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Information for Medical Staff

NEW Dr. Kow Update - May 20, 2020
  1. No PPE supply issues over the weekend.
  2. Divisions of FP have sent lots of communications out to their members in order to support them to get their office back up and running. Also doing work to ensure GPs return to LTC in a face to face capacity.
  3. Regional group is coming together to plan around the resumption of Adult Day Programs. Will not resume as of yet, will wait for the plan to be approved.
  4. VCH: Only 5 new cases since Friday. All have an identified source. Single biggest risk factor now is known contact.
  5. A few new cases among the temporary foreign workers (all are 14day quarantine in Richmond). Their overall positivity rate is higher than the BC rate.
  6. No new LTC outbreaks.
  7. Recovery so far: pretty smooth, new elevator policies and mask use. Surgeries and ambulatory openings going well so far. Hurlburt is seconded right now for waiting area - lab and DI at SPH. We are monitoring carefully in various areas for crowding. Mask use if patients are bunching up including in ED waiting areas. We will be trialing some software to count patients in waiting areas to look at patterns. MSJ Eye clinic now using flashing buzzers to enable waiting outside.
COVID-19: Physician's Update: Testing Guidelines (April 23, 2020)
Read the new update.
PREVIOUS Updates from Dr. Janet Kow

April 30, 2020

  • No positive tests at PHC since April 20! Despite a high level of testing. 5 patients at SPH with COVID, most have been in hospital for a number of weeks.
  • Outbreaks of significance remain at poultry factories and Mission penitentiary. The challenge is tracking released inmates.
  • We have struck working groups to craft guidelines for screening, waiting room and clinic processes, visiting, virtual health.
  • No significant issues at this time with PPE or drugs. Still of course high use of PPE. there is a need a robust longterm plan for both.
  • Public health and VCH trying to slowly move people out of Oppenheimer park and into hotels. Our EDs are aware, especially as a number of them have significant health issues.

April 22, 2020

  • The outbreak at the closed poultry processing plant in Vancouver is being very closely followed up by Public Health, no one from the factory hospitalized yet.
  • Much discussion at high levels about what to do with tent city in Oppenheimer Park.
  • Continued very detailed provincial discussions about PPE management, we are still getting new supplies of 3M on an ongoing basis, but management of non-3M masks and reprocessed masks are part of the ongoing plan - they have not been needed, are just being stockpiled right now.
  • A handful of LTC residents have been taken home by families, trying to figure out how to properly serve those people.

April 20, 2020

  • Internal medicine is now seeing any presumptive or definite covid cases as outpatient/virtual. Feel free to refer anyone from ED, or outpatient, call the Medicine rapid access clinic. They will also be following everyone discharged from PHC with COVID.
  • A comprehensive medical/resp/rehab plan to be formulated for all COVID discharges. Thanks to Drs McKay, Ryerson, Kwong and Spencer for the collaborative process between those divisions! PSS (personalized support and stabilization) program from VCH involved for close follow up.PHSA has ok'ed some of the other PPE supplies, including the Alberta gifts. You may notice again some changes in masks etc.
  • We have collected Zoom data and will be sharing. High users of Zoom over last month: psychiatry, cardiology, orthopedic surgery. Virtual clinics to be a focus in all our planning for all programs going forward as face-to-face will continue to be limited for the foreseeable future.
  • All surgical heads involved in planning for elective surgery planning as some regular activities resume at both SPH and MSJ. All details need to be carefully sketched out and looking at May as target if we remain stable.
  • Some PHC employees (such as corporate) who have been seconded to COVID activities will need to go back to their regular jobs in the next weeks. Looking into hiring additional staff to take on tasks (greeters, etc) that may be necessary to continue.

April 15, 2020

  • Great questions at the town hall last night! The main message to reiterate is that testing of symptomatic patients is encouraged and we have capacity. This message is being disseminated to the community, and we’ll post places patients can go. In the meantime, the Urgent Primary Care Centres and calling 8-1-1 are options. We are testing extensively in our admitted patients and most are negative, which is a good sign. Our number of covid patients low throughout the system, only 9 at PHC (as of 11AM April 15, 2020).
  • The Province has received multiple large deliveries of Personal Protective Equipment (PPE), including N95 masks. Many have been stored at the main depot at Langley for redistribution. Including the gift from Alberta! A dashboard is being developed to aid in supply chain management. The model will be more of a ‘just in time’ situation to smooth the supply chain which has been haphazard in the past but now we need to have an Amazon like situation where you get what you need when you need it. Our Chief Financial Officer, Brian Simmers, is very involved in the discussions.
  • Dozens of iPads have arrived and will be distributed to different wards and facilities over the next few weeks.
  • We continue to finesse policies including maintaining red/yellow/green, visitors.
  • We have ordered more scrubs and looking at laundering on site at St. Paul's Hospital. However we still don’t have enough for everyone. We will be setting up distribution for residents. Physicians are encouraged to purchase your own. We need to make sure we have enough for the OR etc.
  • We are starting to discuss how we encourage other important non covid activities to continue or resume.
  • The Convention Centre site is ready to be opened with a 48 hour notice, but it is unclear at this time whether will be needed.

April 7, 2020

  • A charter plane with 19 pallets of masks ordered by the province from China arrived yesterday at YVR!! We are also getting smaller shipments in.
  • Sterilization of N95s has started at SPH and I'll update you as we see how usable they are.
  • Our numbers are still stable and low, no significant increase in patients and still 50-60% occupancy.
  • We anticipate a new regional testing guideline, our MSA has advocated for increased sampling especially in our vulnerable populations.
  • We are seeing some unintended consequences such as increased overdoses, domestic violence and some people waiting too long at home for both Covid and non-covid issues. Need to encourage our patients to continue to seek out health care when appropriate.

April 1, 2020

  • Connections Clinic (DTES) has limited HR capacity due to increase in access required for safe supply - redeployment likely coming from primary care soon.
  • The RAAC is moving into the Dusk to Dawn space by the end of next week, to free up the HUB ED pre-surge​
  • Our Clinical Nurse Educator for Substance Use, Emma Garrod is currently working rapidly with Professional Practice and Pharmacy on guidelines for Cannabis, Stimulant and Benzodiazepine replacement therapy
  • Our AMCT have created guidelines for the team, to ensure that opioid prescribing is done carefully to avoid respiratory depression and unnecessary respiratory interventions
  • A Physician Line is in place with 25 physicians sharing call to provide support to existing providers in prescribing from the new guidelines - this is quite already overwhelmed
  • Overdose Outreach Team, Housing Support Nurses and STOP teams are doing following up for newly prescribed patients
  • There is now a designated addictions physician in the community providing safe supply support for COVID+ patients who are unattached to another care provider
  • Please continue to ensure that all patients with disclosed substance use are referred to AMCT on admission.
    • The UPCCs are still quite busy, the freestanding tent for Staff testing is still planning to be up by end of the week. Details will be confirmed by end-of-day Thursday.

    • 7A and 3B are designated wards for Persons Under Investigations (PUI) or COVID-19 positive. This will help the medical teams who are designated to gain expertise with COVID-19 to maintain continuity. We also know we don't want to move patients around too much, that is also a risk. So we will need to work on the actual mechanics of patient placement and transfers.

    • We are redeploying all corporate and research staff that are not able to work into other areas of need.

    • Occupational Health & Safety will be helping all staff whether medical, allied, nursing etc. to navigate testing and when to return to work. Once they sort out the process they will start to contact Health Care Workers directly.

    • We are aware everyone wants to wear scrubs but people have been taking scrubs from the change rooms including taking them home. This is NOT APPROPRIATE our scrubs are to stay within our walls and need to be laundered here to ensure they are appropriately clean. Laundering them at home is probably not enough, and it really doesn't make sense to wear scrubs if you're taking dirty/infected clothing home! Certain departments have started having issues ensuring there are enough scrubs for staff. THIS IS NOT ACCEPTABLE. We will be reviewing our scrubs processes, looking at buying more, but will get back to you. There is no solid scientific evidence for using scrubs on the general wards if you are using appropriate precautions!

    • We have connected with UBC regarding redeploying students and residents. But remember there are also many people who are already being laid off in the province who may be willing to do some of this work and we do need to still support the community. We will plan for this as well.

March 27, 2020

  • We did receive a large shipment of NP swabs on Tues!
  • A shipment of 1200 N95s arrived yesterday. We continue to receive other donations of masks. Also collection has begun for N95s for the VCH sterilization plan.
  • Every one of the 19 ICU beds are now negative pressure! Amazing work from Facilities. Ongoing work to make other areas negative pressure.
  • Message going out from Med affairs today for MD volunteers for COVID teams. Thank you for continuing to support our patients in this scary and tough time!

March 25, 2020

  • One order of procedure masks arrived yesterday! Also many many orders put in by us and VCH.
  • VCH actively working on sterilization and reusing procedure N95 masks, for now we are going to be collecting them and sending on to VCH. Look for bins where you work collecting N95s only. They are working with 3M on ensuring the process is safe.
  • Province working with a company in BC to see if can mass produce 3D printing of visors.
  • Scott Harrison reports multiple community supports being directed to Covid, including one pod of STOP HIV working only on supporting patients. BC housing and City of Vancouver also part of planning, Hope for announcements in coming days.

March 24, 2020

  • You are free and encouraged to take your temperature at home daily, but will be asked again when you get to your unit. If your temp is over 38 and/or you have a cough find a replacement and present for testing.
  • Don't forget to SHOW your ID if you use the main Burrard or Thurlow entrances, or use the staff only entrances: Code orange entrances off Thurlow or the alley behind Davie, parkade Burrard entrance which are ID swipe only.
  • Scott Harrison is back and now on the EOC for the DTES. He will be keeping us up to date on their actions and needs.
  • A hotel for patients who are positive is going to be opened soon. One of our patients may be the first resident! VCH also looking at a shelter option which would house more people too.

March 23, 2020

  • Progress on lab – approved for high volume testing and also rapid turnaround testing (pictures below of work over the weekend to make it happen!)

  • Long term care sites – moving staff to work at one site only, assessing all staff (inc temperature check) at start of every shift

  • Acute site access – closed to visitors except compassionate end of life / assistance with care. Staff health checks to start. Reminder to PLEASE wear and display your staff ID so we do not have to question why you're on site.

  • Supplies – at all levels (PHC, VCH/PHC, PHSA, MoH) every effort being made to secure supplies and orders being placed, all types of masks on order and await shipment.

  • Reminder that pharmacists can provide refills without doctors prescription: https://www.bcpharmacists.org

  • Acute care response plan well under way, equipment such as scrubs and tablets for patient assessment to be acquired.

  • Although if you are tested at SPH/MSJ ED you will be called, you can also sign up for eHealth to access your own results regardless of which lab takes your swab: https://myehealth.ca/

March 18, 2020

Letter from PHC Medical Staff to BC Residents March 22
Read the Letter from Medical Staff to the people of BC
Update from Emergency Department at SPH March 18, 2020 

We are controlling access to all ED entry points and have closed Comox Entrance.

  • A "pivot" nurse is meeting all patients at the door (before Triage) and screening for COVID-19 with a brief history and temperature, O2 saturation, pulse. The patients will flow as follows from there:
    • If a patient is in acute distress or hemoydnamically stable, he or she would be taken to our first open negative pressure room.
    • If patients looks otherwise well (and is not from LTC or a health care worker) and has no symptoms or mild symptoms, they are informed that NO testing will be done for COVID-19 as per the current BCCDC/MoH testing guidelines, given an information package, and encouraged to leave.
    • If patient appears unwell OR is mildly symptomatic and wants to stay to be assessed by an EP, they will be moved to the Covid screening area in ABSU (where everyone wears PPEs and patient areas are separated by 2 m).
    • If a patient looks too unwell for discharge, they will be swabbed and transferred to our RESP ZONE in the Acute side.
  • We are working on a holding plan for NFA patients.
  • We have turned Acute stretchers 1 to 12 (including negative pressure rooms 3,4,5 and 6) into a RESP ZONE. All respiratory complaints that require an acute bed will be seen here, even if not obviously COVID-19 related.
  • We are following the most up-to-date PPE precautions with droplet precautions (mask, eye cover, gloves, and yellow gown) for all patient contact with PUIs.
  • Advanced PPE (documented earlier) with any aerosolized process, which we are trying to minimize to intubation only (NO CPAP, BiPAP, Nebulizer, high flow nasal O2).
  • Suspect COVID-19 Patients will be admitted respiratory etiquette to the appropriate inpatient unit.
  • Mount Saint Joseph Hospital has similar mirroring process places.

So far the volumes at both EDs have been manageable. We have not had any significant sick calls from staff. And the morale is good. Obviously, this is fluid and could change daily.

Please let me know if you have further questions.

Cheers

Dan

Dan Kalla, MD

Department Head, Emergency Medicine, St. Paul's Hospital and Mount Saint Joseph Hospital

This page last updated May 20, 2020 11:02am PDT