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MORE Q&A FROM THE APRIL 14 PHC MEDICAL STAFF/STAFF TOWN HALL

If you missed the April 14 evening PHC combined Medical Staff/All Staff Town Hall, here’s Part Two of the Q&A session, covering questions we ran out of time to answer at the session. 

On hand to answer questions were Patricia Daly, Vice-President, Public Health and Chief Medical Health Officer, Vancouver Coastal Health and Fiona Dalton, CEO and President of Providence Health Care.

Read Part One of the Q&A here (questions answered during the session)

You can watch the Town Hall here. Thank you to all you attended. 

Why are authors not included in Provincial documents related to COVID-19?
In general, directives or orders from the provincial government do not have specific authors’ names to them. 
Do we have strategy for people with developmental disabilities? Risk of exposure (cohabitation, multiple support workers) + mental health risks (isolation, disruption of activity, coping)?
On April 8, 2020, a letter with recommendations was sent to licensed care facilities by Dr. Mark Lysyshyn, Deputy Chief Medical Health Officer, Vancouver Coastal Health, which could apply to congregate living settings for people with developmental disabilities. Please click here to view the letter of recommendations. 
Two long term care facilities in our region had testing done even for asymptomatic residents. This is different than the guidance from the April 8th physician update. Please explain.
Testing is recommended for all residents at long-term care homes who develop new respiratory or gastrointestinal symptoms, however mild. Because long-term care facilities are high-risk settings and have severe outcomes in the event of outbreaks, we have tried different strategies to aggressively manage outbreaks and continue to evaluate how effective those strategies may or may not be.
I think the “surge” also includes patients whose chronic health issues decompensate and get really sick. Agree?
There is a shared concern that a surge could involve COVID-19 positive patients - should broader social distancing become too relaxed too soon, as well as the many patients we are not currently seeing due to the marked reduction in ED and clinic visits. Hence there is a shared interest in encouraging patients to seek medical attention if they are not well, and by facilitating virtual visits and planning for the gradual resumption of outpatient activity.
At what point shall we consider opening the outpatient clinics? 

Updated: On May 6, BC Premier John Horgan outlined BC’s program to “restart” BC, including resuming elective surgeries and other regulated services like physiotherapy, dentistry, chiropractors and in-person counselling. Health Minister Adrian Dix has requested BC health authorities restart beginning May 19, with the eventual goal to catch up on a backlog of 30,000 surgeries and other previously postponed ambulatory and outpatient procedures.

As a provider of key regional and provincial services and programs, Providence is playing an integral role in the health system’s restart plans and in addressing the accumulated backlog, working closely with Vancouver Coastal Health, other health authorities and the Ministry of Health.

Providence working groups spent the days and weeks prior to the opening on May 19 developing detailed plans to address the complex logistical, resourcing and operational issues of re-starting the required services and program in a manner that puts staff and public safety first. We have in place appropriate screening of patients, appropriate availability and promotion of PPE usage for patients and staff, enhanced cleaning and disinfecting of common touch points and exam rooms, improved wayfinding and communications, and proper readiness of waiting rooms, ensuring physical distancing and safety for staff and patients. By all accounts the restart has gone smoothly.

How’s free parking enforced at SPH and how is the situation? It’s bad enough usually. Haven’t been there since the roll out but will be back soon.

For the latest information on parking at Providence sites, please visit the Parking page on the COVID-19 website.  

I understand IPAC has set up on the 6th floor of Youville. Does this IPAC staff presence not increase the risk to elderly at Youville?

There are strict control measures in place to protect the safety of staff and residents at Youville.

When will we have adequate numbers of external screening staff, instead of relying on our own people?

Long term care has 40 screening staff so there is no longer a requirement for staff to screen other staff. Mount Saint Joseph Hospital has redeployed nurses who are underutilized to screen staff between 0600-1200. After 1200 daily and on the weekend, students are screening staff. Screening of staff at St. Paul’s Hospital will continue to be done at the unit/dept level. 

 

Recent data in NEJM shows 14% of all comers admitted to hospital were positive for Corona virus . Would we change testing policy for all comers to protect HCW?
Updated: Since BC expanded its testing guidelines on April 8, BC CDC testing shows about a 2 to 8% positive rate. Since the beginning of May, however, the rate has been consistent at 2% positive or slightly below. See the provincial dashboard for the latest up to date numbers. Updated testing guidelines released on May 11 also prioritize testing for individuals requiring admission to hospital or likely to be admitted, such as pregnant individuals near-term, patients on hemodialysis, or cancer patients receiving radiation or chemotherapy.
Will we be doing more surgeries again soon? Will patients be tested for COVID-19 pre-op to prevent infecting other patients and staff? 
Providence Health Care is taking the steps to begin scheduling surgeries over the coming days and weeks. A surgical plan has been developed and includes important goals. As per the BC Ministry of Health and BC Centre for Disease Control Infection Prevention and Control (IPC) Protocol for Surgical Procedures During COVID-19: Adult, people who are scheduled for surgery and do not have risk factors for or symptoms of COVID-19 should not be considered suspect cases.
Why are we using the thrive app when better and free apps like flatten.ca are available?
This was chosen by the province but as our needs change perhaps other tech solutions might be needed.
What surgeries are considered agmp if no general anesthetic is used? Where is this listed?
The PPE needed for each procedure is dependent on the specific interventions, site of surgery etc.  So this is figured out individually between the program and infection control.

Should casual staff who are not being used currently be considering going other places to help? Are there any resources on this?

Due to the reduced capacity of our hospitals at this time there has been less need for casual staff, however this is only temporary and could quickly change if we have a surge in patients. Furthermore, it is anticipated that in the future we will ramp up services that are currently on hold. 
If specificity is close to 100%, then a + test result means the viral RNA is present, and the patient probably has COVID-19. Positive predictive value is good!? 
Please see a hypothetical 2x2 table below:

Even if specificity is close to 100% (ie.  b is close to 0), and PPV is high, it is only relevant if the prevalence of the disease is same as the prevalence in the study from which the specificity and sensitivity was calculated. This is not the case for any testing including COVID-19 tests. Therefore, it is better to think about likelihood ratios rather than the PPV.

*Information is still being gathered to answer the remaining questions that were raised on April 14. We will add the remaining questions in the coming days.

This page last updated May 28, 2020 4:26pm PDT