February 5 Town Hall Q + A

The following Town Hall questions were answered with information that was current at the time. Information around COVID-19 and our response continues to evolve. If you are unsure if the information below is still current, or if you can’t find the information elsewhere on the website, please talk to your leader or email: COVID-19@providencehealth.bc.ca

TESTING

If there is an ongoing need for repeat testing of staff on a near weekly basis can this be done on-site? Doing it off-site may decrease staff follow through.
If repeated staff testing is required, such as during outbreaks, the location of staff testing is coordinated between the unit, department, IPAC and Public Health.  It is dependent on whether the unit has sufficient capacity to sustain on-site testing, and also whether Public Health approves  for staff to be tested off-site.
How readily are we using rapid testing for routine testing?
It is important to distinguish that there are two different types of rapid testing.  One is the rapid antigen test which is only available for asymptomatic staff surveillance testing.  For diagnostic purposes, there is a rapid PCR test available through the Microbiology laboratory, and has been used to help in issues arising during outbreaks.  At PHC, we have been utilizing both methods, but it is important to understand that they serve different purposes. Read more on  PHC's testing outline here.
Why are we not currently doing any rapid antigen testing on site at our acute care centers?
Rapid antigen testing is a quick and easy to use kit that is targeted for asymptomatic staff surveillance testing.  It is less sensitive than PCR testing, and so is not appropriate for diagnostic testing on patients, which can increase the risk of false negative results.
PCR only detects viral RNA and not live virus and doesn't determine infectivity or transmissibility. WHO states tests may be too sensitive. Current CT of PCR?  

You are right that the RT PCR detects viral genetic material. When you have a positive PCR result, it does not tell you whether that virus is viable, or whether it's just genetic material that has no ability to replicate. So, currently the CT, the piece RT PCR is still used as the gold standard diagnostic test. When it comes to whether it's too sensitive, you must asks what you're using the testing for. So if it's to identify if this person been infected with the SARS-COVID virus, this will give you a longer range ability to detect that someone may be pre-infectious up until they've recovered. Several months later, you can still detect the viral material. So in that scenario it's answering the question that did this person have source COVID. At some point. This test will no longer be useful. Once someone has completely recovered, an example of that is three months later, in most people you would not be able to detect this. So then we have to use a different type of test. An example of that would be antibody testing to look for the person's immune response to this virus. We also have other tests that are available now. They're sometimes called less sensitive tests, but they're used for different purposes. So an example of that would be a screening or surveillance test. And some of you may have already experienced those when we conducted the rapid antigen testing clinics, down in the conference room here at SPH. The purpose of those tests was to ensure that we were detecting, at a broad scale, anyone who may be have the infectious virus right now. Even though that test is less sensitive than the PCR test for detecting whether the virus is there, it will be sufficiently sensitive to tell us if someone is likely to be infectious or not.

So when we look at all the various tests that we have for COVID, the important thing to remember is what question we're trying to answer as that will give us a better sense of what is the most appropriate test to use at the time. 

In relation to RT PCR, the CT stands for cycle threshold. A simple way to understand this is how many times this needs to be amplified before it's detectable. If the CT is very high, it suggests that there's very little virus in that sample. If the CT is very low. It means it doesn't take many amplification cycles to detect the virus.  

MASKS

Why can’t everyone wear an N95 mask if it makes them feel safer?  

N95’s are not masks – they are respirators. N95 respirators are used for fluid and particle resistance; they are used in situations where the airborne precautions are required. We have had communicable diseases that are airborne for a very long time and N95’s are required. With COVID-19, we know that they are required when you are doing an aerosol generating medical procedure because the risk is higher. We ask you to use your clinical judgment if you are in a situation with a COVID-19 positive patient and you feel that you're at a risk, then wear an N95 respirator.

We have hundreds of thousands of employees in the health care industry in BC. So we need them when we need them. And if everyone just decides to wear them because it makes them feel safer, then they will not be there when we need them.  

A well fitting mask will do the job to keep you protected for droplet and precautions. 

What are your thoughts about wearing 2 masks--especially pertaining to management against the new variants.  

We really need to look at the fact that in health care we wear ASCM Level 3 masks so it is safe. If you don't have a good fit for your mask, we do have other options. Rather than wearing two masks, you can get a properly fitted mask for you. If you’d like more information on properly fitted masks, please reach out to your leader who will connect you with OH&S.

The mask is two things: it’s a filter, and it’s a barrier. In the hospital, we want people to be thinking about the fact that it’s a filter. But when you’re outside the hospital, think about how it’s a barrier to prevent you from potentially exposing someone else if you were ill and didn’t know it. Both of these things are reliant on fit, and where it becomes problematic is that when you have multiple masks, it becomes more difficult to wear. We do know that if you are touching your mask you are potentially putting yourself at an increased risk of contamination. And when we see people wearing multiple masks we see that a lot. People don't even realize that subconsciously they are touching the front of that mask constantly and readjusting, and so we worry that putting two masks on gives you this false sense of confidence that might actually be leading to higher risk. Collectively we can work together to keep each other safe. 

Tips for mask fit 

One easy way to check if your mask is fitting well if you don't have glasses (if you have glasses or goggles, make sure that they're not fogging up, because of the fogging up suggests that there's leak across the band) is to breathe in. Inhale, and then blow out. If you have a properly fitting mask, the mask should move in when you're inhaling as a good fit. If there's obvious large leaks, that won't happen. 

If you'd like to learn more about masks, we recommend this YouTube video by the University of Colorado:
https://www.youtube.com/watch?v=lxzznIsXU9w&feature=youtu.be

Why have I been fit tested on a different N95 than I normally wear? 

There are times that the supply of a certain N95 size may become unstable, so we fit test on appropriate alternatives to ensure our staff have access to a good fitting N95 respirator when they need it.

Some staff in non-clinical areas still wear cloth masks or not masks from the hospital, can this be enforced? 

Anyone working within a facility is required to wear a medical grade mask and it is up to their manager to ensure that happens.  It is also perfectly okay for you to respectfully remind a colleague that a medical grade mask is required.   For corporate support areas that are not located within a facility setting, it is okay to wear a cloth mask.
Why have I been fit tested on a different N95 than I normally wear?
There are times that the supply of a certain N95 size may become unstable, so we fit test on appropriate alternatives to ensure our staff have access to a good fitting N95 respirator when they need it.
Some staff in non-clinical areas still wear cloth masks or not masks from the hospital, can this be enforced?
Anyone working within a facility is required to wear a medical grade mask and it is up to their manager to ensure that happens. It is also perfectly okay for you to respectfully remind a colleague that a medical grade mask is required. For corporate support areas that are not located within a facility setting, it is okay to wear a cloth mask.

VACCINES

Is there any data on using different brand of vaccine (from the initial dose) for the second dose of COVID vaccine?
There is insufficient data currently regarding being vaccinated with a different vaccine from the initial dose, and it is recommended to be given two doses of the same vaccine.
With the new variants will the vaccines be effective?
With the emergence of variants which have mutations in the spike region, there is a theoretical possibility it could affect the efficacy of the vaccine.  More data is needed to understand the impact of the different variants (B.1.1.7, B.1.351, and others) on the available vaccines, but  despite this, it is still recommended to get the COVID vaccine when eligible.
We don't know the long term effect with COVID-19 vaccine on babies. Should pregnant women (and women planning to get pregnant) wait and see?  
Both the National Advisory Committee on Immunization (NACI) and the Society of Obstetricians gynecologists in Canada recommend that this is an individual assessment, and that for many individuals, the risks and the harms of getting COVID-19 while pregnant are greater than the potential side effects. At this moment there are no known potential harms. It's recommended to make that individual decision. Being pregnant or planning to get pregnant is not a contraindication for the vaccine. 
When will we receive our second vaccine dosage? First, I was told I would wait 28 days, then 35 days, now 40 plus days. Is there a guaranteed timeframe?  
The province is committed to 42 days and they are delivering on that. Some of this week's vaccines are being held to make sure that there are they are available for next week. We have learned in the last year, to be very careful about committing to things in the future that we don't know about. But from everything that we know in terms of the current vaccine schedules, We will be continuing at the current 42 days. 
What happens if you missed the second dose of vaccine (past the 42 days)? Does that mean you start all over again?  
With vaccinations – although there is science behind the vaccination schedules in terms of priming the immune system and then reintroducing another stimulant as a boost – it's thought that even if you missed the 42 days, you can prolong the second vaccination and still have similar or possibly even greater efficacy. So, as much as possible the province established that 42 days as the target. But if you miss the 42 days, they won't need to reinitiate the whole schedule from the beginning. Clinics are available for everyone to get their vaccine after 42 days. So far, the clinics have been well attended. So please take that opportunity, and make sure that you do get your second dose. 
 
When will front line staff that have had Covid-19 receive vaccination?

Individuals with previously confirmed COVID-19 infection may receive their vaccine, first or second dose, as follows:  

1) Meets current staff eligibility criteria for the AND;
2) At least three months have passed since the date of their PCR positive lab confirmation  
3) For second doses, an interval of 35-42 days has passed since their first dose (subject to change based on supply) AND at least three months have passed since the date of their PCR positive lab confirmation. 

Wouldn't it have been better to make sure that residents in LTCs had access to the second dose before others get their first shot, because they're at higher risk of severe outcomes?

The vaccination rollout is being coordinated provincially, and B.C. is committed to an ethical approach to immunization phases. The COVID-19 vaccine will be distributed equitably and ethically to people in B.C. following national ethical frameworks and BCCDC’s COVID-19 Ethical Decision-Making Framework. 

Is there a rough timeline as to when PHC will be vaccinated completely (including non-clinical staff and office workers)? 

At this point it is most likely that non-clinical staff will be done with general population, but if there is any change we will let staff know.

When we say 50% HCW have been vaccinated, does this mean that include support staff (food service, opps support are also getting vaccinated?

 Some, we have tried to vaccinate those who work in tier one - ED, ICU, COVID units, and then outbreak units –  and that has included anyone who works in those units.

Do co-op students working at the hospitals count as staff who are eligible for vaccination? 

All clinical students/learners are included and eligible.

Will clinical research staff be included in the priority phase of vaccination? 

If they work directly with patients, yes.
Is there a rough timeline as to when PHC will be vaccinated completely (including non-clinical staff and office workers)? At this point it is most likely that non-clinical staff will be done with general population, but if there is any change we will let staff know.
When we say 50% HCW have been vaccinated, does this mean that include support staff (food service, opps support are also getting vaccinated? Some, we have tried to vaccinate those who work in tier one - ED, ICU, COVID units, and then outbreak units – and that has included anyone who works in those units.
Do co-op students working at the hospitals count as staff who are eligible for vaccination?
All clinical students/learners are included and eligible.
Will clinical research staff be included in the priority phase of vaccination?
If they work directly with patients, yes.

OUTBREAKS & TRANSMISSION

How prevalent is asymptomatic transmission and how infectious are they? How often do they test positive? How frequent should you test them?  

A recent study published in Science Advances looked at frequency of testing, and whether you're able to detect individuals who are positive with the possibility of having earlier supportive isolation. Through modelling, it appears that frequent testing, up to two times per week, in those without symptoms shows that it can detect a significant number of individuals and bring down further transmission. Now this was done in modeling exercises, of course, so there will be limitations. In many places, it’s not practical or possible to do this. The type of test that is used may not have to be a PCR test, if we are doing frequent testing to detect individuals and then subsequently provide supportive isolation.  

The prevalence of asymptomatic transmission is now largely thought to be due to viral load. So we talked previously about cycle threshold. The cycle threshold is a proxy, but other measures can be used to detect viral load in individuals. Additionally, it appears that in those who are asymptomatic, transmission seems to be highly correlated with the index case having a high viral load in terms of who gets secondary transmission.  

Those are the two key points that summarize the current evidence: viral load and asymptomatic transmission are the most highly associated; and frequent asymptomatic testing appears to be one way to bring down transmission, if it's followed by supportive isolation. 

Why is SPH not sharing the info about ventilation? We see facilities check air quality but are told everything is fine and Outbreaks are due to PPE break rooms.  

All buildings are designed to have a certain number of air changes to maintain a certain level of humidity and temperature. We are doing our due diligence by going through all the inpatient rooms and ensuring that they're getting their six air changes per hour, if that's what they're meant to be getting, and that the humidity is good. This information is shared with the EOC and the department heads.  

Currently, we are focusing on the negative air isolation rooms, which are the private rooms throughout the towers. If we find any issues, then we do intervene. And that might be the implementation of a HEPA filtered recirculation unit. You can be sure that we're on top of things and why you may see us around more often. 

How is the transmission so rampant in the January 2021 outbreaks if all staff are required to wear masks for the duration of their shift?  

The preliminary data suggests that the index case is either someone who was missed in terms of their diagnosis or had no symptoms that would have prompted testing during their admission to hospital. And it's very hard to prove who the index case is until we have the complete set of data, and even when we have the best available data, it's not necessarily possible to draw definitive conclusions on the first case. The preliminary data suggests that when cases are missed while in hospital, there could be transmission within the most common setting, which is the hospital room. When that transmission amplifies undetected. The amount of virus within a room or within a hospital setting will increase; and that is a significant risk for propagation of outbreaks.  

Although, PPE is one measure for protection. It's not going to be the only measure that's sufficient to prevent outbreaks from occurring. So in this setting we've looked at multiple factors, both in terms of who the patients are and the healthcare workers who provide care. Most of the information that we have suggests that healthcare workers, during the contact tracing history with public health, had no identified breaks in PPE. Earlier self-identification or breaks it's not always possible, we're all humans and we think we're doing things right, but sometimes even just small gaps in a mask can increase the risk. 

Whether or not the outbreaks are related on the various floors also remains unknown. We have to wait for the complete clinical information, the contact tracing data informed by whole genome sequencing, and hopefully more informed by the social network analysis to be able to provide you with more information.  

Additionally, we know that if there's more virus in the community, you're more likely to have an outbreak in acute care, and it could have been introduced a couple or even three times. There was some information that came from one of the nursing home outbreaks in the region, where when they finally got the genome sequencing, it was actually two different strains in that nursing home, so it was probably introduced a couple of different ways and that could possibly be what happened here as well. 

SAFETY & PATIENT CARE

Is there anything we can do about COVID+ patients who go off unit and move about the hospital and refuse to wear a mask/wear it properly? Especially cafeteria?  

When you are in the hospital and you see a patient that you know is COVID-19 positive, please ensure you are aware of what you need to do to keep yourself safe. We need to do everything we can to ensure our own safety. What you don't know are the other people in the cafeteria, who may or may not actually be asymptomatic or symptomatic. Limiting the movement of COVID-19 positive patients might give you a feeling of safety but it might not be well-served. We need to also think about our COVID-19 positive patients who have little opportunity to get outside the four walls of their room so we need to balance that risk. And when we try to balance it, limiting their movement might not actually makes us safer as a whole. Use your PPE appropriately, use your physical distancing, and wash your hands. 

The hospital is not a prison, so we don't have the ability to keep people in their rooms. However, what we can do is provide the best person-centered care that we can. We’ve talked quite a bit about ensuring that patients who don't need to be in hospital anymore are moved to the Opus hotel and the Plaza of Nations if they don't have a safe and secure home to go to. What we've observed is that when someone is acutely unwell with COVID-19, they don’t want to walk around that much; but, of course once they get better, they naturally do want to move around. So as soon as that is the case, we strive to ensure we have somewhere for people to go. 

Why are we the only health authority in BC that allows visitors into COVID positive patient rooms? 

We are following the provincial guideline that allows for essential visitors. There remain some variation between different parts of the province in how they are applying the guidelines.  Comfortingly we have found that our policies have not been any issue with risk of transmission.

With the different COVID variants now, is it now recommended for staff to change scrubs if seeing patients from different units? 

The rules around the “red” units apply here regardless of the variants. Although there is evidence from other countries that the variants may be more contagious, there is no evidence yet that changing any processes around PPE, scrubs, etc would affect this.  Also if you are appropriately changing your isolation gown between patients on precautions there is low risk that your scrubs are significantly contaminated.

Will there be any changes to isolation requirements for exposures if a staff member or a patient has had one or two vaccine doses?

There will be no changes to isolation requirements.  If a patient is on droplet and contact precautions, then usual protocol will be followed. We will continue to follow the provincial guidelines for PPE.  Until such time as there is a change in the provincial guideline, we will continue with our current direction for PPE usage.  However it is important to remember that, while vaccination is an important tool against COVID-19, it is not guaranteed to be 100% effective, and efficacy against the variants is unknown at this time.  For these reasons we believe requirements for mask and eye protection will continue for some time. 
Why are we the only health authority in BC that allows visitors into COVID positive patient rooms? 
We are following the provincial guideline that allows for essential visitors. There remain some variation between different parts of the province in how they are applying the guidelines.  Comfortingly we have found that our policies have not been any issue with risk of transmission.
With the different COVID variants now, is it now recommended for staff to change scrubs if seeing patients from different units? 
The rules around the “red” units apply here regardless of the variants. Although there is evidence from other countries that the variants may be more contagious, there is no evidence yet that changing any processes around PPE, scrubs, etc would affect this.  Also if you are appropriately changing your isolation gown between patients on precautions there is low risk that your scrubs are significantly contaminated.
Will there be any changes to isolation requirements for exposures if a staff member or a patient has had one or two vaccine doses?
There will be no changes to isolation requirements.  If a patient is on droplet and contact precautions, then usual protocol will be followed. We will continue to follow the provincial guidelines for PPE.  Until such time as there is a change in the provincial guideline, we will continue with our current direction for PPE usage.  However it is important to remember that, while vaccination is an important tool against COVID-19, it is not guaranteed to be 100% effective, and efficacy against the variants is unknown at this time.  For these reasons we believe requirements for mask and eye protection will continue for some time.

ESSENTIAL VISITORS

Are Spiritual Health Leaders (from the community) considered an essential visitor or in addition to a designated essential visitor?  

We really appreciate this question because we've consistently had conversations about holistic health care across this pandemic; we'd like to address it in two ways. The first is just a reminder that when we were in outbreaks, particularly within long term care, we had a really robust way to ensure that there could be emergency spiritual care; whether that was from the community or from one of our own excellent spiritual health practitioners in those moments of end-of-life. And always remembering that our essential concern was to reduce any risk of transmission. What we've learned from the last year of doing this is that it's really important to have a process in place. We'd like to stress less what an essential versus non-essential is, and instead highlight that our spiritual care teams and our site leaders have developed a process for when it is indicated that a person wants to receive a visitor from either our spiritual care staff, or from their community. So the point is that spiritual leaders have been accessing our sites, but they've been doing it in a very controlled and safe way. 

For more information please reach out to Beth Burton.  

This page last updated Feb 22, 2021 3:35pm PST