Physician Town Hall Hosted by: Dr. Susan Shaw - Saskatchewan Health Authority
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Physician Town Hall
Hosted by: Dr. Susan Shaw
October 21, 2021
www.saskatchewan.ca/COVID19
Town Hall Reminders
• This event is being recorded and will be available to view on
the Physician Town Hall webpage (Names, Polling Results,
and Q&A are not posted unless a question is asked verbally).
• Please sign in using your full name!
• Watch for this icon during the event and respond to our live
polls.
• Submit your questions using the Q&A function at anytime!
www.saskatchewan.ca/COVID19
Panelists joining us this evening...
• Beyond the list of presenters on the agenda, we also have a
number of colleagues joining us to support the Q&A.
• Panelists – please introduce yourselves in the chat.
• Ask your questions during the event and panelists will try to
answer!
www.saskatchewan.ca/COVID19
Truth and Reconciliation
We would like to acknowledge that we are
gathering on Treaty 2, 4, 5, 6, 7, 8 and 10
territory and the Homeland of the Métis.
Recognizing this history is important to our
future and our efforts to close the gap in
health outcomes between Indigenous and
non-Indigenous peoples. I pay my respects to
the traditional caretakers of this land.
www.saskatchewan.ca/COVID19
Agenda
Dr. Mahli Brindamour
Care in Kids with COVID
Dr. Ayisha Kurji
COVID-19 Surveillance and Epidemiological Trends Dr. Johnmark Opondo
Offensive Strategy Highlights Dr. Johnmark Opondo
Dr. Tania Diener
Vaccine Strategy Highlights Dr. Kevin Wasko
Dr. Julie Stakiw
Dr. John Froh
Defensive Strategy Highlights
John Ash
Safety Updates Dr. Mike Kelly
Physician Wellness Patti Stewart McCord
Q&A Opportunity to ask your questions live!
www.saskatchewan.ca/COVID19
Care in Kids with COVID
Dr. Mahli Brindamour MD, FRCPC Dr. Ayisha Kurji MD, FRCPC
General Pediatrician General Pediatrician
Assistant Professor Assistant Professor
University of Saskatchewan University of Saskatchewan
COVID-19
Health System Update
www.saskatchewan.ca/COVID19
Covid in kids SK – data as of Oct 17, 2021
BCCDC
Pediatric Clinical School start Sept 1
Guidance for COVID-19
1st Delta case in SK – May 14
Lifting
restrictions
School-associated cases
Sept 1, 2020 - Jul 12, 2021
www.saskatchewan.ca/COVID19
Management of Pediatric COVID-19
www.saskatchewan.ca/COVID19
Scan for Tiers of Service www.saskatchewan.ca/COVID19
www.saskatchewan.ca/COVID19
More information
from SharedCare
www.saskatchewan.ca/COVID19COVID-19 Surveillance and
Epidemiological Trends
Dr. Johnmark Opondo
Medical Health Officer
COVID-19
Health System Update
www.saskatchewan.ca/COVID19Key messages
• We are at a high plateau of cases, this rate of case production is not
sustainable for our system.
• We continue to experience high service demand, death rates are high and
we are going in to winter and holiday season at high numbers.
• Covid-19 vaccines protect against severe outcomes; however at high
background rates of community transmission Covid can still impact individuals
who may have otherwise been protected.
• We need to address misinformation and disinformation (infodemic);
remember: estimated 400,000 SK residents remain partially and
unvaccinated
• Hospitalization and critical care remain strained, and maintaining this volume
of service is costing the system in it’s standards of care, staff patient ratios
and the potential need to transfer patients out-of –province.
www.saskatchewan.ca/COVID19COVID-19 cases, rate per 100,000 (last 7-days), by province/territory, October
20, 2021
SK now has the
highest new case
rate among the
provinces in
Canada
www.saskatchewan.ca/COVID19
Source: Public Health Agency of Canada https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.htmlCOVID-19 deaths, rate per 100,000 (last 14-days), by P/T, Canada, October 20, 2021
In the last 14-days,
SK ranks 1st in
COVID death rates
in Canada
www.saskatchewan.ca/COVID19
Source: Public Health Agency of Canada https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.htmlRecent COVID-19 deaths: Sep 1 – Oct 10 (n = 145)
Deaths
• The majority, 87%, of deaths
n = 145
were individuals 70+ years
• Among those7-Day Case Average
0.0
100.0
200.0
300.0
400.0
500.0
600.0
1-Feb-21
4-Feb-21
7-Feb-21
10-Feb-21
13-Feb-21
16-Feb-21
19-Feb-21
22-Feb-21
25-Feb-21
28-Feb-21
3-Mar-21
6-Mar-21
9-Mar-21
12-Mar-21
15-Mar-21
18-Mar-21
21-Mar-21
24-Mar-21
27-Mar-21
30-Mar-21
2-Apr-21
5-Apr-21
8-Apr-21
11-Apr-21
14-Apr-21
17-Apr-21
20-Apr-21
23-Apr-21
Cases
26-Apr-21
29-Apr-21
2-May-21
5-May-21
8-May-21
declining
11-May-21
14-May-21
17-May-21
20-May-21
23-May-21
26-May-21
29-May-21
1-Jun-21
4-Jun-21
7-Jun-21
10-Jun-21
13-Jun-21
average, Feb 1 – Oct 12, 2021
16-Jun-21
19-Jun-21
22-Jun-21
25-Jun-21
Test positivity is HIGH and not
28-Jun-21
1-Jul-21
4-Jul-21
7-Jul-21
10-Jul-21
13-Jul-21
16-Jul-21
19-Jul-21
22-Jul-21
25-Jul-21
28-Jul-21
31-Jul-21
3-Aug-21
Test Positivity
6-Aug-21
9-Aug-21
12-Aug-21
15-Aug-21
18-Aug-21
21-Aug-21
24-Aug-21
27-Aug-21
30-Aug-21
2-Sep-21
5-Sep-21
8-Sep-21
11-Sep-21
14-Sep-21
COVID-19 cases and test positivity, 7-day rolling
17-Sep-21
20-Sep-21
23-Sep-21
26-Sep-21
29-Sep-21
2-Oct-21
5-Oct-21
8-Oct-21
11-Oct-21
0.0
4.0
6.0
8.0
2.0
5%
12.0
14.0
16.0
10.0
Test Positivity (%)Offensive Strategy
Dr. Johnmark Opondo
Medical Health Officer
COVID-19
Health System Update
www.saskatchewan.ca/COVID19Update from Local Public Health
• Contact Tracing has improved is now overall rated as yellow,
although some areas are experiencing a plateau
• Positive case management going well
• Auto-notification delivering majority of positive results
• Case investigation meeting 24 hour TAKT time
• School investigations remain high priority and busy at this level of
social mixing
• Our capacity to maintain “Test, Trace and Isolate” are:
• Taxed for Human Resources
• Shoal Lake Fire Evacuation adds pressure to ASIS and Contact
Tracing Work
www.saskatchewan.ca/COVID19Areas with at least 5% increase in Dose 1 coverage between Sept 16 and Oct 12,
2021
Athabasca Health Authority 13.1
North West 4.1 (Lloydminster) 7.0
North West 4.2 (Maidstone) 6.5
South East 9.2 (Estevan) 6.3
South East 9.3 (Oxbow) 6.1 Proof-of-vaccination policy
North West 2.2 (Meadow Lake)
South West 1.1 (Biggar)
6.1
6.0
appears to be universally
North West 2.1 (Loon Lake) 5.7 effective at increasing coverage
North West 1.2 (Île-à-la-Crosse) 5.6
rates across the province –
South West 6.2 (Ponteix) 5.6
North East 4.1 (Prince Albert) 5.5
regardless of the coverage rate
North East 3.1 (Big River) 5.3 the local area had prior to the
North West 3.2 (Edam) 5.3
North East 1.1 (La Ronge) 5.2
requirement
South East 9.1 (Carlyle) 5.1
South West 1.3 (Kindersley) 5.1
0 2 4 6 8 10 12 14
Change in Total population coverage rate (%) between Sept 16 and Oct 12, 2021
www.saskatchewan.ca/COVID19Key public health messages
• COVID zero may not be an easily achievable goal - our goal is to
prevent severe outcomes and protect health system capacity
• Vaccinations, mask mandates, proof-of-vaccination policies have all
reduced the rate of growth, however, still in exponential growth
• SK is NOT in decline and rate of case production remains HIGH;
• What we can do as individuals: reduce non-essential interactions,
and stay HEALTHY as our acute care system is stretched
• We recommend gathering restrictions: Small gathering limits,
capacity limits, schools still open (hybrid, cohorting, ventilation,
masking, isolate cases, frequent testing)
www.saskatchewan.ca/COVID19Vaccine Strategy
Dr. Tania Diener Dr. Julie Stakiw
COVID-19 Vaccine Strategy Chief Physician Lead – Vulnerable Populations
Dr. Kevin Wasko
Physician Executive – Integrated Rural Health
COVID-19
Health System Update
www.saskatchewan.ca/COVID19Vaccine Strategy
Key Goals:
• Minimize serious illness & death
• Protect health care capacity
• Minimize spread of COVID-19
• Immunize as many people, as quickly as
possible; safely.Vaccine Administration as a Percentage of Population Eligible (12+)
Canada Canada
85.5% 83.2%
Percentage of Eligible
Population (12+) Vaccinated
91.0%
As of October 21, 2021
https://covid19tracker.ca/vaccinationtracker.html
88.1%
94.8%
87.2% 76.4%
89.1%
89.2% 86.9%
85.5% 94.0%
86.2%
83.5% 87.8%
77.2% 92.2% 86.0%
77.3% 90.0%
84.3%
87.6%
83.4% 85.9%
90.6% 84.8%
FIRST SECOND
DOSES DOSES
91.0% 82.1%Who has been immunized?
First Doses (%) Fully Vaccinated (%)
October 21, 2021
Oct 7 Oct 21 % Change Oct 7 Oct 21 % Change
Ages 80+ 95 95 -- 91 91 --
Ages 70 - 79 92 93 + 1% 89 89 --
Ages 60 - 69 90 91 + 1% 86 87 + 1%
Ages 50 - 59 85 87 + 2% 78 80 + 2%
Ages 40 - 49 81 83 + 2% 72 75 + 3%
Ages 30 - 39 76 79 + 3% 65 68 + 3%
Ages 18 - 29 77 80 + 3% 62 66 + 4%
Ages 12 - 17 76 81 + 5% 63 68 + 5%
Overall (12+) 82 85 + 3% 73 76 + 3%
www.saskatchewan.ca/COVID19Vaccination for 5-11 year olds
• Pfizer has made application to Health Canada
• SHA currently planning for roll out
• Clinical Advisory Committee will be discussing next week,
including possible sequencing
Statement from Health Canada
regarding submission from Pfizer
www.saskatchewan.ca/COVID19Phase 2A Eligible Populations as of October 4, 2021
Population Interval from dose 2 to dose 3
80 years and older living in the community 6 months (If 3rd dose for travel
administered ≥ 28 days after 2nd dose
it counts as booster)
Individuals with primary or acquired immunodeficiency states: 28 days
- Including but not limited to poorly controlled HIV/AIDS (i.e. a current CD4 count ofPhase 2B Eligible Populations effective October 25, 2021
Eligible Populations Interval from dose 2 to dose 3
Individuals aged 65 years and older 6 months
Individuals living in the Far North and those living on First Nation communities, aged 50 6 months
years and older
Health care workers will be eligible for a booster dose at least 6 months after the date of 6 months
their second dose (proof of HCW status will be required)
Individuals born in 2009 or earlier with underlying health conditions that are clinically 6 months
extremely vulnerable including:
1. People with severe respiratory conditions, including all cystic fibrosis, severe asthma
and severe chronic obstructive pulmonary disease (COPD)
2. People with rare diseases that significantly increase the risk of infections (such as
homozygous sickle cell disease)
3. People who had their spleen removed
4. Individuals with very significant developmental disabilities that increase risk (such as
Down’s syndrome)
5. Individuals on dialysis or with chronic kidney disease (stage 5)
6. People with significant neuromuscular conditions requiring respiratory support
www.saskatchewan.ca/COVID19Proof of COVID-19 Vaccination Policy
Vaccination information from Panorama:
• Total # of Physicians: 2702
• Fully vaccinated: 2118
• Partially vaccinated: 54
• Unvaccinated/Unknown: 530
**this data does not account for any vaccinations received out of province
All physicians who have SHA privileges, need to follow the policy directive
To prepare for the roll out of the program in November, all physicians should register for a
MySaskHealthRecord account and access their COVID-19 Vaccine Record.
https://www.ehealthsask.ca/MySaskHealthRecord/MySaskHealthRecord
• More resources for physicians regarding the
vaccine policy
www.saskatchewan.ca/COVID19Influenza Vaccine Reminder – Did you know?
• Every health care encounter NEEDS to be an
opportunity to vaccinate for COVID-19 and Influenza
• Flu vaccine clinics opened on October 12.
• Flu and COVID-19 immunizations can be received
together
• This is very convenient for patients and their families
• Promote this option to your patients going for their
flu shots/COVID-19 vaccinations
For more information see
• Delivery of vaccine immunization is a team effort the October 13, 2021 -
requiring every health care worker’s dedication Get your COVID vaccine
and flu shot together
www.saskatchewan.ca/COVID19Defensive Strategy Highlights
Dr. John Froh
Defensive Strategy Co-Chief
John Ash
Defensive Strategy Co-Chief
COVID-19
Health System Update
www.saskatchewan.ca/COVID19Strategy – Maintain our COVID-19 Defensive Strategy
through ongoing readiness of the acute care system
to match incoming demand (including ICU) while
providing essential services to non-COVID-19
patients
COVID-19
Health System UpdateActions
Maintain strategies to prevent COVID-19 transmission, and response to
suspect and actual acute care outbreaks
Maintain and update acute care surge plans based on modelling.
Implement COVID-19 POC testing in the acute care setting
Implement HCW antigen testing in the acute care setting
Assess and develop plans to address the patients suffering long-term impacts
of COVID
Develop and implement operational and staffing plan to maintain acute and
ICU capacity within operations and prepare for fall surge
Utilize low acuity care transfers from tier 6 (tertiary) facilities to enhance load
leveling and fully utilize acute care capacity.
Develop and implement ICU Out of Province Evacuation Transport process
COVID-19
Health System UpdateHospital Capacity: COVID + Non-COVID
Key indicators: COVID + Non-COVID Pressures
Offload Delays
Out of Province Transfers Admit No Beds Saskatoon (Oct 3-9) Regina (Oct 8-14)
Transfers: 6 • Every patient has an offload delay • RGH longest delay was 4.2 hours
Repatriations: 0 27 • 50% of offloads were longer than 1 hour • Pasqua longest delay was 1.6 hours
As of Oct 21, 2021 8am, Oct 21th • 19 were longer than 4 hours
Census of Covid Patients in Hospital
Inpatient
capacity
required
equivalent to
Swift+PA+MJ
Hospitals
combinedPatients on high flow oxygen outside of ICU
Unmet ICU
demand! – Acute
teams caring for
patients that
would normally be
in ICU with no
change to staffing
ratios
Data only collected M-F during end of previous wave (May 4-June 15) and this wave starting Sept 21Exceeding safe and sustainable capacity – Driving need to transfer ICU
patients out of province
Care deteriorating as
we surge towards 125
Trigger for Out of
Province is 116
At last update, 57
patients receiving high
flow oxygen with a high
probability of requiring
ICU care or would
normally be receiving
care in ICUArea Hospital ICU Census – October 20, 2021
North Saskatoon
South ReginaProvincial ICU Pressure
Current Impacts of Managing ICU
Capacity
• Approval required on emergent,
cancer and 3 week urgent surgeries
• Substandard care for those in
critical need and/or at risk of death
Patient Census: • Reduction in critical care surgeries
117 0730h Oct 21
57 High Flow (including open heart and neuro
Oxygen patients
not in ICU
patients)
Impacts of managing within the red
• Requirement for evacuation of ICU
patients out of province
• Increased preventable deathsHighest per capita COVID ICU census: multiple strategies required to manage (OOP TF, CAMPUS, PCCP)
Pandemic Crisis Care Principles • PCCP established to guide IHICCs in making staffing and other care related decisions in managing escalating resource constrained environments • Each IHICC has provided an assessment of impacts to models of care utilizing the PCCP, some variation in application of tool making it difficult to compare across IHICCs and risk of care environment as capacity increases • IHICC planning and operational leads to be engaged to support consistent application of the PCCP and quantifying linkage to ICU capacity. • Outcome will assist with balancing care environment risk across all ICUs and support OOPT volume
ICU Out of Province Transfer Program
Provincial Out of Province ICU Patient Evacuation
Concept of Operations Organizational Structure
• To provide ICU care for all SK patients, This structure stands up outside of regular transport (Red Patient and
transfer of Tertiary ICU patients to Out of Pediatric Transport Algorithms) and utilizes existing coordination and
Province ICUs has occurred communications infrastructure, reporting into EOC Defensive Command
• A Provincial Evacuation Team has been
activated to support the safe transfer of
patients
Guiding Principles
• Maintaining ICU care for all SK patients
• Prevention of the Escalation of the Critical
Care Resource Allocation Framework
• Patient movement will be as safe as possible
Key support from
Social Work, Digital
COVID-19 Health, SFCC and PFCC
Health System UpdateOut of Province ICU Transports
• Co-Leads: Dr. Jon Witt and Lori Garchinski, Flight logistics lead: Evan Ulmer
• Established daily planning and coordination network with Ontario and Manitoba
• Travel support for up to 2 family members
• Evacuated 6 patients to Ontario to date
• 3 Additional patients will be transported over next 3 days
• Goal to proactively bring provincial ICU census to a lower, sustainable level
• ICU capacity for HFO patients and Non-Covid patients requiring ICU.
• Clinically appropriate ICU patients able to access tertiary care.Saskatchewan Modelling – Impact of Reducing Mixing
Accuracy of Saskatchewan Models: June 15 2021 Model Projections
Indicated that size and timing of fall
surge would depend on:
• Public behaviour in response to re-
opening / surge
• Vaccine uptake, especially 2nd dose
• Delta variant infectiousness
• How well vaccines work against
Delta
• Delta VOC driving surge
• If public health measures are taken
with surge
• Modeling at that time did not
account for impact of boosters yet
Actuals will start changing trajectory from this set of model results due to
additional public health orders having now started. This model scenario did
not include mask mandate or proof of vaccination requirements.Key Messages
• As we approach/exceed the limits of capacity the care environment rapidly deteriorates
• Ethical choices about who receives appropriate level of critical care and who receives substandard care are
already occurring
• Patient to staff ratios are already eroding affecting quality of care
• Pandemic Crisis Care Principles established that will balance the resultant risk from required reduced care
standards across provincial ICU’s and Acute care units for COVID and Non-COVID care
• Increasing risk of potential patient harm and preventable death
• Limited HR capacity to surge ICU
• Additional support is being explored; including Federal support
• Anticipating current acute and ICU pressures will remain until at least December and be dependent upon public
health orders
• Out of Province Transfer Teams in place and have been activated:
• Letters to patients and families are being distributed upon admission
• It is recognized that current ICU census is not sustainable for long periods of time and application of the
Pandemic Crisis Care Principles will assist in informing a safe sustainable Pandemic ICU surge capacitySafety Update
Dr. Mike Kelly
EOC Safety Officer
COVID-19
Health System Update
www.saskatchewan.ca/COVID19Facial hair policy
Hair today, gone tomorrow:
• To properly fit for an N95 you must be cleanly shaven
• Do not show up to your fit testing appointment without
shaving first – Beard covers are not allowed
• Facial hair is permitted in areas that do not interfere
(growing in or protruding into) with the respirator sealing
surface or function (see Facial Hairstyles Infographic for
pictures).
SHA Facial Hair
Policy available here
www.saskatchewan.ca/COVID19Return to Work Guidance
- Guidance for the general public is not healthcare guidance and is not intended to be applied in the
health-care setting where extra precautions are necessary to protect vulnerable patient and
resident populations, as well as your colleagues.
- If you are deemed a close-contact and are not fully vaccinated you cannot come to work for 14
days following the contact.
- If you have a positive PCR test you cannot come back to work for 10 days following onset of
symptoms
- If you are the primary care-giver of a COVID case (i.e. small child, elderly parent) and you CANNOT
ISOLATE from them, you cannot come to work for 14 days following the end of their 10 day
isolation period – vaccination status does not matter
Call the OHS Hotline at
1-833-233-4403 or email
Return to Work OHS_Healthcareworkers_CO
FAQs VID19@saskhealthauthority.
ca
www.saskatchewan.ca/COVID19Double masking
• The SHA is not recommending double masking.
• Two is not always better than one.
• You may think that by layering up your protection by
donning two masks, either two procedure masks or
a procedure mask over your N95, you are going the
extra mile to protect yourself.
• However, you unfortunately are increasing your
chances for cross contamination during donning and
doffing.
• The SHA is not recommending double masking.
www.saskatchewan.ca/COVID19Everyone’s fine…really.
Patty Stewart McCord, BGS, CCISM
ICISF Faculty/ Canadian Representative to ICISF Board of Directors
SHA Peer Support Program Co-Lead
Exec. Director, Sask. CISM Network
COVID-19
Health System Update
www.saskatchewan.ca/COVID19www.saskatchewan.ca/COVID19
The work environment… 1) Delta is a different situation… 2) We have more knowledge 3) The patient care is familiar work 4) In “operational mode”…Head down and into work you go! 5) Public opinion has changed - Everyone’s tired of COVID 6) Staff experiencing fatigue/ burnout/ cumulative stress
www.saskatchewan.ca/COVID19
THE MEDICINE
WHEEL
MIND
BODY YOU SPIRIT
EMOTIONS
What are you doing to restore your
whole being so that you can sustain
yourself through this?www.saskatchewan.ca/COVID19
Your Physician Health Physicians experiencing reactions to
& Wellness Supports the current health crisis is not
uncommon. The Physician Peer
Scan the QR Code to Support Team are available to you
access Physician Town Hall
Wellness presentations upon request.
and more! If you or a colleague have questions
about the Peer Support program,
or are inquiring about support,
Health Care Worker Mental Health Support Hotline: please email us at:
1-833-233-3314 8am – 4:30pm, Monday-Friday
Saskatoon, NE, NW:
Brenda Senger
306-657-4553 physicianpeersupport@saskhealthauthority.ca
Physician Regina, SE/SW:
Health Jessica Richardson
Program 306- 359-2750Partners
www.saskatchewan.ca/COVID19Q&A Please respond to
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Next Town Hall:
November 4th, 2021
www.saskatchewan.ca/COVID19You can also read
