April 3 Town Hall Q&A: Part Two

If you missed the Friday, April 3 PHC All-Staff Town Hall, here’s Part Two of the Q&As which has answers to most, but not all, of the questions which we didn’t have time to address during the session.

You can find Part One here (questions that were addressed at the Town Hall)

If you missed it, you can watch the Town Hall here

PPE Supplies

Should we be worried there have been European countries which have had to recall PPE received from China because the PPE was defective?

As a result of recent issues European countries have had, Trudeau stated on April 1st federal health authorities will not cut any corners when it comes to making sure masks provided by foreign supplies meet the necessary standards.

And in response to recent supply recalls, on March 31, China’s Ministry of Commerce announced that PPE — which includes COVID-19 test kits, N95 respirator masks, ventilators and infrared thermometers — can only be exported if its manufacturers show certification by a national registry and documentation proving it meets the import country’s standards. The exports will be checked at customs in China to confirm the paperwork, according to the government release.

At PHC every proposed N95 alternative is being cross matched with the Provincial Working Group that has already done the appropriate qualitative testing. If we get a respirator that isn’t on that list, which has happened, we do an assessment of the certification equivalency, quality of the construction and a fit test using our Sibata Respiratory Fit Test System that gives us the data on pass/fail. 

Will we provide PPE to company service engineers who are coming to St. Paul's to fix essential equipment? 

If consolidated or contracted service partners, including our service technicians, will be working in an area that does not have direct interaction with patients, then personal protective equipment is not required. For example, if they are working in a boiler room.

If they are working in a patient area that requires PPE, we would support their understanding of PPE and provide the PPE appropriate for that work area.

Occupational Health & Safety

How does PHC track infected health care workers?
OH&S, IPAC and Public Health work together to track employees who test positive for COVID-19. Virology informs IPAC and OH&S; OH&S then reaches out to the employee and informs their manager. Public Health also reaches out to the employee to do their follow-up and contact tracing. OH&S will continue to follow-up with the employee to see how they are doing. Employees must be cleared by Public Health before returning to work. 
What exactly is meant by "COVID19-like symptoms"?
The symptoms of COVID-19, are similar to other respiratory illnesses, including the flu and common cold. They include:
  • Fever
  • Chills
  • Cough
  • Shortness of breath
  • Sore throat and painful swallowing
  • Stuffy or runny nose
  • Loss of sense of smell
  • Headache
  • Muscle aches
  • Fatigue
  • Loss of appetite
Symptoms can range from mild to severe. For more on symptoms and a self-assessment tool, visit the BCCDC's website.
What exactly is meant by "if you may have been exposed to COVID-19”?

Staff are considered ‘exposed’ if there was a positive test result on their unit and they worked during that time.

In the event of a possible exposure, if staff are asymptomatic, they can work while wearing a mask and being hyper-vigilant about self-monitoring for symptoms for 14 days. If symptoms appear, staff must get tested and self-isolate for 10 days.

Are the buttons in the elevators, bathroom door handles and entry doors being cleaned after being touched at all sites? 
We have enhanced cleaning at all of our facilities, which includes our elevators and door handles; however, we always recommend that everyone wash their hands after touching common surfaces as surfaces are not cleaned after every touch.  
Should staff and COVID patients be using the same entrances?
At SPH, staff and medical staff are to use ONLY the 5 staff entrances:
  • The Code Orange entrance into the Providence Building (from inside the building, this entrance is located at the end of the hall between Cardiac Echo and Cardiac Ultrasound)
  • The back alley entrance into the Providence Main Building (between Medical Device Reprocessing and Physical Plant)
  • P1 Providence Building entrance (shared staff¬/public entrance)
  • Stairwell 16 (accessed from the Courtyard via Thurlow Street, and from inside the building it is located opposite the main Burrard entrance).
  • Stairwell 15 (accessed via the walkway beside the P1 Parkade vehicle ramp, and from inside the building it is located on the first floor near the main Burrard elevator & link elevators).

Staff should NOT be using the Emergency entrance, even after hours.

Visitors use the Burrard Street Main Entrance and P1 Providence Entrance until 8pm and the Thurlow Entrance until 6 pm.

All three entrances at MSJ remain open to staff. Long term care staff are asked to use the Kingsway entrance for screening.

HR/Redeployment

Should nurses continue to work at both sites (at SPH AND MSJ) simultaneously? 
Updated: As of May 18, 2020, there was a final MHO order allowing employees to now work at an long-term care site and acute site. Employees can still not work in more than one long-term care site.
How is a casual employee paid if they need to call in sick due to symptoms? 
If a casual staff member is exhibiting COVID-19 symptoms, they should get tested and self-isolate at home until they are contacted with the test result. During the isolation period, casual staff will be paid for any shifts they had accepted and were scheduled to work. 

Treatment/Transmission

Are virus transmission and immunity defences affected by ambient temperature and humidity? Would increasing the temp in facilities reduce virus transmission? 
According to the World Health Organization, exposing yourself to the sun or to temperatures higher than 25C degrees DOES NOT prevent the coronavirus disease (COVID-19). COVID-19 virus can be transmitted in areas with hot and humid climates. To protect yourself, make sure you clean your hands frequently and thoroughly and avoid touching your eyes, mouth, and nose. 
Is it better NOT to give acetaminophen to lower the body temperature as a patient’s/resident's ability to fight the virus may be impaired? 
Certain observations, mostly in the laboratory, suggest a beneficial relationship between elevated temperature and certain immune responses such as leukocyte migration. However, available clinical evidence does not provide a clear understanding as to whether fever impairs or enhances the host’s overall immune response to infection, and high fevers (>38.5) are not known to be beneficial. It is not clear if fever is useful for immune response or just a side effect. Studies have shown that taking antipyretics do not significantly worsen outcomes including with COVID-19. We do know suppressing fever WILL reduce the unpleasant effects (headache, myalgia, arthralgia).
If COVID spreads through contact (person to person or fomites), why isn’t wearing gloves (non-medical for the general public) recommended to control or reduce the spread. 

Updated (May 28): The virus does not enter the body through the skin. Good hand hygiene will prevent the virus from staying on the hands. 

If you touch a contaminated surface, whether with your bare hands or with a glove, and then touch your face, the virus can infect you through your eyes, nose or mouth - in this case, gloves offer no protection. In addition, if you don’t take gloves off correctly, you risk contaminating your hands, and then may touch your face. 

For staff working in the patient care setting, the current PPE Recommendation Guidelines require the use of gloves, eye protection and a mask for all patient contact. See bulletin note here from the Ministry of Health (March 25). When gloves are used, ensure you clean your hands before putting on gloves and after removing gloves. Gloves should be changed between every patient contact. Gloves should also not be routinely worn when not providing direct patient care.

Is there any plan to provide virtual or phone based care to stable, hospitalized COVID patients to prevent exposures and preserve PPE?
Yes, there is a virtual health strategy that includes inpatients and outpatients.  Licenses for physicians to use Zoom have been purchased and we have a number of tablets available in most units to both enable virtual bedside visits as well as help patients engage in virtual visits with their families.

Response Planning

Is there enough staff to deal with extra sites like the Convention Centre?
VCH is leading this provincial resource, including staffing the alternate care site; Providence is providing assistance to VCH as part of COVID-19 preparedness planning along with the Ministry of Health, Health Emergency Management BC, the Canadian Red Cross and the Mobile Medical Unit. 

For more information, click here.

We have empty beds now to prepare for COVID. Do we have a recovery plan for the COVID positive patients, & also for the influx of elective and emergency surgeries?

COVID positive patients will be moved to the Red Zone ward. Thereafter only public health can remove COVID precautions. Individual hospitals have been asked not to make decisions about removing precautions and discharging covid positive patients. 

We don’t yet have a plan for how we ramp surgery up once the COVID crisis is over but there are discussions of how we should get to a plan. This will need to be consistent across the region and province and be based on clinical urgency. Discussions will continue and we will try to ensure all the right people are involved in this. 

In terms of a general ‘recovery plan’ we have an opportunity to review our approach to how we manage services and flows. Perhaps the old normal isn’t the best normal. In terms of ambulatory and outpatients the move to virtual clinics clearly works, and for some groups of patients perhaps we wouldn’t want to go back to our previous ways. 

Are we possibly bringing in immigrant doctors with foreign credentials?
Prior to the pandemic a plan had been started to bring in more foreign credentialed doctors for very specific roles. This plan has moved forward with the pandemic and may be of some use going forward with human resources planning. We are still waiting for details from the College of Physicians and Surgeons. 

Research

What are the best resources to stay up to date on emerging COVID research?
There are a number of websites where people can find information on COVID-19 research related to prevention, treatment and diagnostics. These include: the World Health Organization (WHO), the US Food and Drug Administration (FDA), and the Canadian Institutes of Health Research (CIHR). 
What are the responsibilities of the research coordinators in protecting the confidentiality of research participants in the situation when clinicians and clinical care coordinators have asked for access to our research participant email list to contact individuals for clinical care advice about COVID-19?
Per the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, researchers have an obligation to maintain participant confidentiality:

B. Ethical Duty of Confidentiality (Article 5.1) 

Researchers shall safeguard information entrusted to them and not misuse or wrongfully disclose it. Institutions shall support their researchers in maintaining promises of confidentiality.

It is therefore required that the Principal Investigator (PI) or designated research staff member make any necessary contact with participants. This may include contacting participants to get their permission for future contact by the clinical staff for purposes related to covid-19 advice. Participants should be contacted by telephone or individual email (and not via a group email).

Should recruiting participants for research data registries continue even though clinical trials have been for the most part suspended?
Research data registries, with the possible exception of those that involve covid-19, are included in the PHCRI Memo on Research Activity dated March 20, 2020:

In response to the ongoing COVID-19 situation, PHCRI will follow exactly the same procedures as outlined by UBC for research (subject to the directives implemented by the health authority research institutes for clinical trials and REB approved clinical research). Therefore, as of March 24, 2020, all research activities should be curtailed; faculty, staff, undergraduate and graduate students, post-doctoral fellows and visiting professors should work remotely and avoid entering PHC facilities.

Continued enrolment does not adhere to physical distancing directives and prolongs routine visits to the hospital which increases risk to both patients and research staff. Therefore enrolment into these studies should be curtailed until further notice. 

Principal Investigators who propose a new covid-19 registry, or who consider their existing registry to be essential, may complete the PHCRI Exemption form, obtain signature from their Centre Director or Department Head and submit to VPResearchSupport@providencehealth.bc.ca for expedited review by PHCRI. Decisions will be made on a case by case basis.

I haven’t heard of any BC based IVAA (Vit C) trials, nor did BCCDC mention it in its treatment review. Yet it seems like a safe, easy trial to run. Why?
The short answer is no trials are planned for Vitamin C. However, there is a Phase II clinical trial in China looking at an infusion of Vitamin C in severe COVID-19 (https://clinicaltrials.gov/ct2/show/NCT04264533). Its takeup might be influenced by the results of this trial.  
Are there any plans on researching traditional medicines? 
The short answer is no, not as yet. Given the nature of the problem and poor health of patients with COVID-19 in the hospital setting, performing a clinical trial with natural remedies will be difficult. There might be more scope with a community-based trial.
This page last updated May 28, 2020 4:03pm PDT