Code in July. The Health Unit was in support of establishing a maximum indoor air temperature of not more than 26 degrees and it is important that evidence regarding maximum indoor air temperature be monitored as research evolves. Further feedback included:
• Supporting the language “maintaining an indoor air temperature of not more than 26 degrees”.
• Using “in at least one living space” to allow for greater flexibility in the application, potentially allowing application to all living spaces.
• The “living space” should exclude unfinished basements, service rooms, crawl spaces, and other spaces that typically are not used for living purposes.
• Within the amended code, a definition of “cooling facilities” that contains a variety of sustainable, low-carbon, energy efficient systems should be provided.
• Applying the proposed change to both small and large buildings.

D. Jutzi noted that the next steps for the Health Unit are to explore opportunities to reduce risk locally, including enhancing media communication strategies related to extreme heat and encouraging climate resilient neighbourhood design features, such as greenspace and green infrastructure. In particular, staff will continue to collaborate with municipal partners in exploring relevant municipal bylaws related to indoor heat and maximum temperatures.

There were no questions or discussion.

It was moved by M. Smibert, seconded by M. McGuire, that the Board of Health receive Report No. 59-24 re: “Policy Position on Maximum Indoor Air Temperature” for information.
Carried

Chair Newton-Reid noted that the topic of maximum indoor air temperature is being discussed often with the weather becoming warmer (climate change) and the topic will be interesting to follow further.

2023-25 Provisional Plan 2024 Q2 Status Update (Report No. 60-24)

Emily Williams, Chief Executive Officer introduced Marc Resendes, Acting Manager, Strategy, Planning and Performance to present the Q2 update on the Provisional Strategic Plan. E. Williams noted that this would be M. Resendes’ last meeting as Acting Manager, as he was returning to his home role later that week. E. Williams thanked M. Resendes for his service in this role.

M. Resendes noted that Q2 continues to be a productive time for the Health Unit and is reflecting significant progress on all fourteen (14) strategic initiatives with only one (1) tactic yet to be initiated - staff have initiated the final tactic in Q3. Many strategic initiatives have been developed to the point, however, where consultation and engagement with staff and leaders is necessary for successful implementation. To address workload concerns and burnout in light of significant operational work, a prioritization exercise was completed in Q3. M. Resendes noted that there will be a pause on initiatives for the Q3 update. M. Resendes thanked the Board of Health for their guidance and support in implementing the Provisional Plan during his time as Acting Manager.

It was moved by A. DeViet, seconded by M. Smibert, that the Board of Health receive Report No. 60-24 re: “2023-25 Provisional Plan 2024 Q2 Status Update” for information.
Carried

The Oral Health and Clinical Support Services Team – Update (Report No. 61-24)

Mary Lou Albanese, Director, Environmental Health, Infectious Diseases and Clinical Services introduced Donna Kosmack, Manager, Oral Health and Clinical Support Services to present an update on oral health at the Health Unit.

D. Kosmack provided background information on the Ontario Seniors’ Dental Care program. The program is a government-funded dental care program where free, routine dental services are provided for low-income adults who are 65 years and older. The Health Unit has seen a high uptake and has resulted in a waiting list for new patient exams. Last year, the Health Unit opened a new dental clinic in Strathroy, and in July, two new operatories were opened at the Citi Plaza location. New chairs in existing operatories were added, along with windows in doors of existing operatories for staff safety. One of the new operatories is also larger in size to accommodate for mobility aids such as a wheelchair if necessary. In the last year, the Health Unit has reduced the waiting list from 700 to 222 people - everyone on the client waiting list has been contacted and offered a new patient exam. The Health Unit also increased the staffing capacity (10 staff to 38 staff) of the Oral Health and Clinical Support Services team to enable the team to operate the new clinical spaces.

D. Kosmack noted that the Health Unit also supports preventative dental screening in schools and the Healthy Smiles program for children under 16 to receive dental care services. In the 2023-2024 school year, 19,964 students were screened with 2,356 students found to have urgent dental conditions, which represents 12% of children.

D. Kosmack concluded that the Oral Health and Clinical Support Services team is working to prepare for the upcoming school screening year, with September 25 being the first dental screening date in schools. The team will also be working with the Communications team to promote the Health Unit’s dental services.

Chair Newton-Reid inquired on the income cutoff for receiving services within the Ontario Seniors Dental Care program. D. Kosmack stated the income cutoff was $41,500 for a couple.

It was moved by M. McGuire, seconded by M. Steele, that the Board of Health receive Report No. 61-24, re: “The Oral Health and Clinical Support Services Team – Update” for information.
Carried

2024-2025 Respiratory Season Review and Update (Report No. 62-24)

M. Albanese, introduced Andrew Powell, Acting Manager, Infectious Disease Control and welcomed Melissa Thompson, Manager, Vaccine Preventable Disease to the Board of Health to present information on respiratory season. M. Thompson is the new Manager for the Vaccine Preventable Disease team and has worked at the Health Unit for 24 years.

A. Powell noted that this past year, Middlesex-London has had 2800 COVID-19 cases, with 66 deaths. The number of cases is a significant drop from previous years and has to do with the availability of testing as well as some changes within the provincial surveillance system. There have been 146 outbreaks in facilities in the community, and COVID-19 continues to be the main illness of these outbreaks (81%). A. Powell noted that typically, influenza A appears in October and influenza B appears in December, which is typical.

A. Powell provided further information on interventions that the Infectious Disease Control team are using to respond during respiratory season. This includes support of infection, prevention and control (IPAC) measures focused on long-term care, retirements homes, group homes, shelters, supportive housing, residential treatment centres and hospices. The team conducts this through education, development of IPAC programs and supporting congregate settings to implement IPAC programs. The team also supports outbreak investigations, which include identifying the source of transmission, implementation of outbreak control measures and leading outbreak meetings with the facility.

M. Thompson provided further information on interventions that the Vaccine Preventable Disease team are using to respond during respiratory season. M. Thompson noted that the major interventions are vaccine distribution and vaccine administration. The team processes vaccine orders and support for COVID-19, influenza and respiratory syncytial virus (RSV) for hospitals, long-term care and healthcare providers.
Information and support are also provided to these partners. Further, the team also supports immunization for children under two years of age for COVID-19, influenza and RSV at Citi Plaza and Strathroy, RSV for retirement homes and mobile clinics for priority populations.

M. Thompson noted that this year, the Health Unit would not be hosting mass vaccination clinics and emphasizing that having a communication plan is critical for the community to know how to access vaccine.

The Health Unit will also be participating in two (2) respiratory season simulations to prepare stakeholders during respiratory season. The Regional Respiratory Surge Simulation Exercise, facilitated by Ontario Health West was held on June 12 and included regional healthcare provider partners and Health Unit staff. The Health Unit will be hosting a local exercise on September 15, with stakeholders participating from long-term care and health system partners.

Board Member Aina DeViet inquired on how the under two (2) years of age population is being reached in Middlesex-London and how it is ensured that this demographic group is not missed. M. Thompson explained that it takes time to know the full number of children being vaccinated in the community and getting information out on where to access vaccine is very important. M. Thompson encouraged the community to visit the Health Unit’s website and for health care providers to post Health Unit materials and posters to advise where vaccines can be provided. The COVAX system in Ontario can also be used as a great tool to see where vaccine has been given and what areas need to be focused on for vaccine efforts. A. DeViet noted that it may be positive to work with the Library and EarlyON locations to have materials available to members of the community.

It was moved by M. Smibert, seconded by A. DeViet, that the Board of Health receive Report No. 62-24 re: “2024-2025 Respiratory Season Review and Update” for information.
Carried

Q2 2024 Organizational Performance Reporting (Report No. 63-24)

E. Williams and Dr. Joanne Kearon, Acting Medical Officer of Health presented the Q2 Organizational Performance Reporting for the Health Unit.

E. Williams reminded the Board of Health that organizational performance reporting is a part of the Management Operating System, and that this is the administrative system that directs and manages the Health Unit’s work. Organizational reporting measures how well the Health Unit is doing at the interventions it implements. E. Williams added that this is the second time reporting organizational results to the Board. The organizational performance management component contains three (3) different parts - program assessment, planning and evaluation, quarterly performance review, and continuous quality improvement. E. Williams emphasized that there was some trepidation about performance reporting from staff, as their work was being measured – as a result, the Health Unit is promoting a culture of learning and improvement.

Before Dr. Kearon presented the reporting, E. Williams noted that two (2) divisions (Corporate Services and Public Health Foundations) were added to reporting in this quarter. Dr. Kearon noted that the quarterly performance review process enables performance reporting in a fulsome way to the Board. The reporting provides performance updates across programming, finance, human resources, risk, client and community confidence and employee engagement and learning domains.

Dr. Kearon briefly reviewed how performance reporting comes to fruition. It is first developed by managers for what their team delivers in terms of interventions. The managers discuss with their directors, who summarize their work and then it is brought for review to the Chief Executive Officer and Medical Officer of Health.

Dr. Kearon noted the following highlights for Q2:
• The Health Unit continues to see increased demand for services from clients due to lack of access to a family doctor;
• Collaboration is underway with municipal partners on policy positions related to topics such as built environment, Health and Homelessness, and substance use;
• Significant progress continued in Q2 with increased vaccine coverage rates in schools under the Immunization of School Pupils Act, R.S.O. 1990, c. I.1;
• Opening of two (2) new dental operatories at Citi Plaza to decrease the waitlist for clients seeking services under the Ontario Seniors’ Dental Care Program;
• Discussions on the opioid crisis within Middlesex-London were initiated through the reconvening of the Community Drug and Alcohol Committee; and
• Continued work to support recommendations from the Health Unit’s Taking Action for Reconciliation Plan and Anti-Black Racism Plan.

Concluding the presentation, Dr. Kearon noted based on highlights that there are three (3) stories to tell for this reporting – the work by staff being done to meet the needs of the public, the incredible demand for services in vaccine preventable disease driven by the lack of access to a family doctor and the progress of staff adjusting to new work and teams in Q2 related to post restructuring.

It was moved by M. Steele, seconded by M. McGuire, that the Board of Health receive Report No. 63-24 re: “Q2 2024 Organizational Performance Reporting” for information.
Carried

Current Public Health Issues (Verbal Report)

Dr. Kearon presented her first “Current Public Health Issues” update to the Board of Health as Acting Medical Officer of Health.

Legionella Outbreak
Dr. Kearon noted that there is an active outbreak of legionella bacteria within the community, and explained what legionella bacteria is. Legionella is a bacteria commonly found in natural and human-made water sources and is transmitted by inhaling droplets or mist in the air. The milder illness from exposure can result in Pontiac fever and the serious respiratory illness that can result from exposure is Legionnaires’ disease – most who are exposed will never develop symptoms. Those over aged 40, who are current and former smokers, have chronic lung conditions and underlying health conditions are at greater risk for developing Legionnaires’ disease if exposed. Possible sources of legionella are humidifiers, water heaters, shower heads or sink taps, cooling towers (cooling systems for buildings), home or industrial plumbing systems and hot tubs.

Dr. Kearon noted that the current legionella outbreak was declared on July 26. Positive cases (26) were mapped, and most cases had a work address or a home address within a 5 km radius. Given all cases were not at same address, a larger industrial outdoor system like a cooling tower seemed the most likely source of the bacteria. With guidance from Public Health Ontario, the Health Unit began testing cooling towers within that geographic radius. 17 environmental samples and 5 clinical samples have been sent to Public Health Ontario Labs. Of the environmental samples which tested positive, most were non-viable or a species less likely to cause an outbreak. All clinical samples so far have been the same type, suggesting a common source. Dr. Kearon noted that a source has not been confirmed, but evidence indicates further transmission is decreasing. Dr. Kearon concluded that outbreak protocol is that after 24 days without a new case related to the outbreak, the outbreak is declared over.

Dr. Kearon emphasized that to prevent legionella bacteria, business owners must maintain and sanitize potential sources according to manufacturer’s instructions. Homeowners must regularly clean and disinfect mist producing devices in the home such as shower heads, humidifiers and hot tubs.

Mpox Update
Dr. Kearon noted that on August 14, the World Health Organization declared Mpox a “Public Health Emergency of International Concern”. There is a rise in a more severe clade Ib strain that is currently concentrated in Africa with only two (2) countries outside of Africa reporting cases. Dr. Kearon concluded that there have been no cases of clade Ib mpox virus in Canada and that those in the community who are eligible are encouraged to get vaccinated against Mpox

MLHU at AMO 2024
E. Williams and Dr. Kearon represented the Health Unit at the annual Association of Municipalities of Ontario (AMO) Conference from August 18-21 in Ottawa.

The Health Unit had the following delegation meetings at AMO:
• Minister of Health, the Hon. Sylvia Jones to discuss opportunities for public health to address gaps in the healthcare system, particularly for vulnerable or equity-deserving groups
• Parliamentary Assistant to the Minister of Children, Community and Social Services, Laura Smith to discuss the Nurse-Family Partnership Program
• The Official Opposition/New Democratic Party of Ontario Caucus to discuss the above
• Deputy Leader of the Green Party of Ontario, Aislinn Clancy to discuss the above

Provincial Announcement: Consumption and Treatment Services
Sylvia Jones, Minister of Health announced at AMO on August 20 changes regarding the operation of Consumption and Treatment Services (CTS) in Ontario. The Ontario government will no longer fund new CTS sites and are banning the operation of CTS sites within 200 meters of a school or daycare.
Additional requirements will be introduced regarding safety, security and reporting for existing CTS sites. New legislation will be proposed in the fall that, if passed, would prohibit municipalities or any organizations from starting a new CTS site, participating in federal safer supply initiatives, or requesting decriminalization of illegal drugs from the federal government. The government has also introduced a new model called “HART Hubs” with more information on their implementation pending.

Ten (10) CTS sites in the province will close by March 31, 2025, under this new announcement (9 provincially funded and 1 self-funded). London’s consumption and treatment site called Carepoint on York Street is not due to close due to its distance from schools and daycares. Needle exchange and safer supply services are not currently impacted by the requirement to be 200 meters away from a school or daycare. The impact of additional requirements for sites regarding safety, security and reporting have not yet been evaluated.

MLHU in the News
Dr. Kearon noted that the Health Unit was in the news for different matters recently, related to consumption and treatment sites, legionella, West Nile Virus and Ontario Seniors Dental Care.

Board Member Michael (Mike) McGuire inquired on the recent news of rabies in Ontario. Dr. Kearon explained that Brant County Public Health announced recently that they have had a case of rabies in humans following a bat exposure, the first case in Canada since 1967. At this time, there is no change in risk and public health units are conducting public education on rabies. Dr. Kearon emphasized if there is exposure to a bat to seek medical attention to access a rabies vaccine.

Chair Newton-Reid inquired what type of exposure occurred for this situation. Dr. Kearon explained that it was contact with a bat directly and noting that sometimes scratches or bites from a bat are hard to see.

It was moved by A. DeViet, seconded by M. Smibert, that the Board of Health receive the verbal report re: Current Public Health Issues for information.
Carried

Acting Medical Officer of Health Activity Report for July and August (Report No. 64-24)

Dr. Kearon presented her activity report for July and August, noting that she has been in the Acting Medical Officer of Health role since August 6.

There were no questions or discussion.

It was moved by M. McGuire, seconded by M. Steele, that the Board of Health receive Report No. 64-24 re: “Acting Medical Officer of Health Activity Report for July and August 2024” for information.
Carried

Chief Executive Officer Activity Report for July and August (Report No. 65-24)

E. Williams presented her activity report for July and August.

There were no questions or discussion.

It was moved by M. Smibert, seconded by A. DeViet, that the Board of Health receive Report No. 65-24 re: “Chief Executive Officer Activity Report for July and August” for information.
Carried

Board of Health Chair Activity Report for July and August (Report No. 66-24)

Chair Newton-Reid presented his activity report for July and August.

There were no questions or discussion.

It was moved by M. Steele, seconded by M. McGuire, that the Board of Health receive Report No. 66-24 re: “Board of Health Chair Activity Report for July and August 2024” for information.
Carried

Finance and Facilities Committee Meeting Summary (Verbal Report)

It was noted that Board Member Michael (Mike) Steele declared a conflict of interest related to Report No. 12-24FFC, within the Finance and Facilities Committee Meeting Summary. Within this report, the Board will be receiving information related to the Health Unit’s new benefits provider (Manulife) effective January 1, 2025. This declaration was made due to Board Member Steele’s employment and active shareholding with Manulife but noted that he does not work within the Manulife Group Benefits department.

At 7:54 p.m., Chair Steele exited for the remainder of the meeting. Secretary Williams presented the verbal report to the Board.

There were no questions or discussion.

It was moved by M. McGuire, seconded by M. Smibert, that the Board of Health:
1) Receive Report No. 10-24FFC re: “2024 Q2 Financial Update, Borrowing Update and Factual Certificate” for information;
2) Approve the use of reserve funding from the Employment Costs Reserve and the Funding Stabilization Reserve to a maximum of $276,077 for in year pressures;
3) Receive Report No. 11-24FFC re: “Legal Services Roster – Request for Proposal Awards” for information; and
4) Receive Report No. 12-24FFC re: “Employee Benefits – Request for Proposal Awards” for information.
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, October 17, 2024 at 7 p.m.

Closed Session

At 7:57 p.m., it was moved by M. Smibert, seconded by A. DeViet, that the Board of Health will move into a closed session to consider matters regarding personal matters about an identifiable individual, including municipal or local board employees, labour relations or employee negotiations, 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 closed session Board of Health minutes.
Carried

At 8:33 p.m., it was moved by M. McGuire, seconded by M. Smibert, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 8:33 p.m., it was moved by A. DeViet, seconded by M. Smibert, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary