Town Hall Q+A: October 18, 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

Questions answered during the town hall

Is there a possibility that HCW will be eligible for third dose boosters? Many received vaccinations early and are concerned that immunity is waning.  
There is clear evidence that two doses is really effective. But evidence is emerging in terms of waning immunity. We know that that is being considered across BC, and that there will be an announcement coming and some ongoing planning in terms of that. We want to continue to encourage everyone to get vaccinated as quickly as possible. 
Are there updated guidelines for staff gatherings outside of work with Christmas season coming up? (Eg. if I go to party with my coworkers, do we all wear masks?) 

Our position right now, is that we actually still think the safest thing to do is to be masked and to abide by the rules around the density of people that are allowed in a personal space. It’s really important that we start to celebrate some of those traditions that are so important and meaningful to us all.

But every one of us has been given the tools to think about how to do that safely and you're going to still want to be planning around lots of space, lots of fresh air. Knowing that we don't guide your actions outside of work, but all of the rules that we teach you here, the principles about how to keep yourself safe, you can translate those into your outside activities. 

One thing we’ve learned over the last 18 months is not to predict things too. It’s hard to know the position that we'll be in at Christmas.  We all need to keep doing that kind of risk balance in terms of “what's really important to me in terms of social contacts” and “how can I do the things that are important to me, and maintain my mental health, but at the same time try to reduce the risk as much as possible?” 

What will be done about filling the empty positions if unvaccinated staff are put on leave? Staffing levels are not exactly in surplus right now. 

We absolutely recognize that we don't have surplus staffing levels, and we’re doing all that we can to replace any loss we do have from on vaccinated stuff.

We're working very, hand-in-hand with the managers, with staffing, and with the recruitment office to identify where there are gaps because of people not being vaccinated. We've increased our resources in the recruitment side temporarily in order to try to accommodate a high level of recruitment. 

We would also highlight that outbreaks massively increases our use of staff. So it will be a lot easier for everyone, if we can reduce the number of health care outbreaks both in long term care and acute care. And sadly, what we've seen across BC is that unvaccinated staff are a real risk of bringing in virus into a facility and starting outbreaks. 

If the majority of us are fully-vaccinated against severe outcomes, why would we be concerned about working with those who are not vaccinated? 

Our concern is around the vulnerable patients and residents that we look after. We know that vaccinations are less effective in the immunocompromised and in the elderly, and we're seeing that in long term care facilities now that when there's an outbreak, even though the residents are double vaccinated, they're still vulnerable.

The large group of infection control, quality improvement, and PCQI we've come to the office every day as well. And we're here because we know we've provided an important resource to the organization. And so we, we need to keep each other safe as well. But then we all go home to our families. So we have to think about multiple aspects of our life, not just the work stream as well. 

What we're finding with staff that are fully vaccinated because they're not getting as sick, they hardly even know they have symptoms, versus the ones who aren't vaccinated are still having some really significant symptoms.  

How are possible vaccine side effects being monitored and reported on at PHC? What are the findings? What are the effects on menstruation, ovulation/fertility? 

The vaccine adverse events reporting system is the same at PHC as it is in British Columbia and the rest of Canada. When there is a vaccine associated adverse event, those are reported through different channels. The primary channel is either through your primary care provider or through the specialist is who is assessing that adverse event – they have a form or can email the public health team directly. In Vancouver Coastal Health there is a dedicated Medical Health Officer who reviews the forms, and as a team make an assessment.

When we look at the vaccine adverse event reporting surveillance system, the first pass doesn't screen whether those adverse events reported are going to be determined to be directly attributed to or associated with the vaccine, they're just information that generates signals. After that, each case is reviewed by the public health team, and then they determine in a standard way whether it's likely or unlikely that this adverse event is associated with the vaccines. Using both the initial raw data as well as the reviewed data, the adverse events are reported that way so that for example is how mild pharyngitis, some of the vaccines in certain age groups was detected because there's signal both locally, nationally and internationally.  

If you have what you think is an adverse event temporally associated with the vaccine, go to your primary care provider, ensure that they send that information, documented objectively, either using the vaccine adverse event reporting form which is available on the BC CDC website or through an email directly to public health, and then you'll get reviewed. If you live in another health authority, the timing, in which it is responded to may be different, but each of those reports that have significance reported through the provider will be fed back directly to the individual who reports.  

In terms of adverse events related to ovulation or menstruation, there are some reports that there are changes in menstrual cycles, but that there is no impact on fertility. In fact, if we look at COVID infection itself, the risk of infertility or problems with fertility after natural infection are significantly higher. It's now recommended that all those who are wanting to conceive or are already pregnant, should be vaccinated. 

How can we honour our colleagues who are losing their jobs over the vaccine mandate? Some have worked many years for PHC. They should receive due recognition. 

We are grateful for everyone for their years of service. We’ve seen the letters that have been sent out to individuals, which have highlighted how many years of service how much we don't want to lose you. And what else can we do to help you feel confident in getting this vaccine. And we will continue to do everything we can as we talked before. However, fundamentally almost all of these outbreaks and particularly long term care are completely inadvertently and entirely not by anyone's intention, brought in with from a member of staff who is infected. We have a duty to minimize that risk. And so we absolutely are grateful for all the service that anyone gives providence and we're really sorry to lose anyone. But this is not something that we have any choice over. And it's really important that we do encourage both our staff, our colleagues, our friends and our family to have confidence in these, these vaccines.

We have a beautiful tradition of honoring our staff at Providence and so we want that to continue. And that happens at different levels, the units and in the teams. 

Have they produced a clear, acceptable mask for social comfort of staff and visitors so we can see facial expressions again? 

This has been an ambition, both locally and internationally for some time in terms of how there could be a clear mask that doesn't get fogged with the kind of condensation of breath, and we have not yet seen one that works despite lots of really clever people both locally and internationally trying to make it work.

We've tried. We keep thinking it's just a wonderful opportunity for an entrepreneur but there are just so many things that need to be approved in a mask like this. We've tried different models, and tried different things, and we just don't have one that works yet. But we can assure you that it is something we’re all looking on a constant basis. And we are trying different things out, so as soon as we have something that actually works and is approved by all the various standards then we will absolutely roll it out.  

With waning efficacy of the vaccines will double-vaccinated be the new unvaccinated like in Isreal? Will boosters be required for me to retain my job? 
We want to be really careful about predicting things in the future that we don't know. We don't yet know what will be the case in terms of both waning efficacy and how the first doses will be rolled out. I would highlight that there were some specific factors in Israel, for instance that the gap between doses, was really short. The decision that was made in Canada and in BC which at the time was, unclear and it was a risky decision, but the evidence suggests now that it was the right decision in terms of delaying the second dose. And that's not what happened in Israel, and Israel have some other issues in terms of groups or populations that were that were unvaccinated as well. We'll need to wait to see in terms of the doses and when they will be rolled out at the minute there is no employment rule around that. I wouldn't want to predict the future on that one. 

 

Is not getting vaccinated such an egregious act that it warrants termination for cause that leads to one to be ineligible to qualify for EI? It seems excessive 
Right now, unfortunately, this is deemed to be a disciplinary act as far as not getting vaccinated. It's a requirement of employment and those that have indicated that they will not [receive EI]. That's the point that we've been given from a legal perspective, that's what the province is moving forward with.  
Is the current HVAC infrastructure at SPH/MSJ sufficient to prevent/minimize aerosol transmission? (ie. within the same room vs between rooms/units) 

Being an older building of course the HVAC system is difficult to necessarily remediate in a quick and short term way. What we've done for the COVID unit, for example, is improve ventilation and filtration through installing portable HEPA filters with exhaustion, to the exterior. And that's done in the ICU as well. We did this during our most recent long term care facility outbreak. And by doing so we're able to increase air changes per hour. And that means an improvement in ventilation, but also allows air to be filtered, particularly in places where we aren't able to exhaust to the external area.

For example, when we've had exposures in rooms most recently on the cardiac ward, by installing the portable HEPA filter even without exhaustion to the exterior we're able to increase ventilation and filtration. On the COVID wards we’re able to create some negative pressure as well, such that in rooms with these devices when the doors closed, you achieve a level of negative pressure that approaches airborne infection isolation rooms but doesn't meet that level yet. And so for other areas, what the facilities team has done an excellent job of is go around in the different areas to measure air changes per hour. So rooms are rebalanced to, at minimum, achieve what the building was initially built for.  

Unfortunately it doesn't approach, six air changes per hour in each of the rooms but it's close. In most of the areas. When we did our smoke visualization studies we do see that in many hospital rooms airflow will go to the hallway and exterior and that's why there can be still risk of transmission from one room to the other through long range aerosol route. To mitigate that what we've done is whenever we have identified cases, we work quickly with facilities to install these portable filters as a short term corrective measure.  

All this is used to help inform the New St. Paul’s Hospital facility build as well to ensure that we meet the most current standards for ventilation, but also think about different ways in which we can improve efficiency, energy cost savings in achieving a building that has good indoor air quality.   

At the moment, it's reasonable and we have corrective measures when it's needed, but definitely there will be areas where the risk is higher because of poor ventilation so if there are particular areas where we see larger groups gathering, conference rooms for example, we have gone through with facilities to measure those areas as well. That's why some of those postings are there on the door to remind people to decrease density terms of number of people in the room. 

What about the argument in favor of natural immunity? 

This term is sometimes confused in different headlines and then placed out of context. Natural immunity occurs whether you have infection from the virus, or get vaccinated; in that the human immune response is to generate a defense to protect the individual from getting an overwhelming infection, unless you have significant B and T cell compromise either from drugs, or from natural disease state primary immunodeficiency, for example. Whether you're exposed to the virus, or get a vaccination, you are going to develop in most cases an immunogenic response which could be characterized as natural immunity, and that means antibody responses. Later on, memory B cell and memory T cell responses.

The problem with the argument that people would prefer to get infected and develop immunity that way, is you're posing a risk not only to yourself, but to others. It's unpredictable how the course of infection will play out for you because each individual's host response is going to be dependent on their inflammatory response. If, for example, you end up with a significant inflammatory response that could lead to multi-organ disease, landing you in pulmonary disease, respiratory distress and requiring intubation. Sometimes that can be prolonged as we've seen with some of our young patients still being transferred to ECMO for life support, and death.  

So it's a big gamble if someone is relying on natural immunity, through infection. It's much safer to get to natural immunity through vaccination, because through that you don't expose yourself to the risk of the post-inflammatory response to the virus itself and to situations where maybe even the inflammatory responses and input to control the virus. For all purposes, it's clear now that vaccination would be the better way to go. For those who haven't been exposed to the virus yet, and even for those who have been exposed to the virus, we know that does a boost does give transient, increase in neutralizing antibodies. 

Submitted questions, answered by representatives from PHC HR, OH&S, Pandemic Response and IPAC

COVID-19 updates

Where is the timely PHC communication for staff? 
Updates on orders from the Provincial Health Office and the latest COVID-19 updates are emailed out via PHC News, as well as special PHC COVID-19 updates. If you are not receiving these updates, please email: communications@providencehealth.bc.ca  

For the latest COVID-19  updates, please also visit our staff COVID-19 site.

You can also email any COVID-19-related questions to: covid-19@providencehealth.bc.ca

Personal protective equipment

People use the same mask for days, they are putting it off and on multiple times, hanging masks everywhere. What is our IPAC message? 
Mask usage in clinical areas is clearly articulated in the PPE guidelines. Masks are to be left ON until soiled or staff are going on a break.  Once removed, they are to be discarded and preferably recycled.

This is different from cloth masks that people wear outside of hospital. Some direction on cloth masks and masks worn outside of the hospital, please see the BC CDC Masks page.

Should we all be wearing N95s?  

SARS-CoV-2 is predominantly transmitted by inhaling aerosols that contain the virus.  N95 respirators are considered the best available respiratory protective equipment in health care settings.  The decision to wear an N95 respirator should be based on a point of care risk assessment.  

However, in areas where we are actively caring for patients with infectious COVID-19 (e.g. 7B) or during outbreaks, N95 respirators are the respiratory protective equipment of choice for all health care workers on the affected units.  Continuous use of N95 respirators is recommended over intermittent use in these areas because of long range aerosols that can be important in transmission. 

Similar to medical/surgical masks, N95 respirators can be undergo prolonged use to help with conserving supplies and minimizing waste.  They can be changed if dirty or when taking a break.  

Is there a central email where we can order PPE if we need a specific mask type or size of gloves?
For requests, please contact local #63694 (Stores) for PPE requests. This is available 0700-2300, seven days a week at all PHC sites.
Considering aerosols, if with patient for an hour in small consult room, are goggles recommended? Airing out of room between patients? Unvaccinated a concern.  
Eye protection is recommended when providing direct care to patients suspected of having COVID-19.  The type of eye protection (e.g. goggles or visors) can be chosen based on your risk assessment.  

The air changes per hour  (ACH) in each room is different and we do not have a general recommendation that will apply to your particular clinic area. It is expected that most clinic rooms should have 4-6 ACH and this can be measured if needed.  
If a room has a known COVID-19+ patient, one can maximize ventilation between each patient to reduce the risk but this is not always feasible.  

Willingdon Care Home has had a large outbreak. Obviously mostly double-vaccinated transmission. Perhaps we should return to wearing goggles & scrubs for now?
Outbreaks of SARS-CoV-2 are propagated when inadequate prevention and control measures are implemented.  The measures need to target aerosol transmission and outbreak interventions also need to be layered (i.e. rapid and frequent testing to identify new cases, proper PPE for health care workers that includes N95 respirators, improvement in ventilation and filtration (e.g. portable HEPA filters).  Scrubs have little impact as fomite transmission is minimal.  
What are the current criteria for "enhanced surveillance" and "outbreak"? It seems as though we are not using these terms as often despite patients testing positive. 
There is no consistent use of these terms in BC and Public Health will officially declare an outbreak if they consider it necessary.  
 

Provincial vaccine and mask mandates

Will those granted medical/religious exemptions still be allowed to be in PHC facilities (staff and visitors)? What accommodations are being made for them? 
Yes, they would be allowed to continue to work. Details of what would be needed as accommodation would be provided by the Public Health Officer.
Are staff with exemptions allowed to work in an acute care setting?
OH&S: It would depend on what recommendations come from the Public Health Officer, but I don’t see why not.
If staff with exemptions can't be accommodated, will they be put on paid leave? 
It would be unlikely that we couldn’t accommodate someone.
When will staff who are put on unpaid leave receive their ROE? I understand that unpaid leave is an interruption in earnings which requires delivery of the ROE.    
For those who remain unvaccinated and are placed on a temporary unpaid leave, they will be provided their ROE when their employment relationship has been terminated. For any questions surrounding issuance of ROE, they should contact EmployeeRBsupport@hssbc.ca 
Will PHC be liable to any adverse reactions to the vaccine, as it is their request that I have the vaccine in order to carry on employment? 
If someone has an adverse reaction to the vaccination, it would be considered a workplace injury as it is a mandatory condition of employment and would be covered by WorkSafeBC.
I'm double-vaxxed. I've done my part. How much longer will I have to wear a mask? 
Until the Provincial Health Officer states otherwise.
Why the continued mask use for Administrative Staff not doing direct patient care, if we are all vaccinated? 
We have to protect each other, regardless of our role in the organization, and wearing a mask when unable to physically distance reduces the risk of transmission of the virus.
Is there information regarding vaccinating children under 12? 
The provincial government is preparing for an approval of vaccines and is now allowing youth to pre-registration through their Get Vaccinated website.

We are expecting more information soon and we will share more information when it’s been announced from the federal and provincial government.   

Pandemic response

Any new information about cases of vaccine escape (breakthrough cases) locally and from around the world? 
In B.C., in cases of people who are fully vaccinated and still developed COVID, the majority are older (over 65) or have immunocompromised status, which is being addressed with the third dose rollout. For others the risk of hospitalization and death are very low compared to unvaccinated cases.  
This pandemic won't be over until the world is vaccinated. How can we get involved donate to the global vaccine effort, increasing vaccine equity? 
From a Canadian context this is very much a federal decision to donate to COVAX for instance. Writing to your MP or the Prime Minister may be helpful. Individual donations and support for UNICEF can also be directed to enable vaccine equity.
Please confirm a total of 4 doses for LTC residents who are mod/severely immunocompromised (ie. 3 doses primary + 1 booster dose 6 month later) per recent BCCDC?
There is to our knowledge no clear plan regarding a fourth dose of vaccine for LTC residents, undoubtedly the data around this and further refinement of a booster plan will continue to evolve over the next 6 months based on emerging data.
If immunity is higher with delayed dose, why is the window to receive second dose set to be 28-35 days?  
There is high protection with 4-5 week protection versus even better protection at 6 weeks plus.Clearly only being vaccinated x1 is significantly lower protection of our patients and residents.  The public health order tries to balance those benefits and risks.
Can we have a 72 hour valid Covid swab done for all patients that are due to have surgery as daycare or inpatient cases to prevent and decrease staff exposure? 
Our preoperative COVID screening and testing is subject to Ministry og Health policy.  There is no change in their policies on this at this time. We acknowledge that there is still anxiety from some staff around this.
If I’ve already had COVID-19, why do I still need to be vaccinated? 
If you had COVID-19 you should still get both doses (if it’s a two dose series) of the vaccine once you have recovered.  Your body naturally generates antibodies when you get COVID-19, but we do not know how long immunity lasts, or how many antibodies your body produces. This is why some people have had COVID-19 more than once, and why it is recommended you still get vaccinated. (from Immunize BC)
Is it being announced if the outbreak in the community is caused by vaccinated? Or only if the cause is unvaccinated? (e.g. - Willingdon Care Centre and BF?)
No, outbreaks are not publically individually identified regarding the presumed index case as it can be very disruptive to the outbreak site’s staff.   It is clear from the information we have that staff who are not vaccinated with two doses are significantly more likely to be the index case for an outbreak.
What are the current criteria for "enhanced surveillance" and "outbreak"? It seems as though we are not using these terms as often despite pts testing positive 
There is no consistent use of these terms in BC and Public Health will officially declare an outbreak if they consider it necessary.  
 
The BC CDC data on vaccine effectiveness does not differentiate between variants. Do you think the data presented are relevant for the Delta variant? 
Yes.  The most recent data from BCCDC includes a time period when Delta VOC has been prevalent in BC.  

Vaccines

How come some individuals get more reactions to the third vaccine (booster)? 
Common side effects from a third vaccine dose are similar to the symptoms experienced at the first two doses.  The most common reported reactions include pain at the injection site, fatigue and headache.  
Can you tell us about B cells and T cells and how it helps long term immunity
Different types of vaccines work in different ways to offer protection. But with all types of vaccines, the body is left with a supply of “memory” T-lymphocytes as well as B-lymphocytes that will remember how to fight that virus in the future.

B-lymphocytes are defensive white blood cells. They produce antibodies that attack the pieces of the virus left behind by the macrophages.
T-lymphocytes are another type of defensive white blood cell. They attack cells in the body that have already been infected.

Source: CDC.

If vaccinated hardly know that that they are sick, can they more likely unknowingly spread the virus? 
Vaccinated people who acquire COVID-19 can also develop symptoms. Symptoms may be more mild or they can also be asymptomatic.  Infectivity of a vaccinated person should be less than that of an unvaccinated person. That is why asymptomatic testing is also important in the highest risk settings.  
If a person has only been vaccinated by first dose, how long will the immunity last in their body if they will not have 2nd dose?  
This is unknown but based on other principles in vaccinology, a longer time interval between doses does not affect the immune response negatively.  However, it is balance between getting better protection after a second dose in the two dose series and delaying the second dose for what appears to be a more robust response.  
On top of getting immunized, what are some other things that we can do to increase our immunity?   
Eating a balanced diet, exercising and getting enough sleep can help support your immune system; however, immunization is the most important way to protect oneself from COVID-19.

Visitors

Ambulatory patients are noted as being exempt from visitor policy mandate; does the visitor policy mandate apply to visitors accompanying ambulatory patients? 
We do not have the new guideline from the Ministry on vaccination requirement for visitors in acute care.  We expect, though, that there will be some room for exceptions in certain circumstances.

Infection Control 

MRSA among others are contagious so what precautions on people spreading these types of issues?

As required, we use Standard Precautions: http://shop.healthcarebc.ca/phc/PHCDSTs/B-00-07-13045.pdf

And transmission based precautions: http://phc-connect/programs/infection_control/infection_control_manual/p...

Testing

Why are we opposing frequent and rapid testing for staff that are not vaccinated? 
Frequent rapid antigen testing is a non-pharmaceutical intervention (NPI) and it should not be pitted against vaccination.  Rapid antigen testing will help protect others and vaccination will protect you and others.  

Vaccination is the most effective prevention approach and this needs to be done in conjunction with other NPIs.  One is not a substitute for the other.

The vaccination mandates come from Public Health. 

Rapid testing will still be made available to HCWs who need them but not as a substitute for vaccination.  
With regard to the rapid antigen tests results, are the results recorded somewhere for reference? (e.g. e-health, CareConnect) 
Self testing with rapid Antigen tests are not recorded for staff.

For patients, we are working on a lab result location in Cerner.  In the meantime, results can be put in the situational awareness section.  

Can we direct staff looking for direction regarding testing/calling in sick to HealthLinkBC self-assessment tool? The recommendations on that site have changed.  
Use the B.C. COVID-19 Self-Assessment Tool to see if you need to be tested for COVID-19

A COVID-19 test is recommended if:

you had a contact with someone who tested positive for COVID-19 and have any one of the symptoms below.  
you are experiencing  symptoms as described here.

If you feel unwell and are unsure about your symptoms, contact your health care provider or call 8-1-1. 

Why aren't we doing the rapid ag tests for potentially exposed pts- they are asked to self monitor but by the time they develop sx, would it not be too late?  
For patients, we are doing rapid Ag tests for high risk exposures.  The frequency and when these tests are done need to be first assessed by IPAC to determine level of risk.  For example, if there is an infectious patient identified who has shared a room with three roommates, the roommates will likely have daily rapid Ag tests for 7 days after the exposure.  Details of each exposure are reviewed by IPAC and recommendations are made (documented in patient chart plus verbal communication) 

 

Why are staff who contracted COVID not given an option to test their anti-bodies?   
Antibody testing is not funded by the provincial MSP.  There are limitations of antibody testing as it is not known what threshold will provide adequate protection.  

Vaccination is recommended even for those with a previously documented infection.  

New St. Paul's Hospital

Many hospitals have gorgeous healthy, heartwarming plants. Will the New St. Paul’s Hospital be implementing healthy live plants as well? 
Inside the hospital vegetation will be in:
  • an outdoor ‘spiritual garden’ courtyard and a large Indigenous traditional medicine garden, both located in the main floor’s atrium
  • a secure outdoor courtyard garden in the mental health Stabilization Unit on the main floor
  • a large therapy garden within the rehabilitation centre on the second floor
  • a garden courtyard in the Critical Care Complex on the 3rd floor
  • four secure garden courtyards in mental health inpatient units on the 8th floor.

Outside, on campus grounds there will be landscaping in:

  • the plaza (leading to the Main Entrance)
  • along the healthcare boulevard (the road in front of the main entrance for patient drop-off),
  • a wellness walkway around the campus’ perimeter.

There will also be 4 ‘green' roofs which won’t be accessible for patients or staff, but give people a view of living vegetation.

This page last updated Oct 26, 2021 3:29pm PDT