Town Hall Q+A: Nov. 15, 2021

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

Watch the November town hall.

Questions answered during the town hall

Now that we need a third booster shot, is it fair to say that this is not a vaccine but rather akin to a flu shot? Vaccines normally give life-long protection. (30:31)

I think there's several questions there. So firstly, it is a vaccine. There's the different terminology used, specifically saying booster or third dose. And that terminology comes down to the studies. When the studies were done initially, they looked at two dose regimens and the effect on outcomes. Now that there are certain groups that have shown to not respond as well to initial doses, the third dose has been recommended. But fundamentally, this is still a vaccine. And the qualifier is that a vaccine doesn't necessarily mean that it's lifelong protection. As with other vaccines there are, in some cases, time limits on some vaccines.

So definitely, this is a vaccine, but then you call it a third dose or booster. Now that some countries have a population with their doses, they're looking at vaccine effectiveness in that population. With regards to symptomatic disease, we'll be able to better understand the durability of immune protective effects from this vaccination dose.

Given that COVID is airborne, will PHC be revising it's policy that masks are not required at work stations in shared spaces?  (32:23)

It is still a point of care risk assessment, even for those of us who aren't working in a clinical space. This means it is dependent on what your shared spaces look like and the regimen that you've bought in your area as well. For example, at Hornby we’re really good at doing our daily symptom check. Anytime we get up and move around in the shared space, we do have our masks on. However, when in our cubicle, we do not have our masks on.

It’s all about cumulative risk. For example, in the one of the pharmacy offices - it is shared space is in the older part of the building - and when we assessed the ventilation there [we found] that you are inhaling over two to three per cent exhaled air from someone else. And so if someone is infectious in that space, that does increase the risk of someone else barring the infection. So what can be done to reduce that risk in a space like that is opening the windows, which we have, and that does reduce the co2 level by bit, but also reducing the number of people in that space.

As part of the reopening plans, or having people come back to work, one of the things that you can do is think about the volume of the space that you're in, how many people are working there and the co2 level that can be measured. If we're looking at non-clinical areas, this is something can be done to give us an objective measure, so that you can have more pieces of information to make a decision on how safe that space is.

The other part is about not coming to work sick. We know that transmission can occur during the asymptomatic phase. That is why these other measures of assessing the risk are important - and that's not something necessarily that you could do yourself, accessing co2 monitors, but Infection Control, we borrowed them from Occ Health. And facilities can help with those requests, if there are a lot of areas people are concerned about. And if you have any concerns, then definitely wear a well-fitting mask while you’re in that enclosed space.

You can also now be confident that all of your work colleagues are vaccinated. While vaccination is not 100%, it does reduce the likelihood significantly of anyone else in that shared space being infectious. That is not the case in any other shared space that you are in, or most other shared spaces. We live in a more complicated world now because we are trying to correlate all of this risk, and making decisions in terms of our whole lives and our working lives is part of this.

Thoughts on stronger PHC proactive direction to have Staff (non-pt care) Work From Home during December?  To prevent spread from gathering outside of work and bringing to work? (37:07)

I just wanted to start by saying that working from home has a lot of benefits, especially in health care. We have to balance any risks from people coming in to our facilities versus the need to continue to have some face-to-face. Certainly some meetings will continue to be online and virtual. But we don't want people coming in if the risks are too high. When people are on site, and since we're all vaccinated, and hopefully we're being relatively careful outside of work and making sure that when we're on site here wearing our medical masks, I think it's important to balance all of those things.

It’s a discussion with your manager or supervisor. And that's been done to kind of make sure there's lots of space to breathe and to move around. The topic of working from home does stand alone from COVID itself and certainly something we were introduced to in a big way as a result of COVID. But the option is there where the job is appropriate, where the team supports it, and that's a discussion with your supervisor or managers. If you never see your team, that's not great for them or for yourself and there is a lot of value in face-to-face and seeing each other. So speak with your manager and what we are we are supporting work from home.

Can you provide guidance on team gatherings for the holidays? What is allowed? What about food - ie does it have to be pre-packaged? And what about gathering? (40:15)

It’s important for people to actually have the time to celebrate together. However, we like the idea of actually engaging with the facilities who are doing this as their business because they have the rules in place and they have the infrastructure in place to do this safely.

If you are going to do an event at a unit level or program level type party, we'd like you to actually work with a restaurant or a hotel that already has all of the infrastructure they need to do that safely. If you're doing something in your unit area, we really need you to abide by the rules that we've had in place all along, which is that we're not having shared food that you should not be removing your masks to eat or drink within close proximity of one another.

For your personal life outside of work, which we hope to be able to influence but we can't dictate, we ask that you please take all of the things that you've learned when you come to work every day and try to apply those to keep yourself safe and all of your loved ones safe over the holidays as well.

We haven't heard much about outbreaks in our sites lately. Are the lack of outbreaks due to vaccination rates or better prevention or just luck? (42:48)

A formal outbreak, with a big O, is called by Public Health. They’re put on the Vancouver Coastal Public Health website and the Vancouver Coastal website - they have their own determination of what an outbreak means. At Providence, we take every exposure very seriously. In terms of whether someone who we didn't know had COVID is on our sites and may have exposed others to COVID. All of those exposures are carefully examined and there are multiple teams that review the situation and figure out what to do next. We have had a number of instances where we've had one patient or a staff member or a couple of patients that have had COVID in certain places. There is quite a very extensive investigation, and often there is testing done and we've also limited movement of either patients or staff in and out of those areas.

Whether that case is a staff member who was working while infectious and asymptomatic or a patient who acquired COVID in hospital or was identified off the unit, those added measures are taken. The added measures do include enhanced personal protection, enhanced portable HEPA filtration, frequent self-testing for staff, and testing patients. So I think it's all three. Vaccination is definitely contributing to the lack of outbreaks that we’re seeing. We know that vaccination will reduce secondary transmission. The better prevention measures are the different added prevention measures that we take.

How many Providence staff had to go on leave without pay because they wouldn't get vaxxed? Is this causing major staffing issues at PHC? (46:51)

We're looking currently at around 30 to 32 staff. It's not high in Providence Health Care, staff have been very, very good. And there's been multiple reasons for people not getting vaccinated. We just simply ask the questions and provide information. We're in quite good shape for where Providence Health Care is concerned, but we're also in pretty good shape as far as the province is concerned.

From a staffing perspective, this is something we've been watching pretty closely and making sure we have resources for and obviously losing even one staff creates a question around staffing and backfilling but know it's something we've been on top of.

Aside from our current EFAP provider, are there any additional resources available to staff? (49:21)

It's been a really, really tough couple of years for everybody, so, of course the OH&S team is also available to help as needed.

We'll bump up resources as we can, if there's something that we're missing and something people want to see. Please reach out to me and let me know we'll explore what's available in addition to what we already have, which is when our staff to be supported. We know it's a tough time.

Note other resources can be found on the Staff Support section of the COVID-19 site.            

Many non-vaccinated visitors are still entering the hospital without proof of vaccination, leaving front line staff to communicate with angry visitors.

I said in my presentation, you know, it's it's still a work in progress. So I want to be just asking for people's patience. And in terms of safety of our patients and safety of our staff, I don't generally want to put this all on the screeners. It is very difficult when people are coming to the front door and people are saying things - we don't have an automatic way of saying well okay, you're saying you're coming to the CCU. I'm going to call up to the CCU and and say who is this person? We just don't have that kind of set up. It would be impossible to put together so I we're going to continue to try to do the best we can and have some clarity around who's doing what at both the front doors as well as at the unit and we don't want to have a whole lot of duplication of work or people getting frustrated.

We also do not want anyone to get hurt I know that this can be a very emotionally-charged subject. And people get upset if they are told they can't come in or are recommended not to come in. The first thing is safety for everybody. We will sort it out. Make sure that you call on leaders on security if you have to. And don't feel that you have to sort of take care of some anger or hostility by yourself. So we will work this out. We are going to work with the leaders with the program directors, with security, with the people that run the screener program, and we'll get this smoothed out as quickly as you can.

Please be sure that you're looking at yourself and your safety first and don’t engage with anyone that seems unsafe.

Would the mask policy change now to N95 as new standard rather than medical masks now that Covid is airborne? (53:24)

That awareness of how the airborne can contribute [to COVID-19 spread] needs to factor into a decision that you make about your mask. But we’re not at a place where a N95 is mandated in every situation. It comes down to understanding the type of work that you're doing, the space that you're doing the work in, and  your proximity to others that will drive what is the right mask for you in the right situation.

To be clear: there is no official policy change from the BC government or hospitals. What Public Health Agency of Canada specifically has changed since Friday, is that they're saying for people who are at higher risk, do strongly consider better fitting masks or respirators. And respirators can now be used by the public.  

In the case of health care, your risks are going to be different depending where you work. We still sporadically have patients with acute infectious COVID being admitted to hospital and in some cases we have seen transmission to health care workers. For example, when the transmission event happens on the ward, that's when we explicitly will remind staff where N95 use should be highly considered.  

If you choose to use a respirator for that purpose, just remember that there's also stewardship of supplies. Just because we don't have a shortage anymore doesn't mean that we shouldn't consider the waste that masks introduce to the environment. Stewardship is an important principle and the respirators can be used for prolonged periods of time, taking into account same principles that when you would switch out to a surgical mask. You change a surgical mask if it's visibly soiled or it's wet, or it's been used and no longer fitting properly.

What we don't want to see is respirators being used and then taken off for every patient encounter because that doesn't introduce a lot of waste. Hopefully we will have a much more robust departmental recycling programs. I know PHC is one of the leaders in that and now with the planetary health lab, and a commitment to health care contribution to waste, I think that there will be more programs to look at recycling and other innovations to look at reusable respirators in the future.

If you are wearing an N95: you also need to make sure you are properly tested for a properly fitted.

Submitted questions

Masks, testing

I don't understand why there's such a big deal about whether the virus is airborne or not. If we're all masked, does it matter if it's droplets or airborne?
Knowing that the virus is airborne helps us protect ourselves at all times. It should also be a key consideration for when doing our point of care risk assessments to determine the appropriate PPE needed.
Why are we not using rapid testing for health care staff? Vaccinated can get infected too.
Rapid testing is used for health care staff when positive cases are identified based on potential exposures.
If regular activities like talking/coughing produce more aerosols than what we used to think of as AGMPs should N95 be worn with all patients with respiratory illness?
Our mask policy directs you to use a point of care risk assessment and where an N95 is appropriate. For instance, if you’re seeing a patient with respiratory illness that has received a negative PCR test, then you don’t need an N95 mask.
PHO has mandate to wear masks indoors. When did PHC change policy that staff in shared non-clinical space don't need to wear masks?
The PHO mask mandate is for public indoor spaces, including places like malls, grocery stores, airports and coffee shops, where everyone may not be vaccinated. This PHO does not include non-clinical office and commercial (private) spaces.

Our safety plans for non-clinical and commercial spaces do advise mask use in doors, in higher traffic and shared areas, like hallways and elevators.

Holiday celebrations

Can we get more clarity on food: if there is a team lunch, what is allowed? Can a team order pizza if only handled by one?
There will be further guidelines coming soon around decorating and celebrating over the holidays, however it’s most important to keep doing the things you’ve been doing to celebrate safely. This includes recognizing where you’re celebrating (indoors versus outdoors), and how many people are invited. Generally, people should not be eating and sitting together at work; buffet-style food sharing should be avoided.

Visitor rules

Are we currently screening for vaccination status of patient's family/visitor's or caregivers?
We do have screeners at the front of the building and in the front of each unit, screening everyone for vaccination status to the best of their availability.
Do the acute care visitor rules (i.e. proof of vaccination) apply to people accompanying outpatients?
There may be exceptions to the acute visitor rules (eg - someone with an outpatient appointment needing care may need to be accompanied with an essential visitor.) Everyone, regardless of vaccination status, is screened for symptoms and is required to wear a medical mask.

Screening & volunteers

Is there a plan to bring volunteers back to SPH? One thought is they could help w screening visitors outside units like the ICU, streamlining info through one person.
Any plans to bring back volunteers should be sent to the Pandemic Response team for consideration and approval. However, volunteers shouldn’t be asked to fill in for the screeners; this is a dedicated, paid-role.

Vaccines & boosters

Is the third dose/booster for HCWs going to be mandatory?
No.
Will there be booster or 3rd dose clinics at Providence hospitals and LTC sites? If not, why not?
All third dose clinics are being coordinated by the provincial registration system, as they have the appropriate resources to plan and execute the vaccination response and will prioritize all health care workers across the province.
For the third doses, will HCWs be prioritized in any order? How will that work?
In order to receive an invitation for your booster dose when you become eligible, you must be registered on the provincial Get Vaccinated online system.

In addition, you will also need to self-identify as a health-care worker on the Get Vaccinated system in one of the following five categories:

Category 1: Long-term care (LTC)/assisted-living (AL) staff, medical and workers – includes everyone working on site in LTC and AL sites.
Category 2: Hospital critical care/emergency department/medicine staff, medical staff and workers – all individuals working in the listed care areas (critical care, emergency and medicine units) in acute-care hospitals.
Category 3: Other hospital staff, medical staff and workers – all individuals working in other care areas of the hospital not covered by Category 2, as well as any corporate/administrative staff working on site in the hospital.
Category 4: Health authority community staff, medical staff and workers – this includes all health authority staff, professionals and workers working in non-hospital areas and includes all other health authority administrative, corporate staff who are not included in categories 1, 2 or 3 above.
Category 5: Other community staff, medical staff and workers – this includes all non-health authority health providers, staff and other workers in the community health sector.

Find more information to register here.

Can we please have the link and code again for registering the 3rd booster dose?
The code and instructions to register can be found here: https://covid19.providencehealthcare.org/immunizations/booster-information-health-care-workers       
Since we now know that less than six weeks gap gives less protection, can we increase the deadline for second dose for those that got recently and not 28-35days?
This is a decision made by the Ministry of Health and Provincial Health Officer, considering all factors to safely meeting the second dose deadlines. 

New hires

Can a new hire start work the day after a second dose or is there a waiting period after the second dose?
A new hire must be fully-vaccinated, which is both doses plus seven days.

Flu shots

Are flu shots mandatory for staff?  And if not, how will that be monitored? Historically staff would need to wear masks if they did not receive the flu shot.
The flu shot isn’t mandatory at this time, however, it is highly recommended to protect you and others, especially given the prediction of a difficult flu season.

After you receive your flu shot, report your status online so we have a record of who has received the flu shot.

Staff support

What are we doing about staff burnout?
We have provided a variety of resources for staff to utilize to address burnout, as this is a very individual issue – it’s different for different people, so different resources are needed.  Check out the Homewood Health website, the PHC Thrives website for more information.
Heard another health organization is giving staff $20 pp for Engagement Funds, will that be the same for PHC?
Not at this time. We plan to talk to staff about what they want to see to increase health and safety in the workplace.
Would having additional violence prevention workshops specific to dealing with aggravated unvaccinated people be helpful for staff in acute? 
Our Violence Prevention courses teach how to de-escalate violent situations, regardless of the cause, so no specific training is planned.
This page last updated Nov 17, 2021 11:36am PST