April 20, 2020
To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus
COVID-19 Physician Information Update
April 20, 2020
Updated Clinical Documents
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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies

Infection Prevention and Control

COVID Primary Assessment Centres and Secondary Assessment Centres

Mental Health and Addictions
Message from Brendan Carr, CEO
Take Care of Yourself and Each Other
Dear Colleagues, 

Many of us are feeling sadness, shock and grief today following the tragic incidents over the weekend. While we don’t yet know all of the details of yesterday’s horrific events, we do know that many of our families, friends, neighbours and colleagues from across this province are experiencing pain and loss. I want to acknowledge our health care teams who cared for and supported the victims and families of yesterday’s shootings and who will continue to do so in the days ahead. 

As we learn more about the senseless acts of violence that occurred yesterday in northern and central Nova Scotia, we need to support one another more than ever. Now is the time, during public health restrictions, to phone a friend or send a note of support to a colleague.

Nova Scotians rely on us to take care of them; we need to also take care of ourselves. Doctors Nova Scotia offers a Professional Support Program at 902-468-8215 or 1-855-275-8215 (toll-free) or via email. Our Employee Family Assistance Program (EFAP) also offers important support and assistance at times like this. Morneau Shepell provides immediate and confidential assistance for any work, health or life concern for both employees and their families who reside together. You can access the EFAP program by calling 1-800-461-5558 or visiting https://www.workhealthlife.com.

If you have mental health or addiction-related concern for yourself or someone else, please reach out for support:
  • The Provincial Mental Health Crisis Line is available for you or someone you are concerned about 24/7, by calling toll-free 1-888-429-8167.
  • If you would like to self-refer to our Community Mental Health and Addictions clinics, Withdrawal Management Services, or Opioid Replacement and Treatment Program, call (toll-free) 1-855-922-1122, weekdays 8:30 a.m. to 4:30 p.m.* *This line has voicemail only evenings, weekends, and statutory holidays.
  • A Kids Help Phone counsellor is available 24/7 at 1-800-668-6868. 
  • Plan to attend a session on Addressing Grief within our Healthcare Community: Mine, Yours & Ours - Join Serena Lewis and Roy Ellis (NSHA Bereavement & Grief Coordinators) from 9:30 to 10:30 am April 23 as we begin the conversation of grief in our current and future workplace. This discussion will provide information on recognizing and understanding how loss is intertwined in our lives, as well as the current landscape of our community of care providing. Roy and Serena want to hear what topics will benefit you in the upcoming weeks that will support you - as you care for yourselves, your own families and within patient care. To join this session: https://zoom.us/j/99728453591?pwd=cVoydFpGSW5kK3VtNzRhZ1VMS3VpQT09

I understand that the details you are hearing are deeply troubling. I want to thank everyone for refraining from speculating on information that has not been verified out of respect for the privacy of grieving families and colleagues, and the ongoing police investigation. 

Please take care of yourselves and support one another. 

Regards, 

Dr. Brendan Carr, President and CEO
Related Grief Support Resources
The following resources were provided by our colleagues in palliative care as they may prove helpful with the tragic circumstances of recent events.

COVID-19 Risk Assessment Form
The Clinical Medical Advisory Committee, in consultation with Infection Prevention and Control and clinicians across the province, have worked to create a COVID-19 Risk Assessment form.

The COVID-19 Risk Assessment is to be completed at the point of care for all patients receiving in person services from NSHA.

If the patient is symptomatic or identifies as having any risk (travel outside the Maritimes, close contact of a known or suspect case, resides within a community or facility cluster) they are to be placed on droplet and contact precautions. The back of the Risk Assessment provides instructions with regards to precautions when a patient is identified as having a risk factor for COVID-19.

The COVID-19 Risk Assessment form should be placed on the front of all patient charts. This form replaces the “COVID-19 Swab form” currently in circulation.

The community and facility clusters will be identified using the Nova Scotia Public Health Epidemiology report. We will create a tab on the COVID-19 Document Hub called Community/ Facility Cluster Information (set to go live within the next two days). Community clusters and facilities will be identified by postal code. The link will also provide a script for staff and physicians to use when explaining to patients why droplet and contact precautions are required.

IM/IT is working to create a flag for patients from these clusters that will append "droplet precautions requried" to their chart. This flag will activate when they are registered for appointments, triaged, or admitted to NSHA facility. This flag will notify staff and physicians in addition to the COVID-19 Risk Assessment.

Work Isolation Criteria
The following guideline has been created by Occupational Health to support employees who have been identified by Public Health as being in contact with a positive COVID-19 case.

Please click here or on the image below to view source document with working hyper links.
Updated Return to Work Guidance for COVID-19 Positive Healthcare Workers
Like many communities in Nova Scotia, NSHA has seen the identification of health care workers confirmed with COVID-19. As the weeks evolve some of these employees are considered recovered and are working with Occupational Health Safety & Wellness to return to the workplace in a safe manner.

The guidelines for return to work have been developed in collaboration with the Chief Medical Officer of Health, Infectious Disease, and Medical Microbiology.Effective April 17, 2020, a health care worker will be deemed recovered and able to return to work IF they are:
  • A minimum of 10 days from symptom onset
  • Do not present with a fever
  • Are clinically improved
  • Are demonstrating an improvement in respiratory symptoms

If all criteria noted above have been met, the employee will be cleared to return to work through Occupational Health Safety & Wellness. If one criterion is present the employee will not be considered recovered and will not be permitted to return to work.

Complex cases will be reviewed with the Occupational Health Safety & Wellness physician and case specific return to work criteria will be provided.

Please note: The return to work guidelines noted above removes the requirement for repeat swabbing of a health care worker prior to return to work. Again, some cases will require case specific guidance and these will be identified through Occupational Health Safety & Wellness.
Information for Healthcare Providers: Delivery of Test Results and Self-Isolation Requirements
Public Health informs people who are tested for COVID-19 of their results, positive or negative, and advises of any ongoing isolation requirements. Test results are typically delivered to people within 48-72 hours of testing, with some variation due to volume. Lab results for COVID-19 are also available on Share.

All people tested for COVID-19 are required to self-isolate pending the results of the test. People who are tested because they are considered ‘exposed’ (either through recent travel or as a close contact with a person who is COVID-19 positive) need to continue to isolate for the entire 14- day incubation period, even if results are negative.

The chart below outlines self-isolation advice being given based on various scenarios.

Please refer to the LTCF directive for additional isolation requirements in these facilities.

Information on self-isolation is available:
Update on Northwood Situation
Our team at NSHA has been working collaboratively with our colleagues at Northwood as they respond to a COVID-19 outbreak at their Halifax campus.

We currently have more than 40 staff including nurses, continuing care staff and rehab therapists working at Northwood and have issued a province-wide call for RNs, LPNs and CCAs from all zones to help support the care of their residents. In addition, several NSHA physicians in geriatrics, family practice and COVID units are providing consultation to the physicians at Northwood. The VON, Red Cross and EHS paramedics have also joined the effort in support of Northwood’s emergency response.

As of Sunday April 19, we are relocating the COVID-19 Unit at the Halifax Infirmary to Northwood to help support the acute care needs of residents. Residents with COVID-19 are being treated onsite and testing is also being conducted there.
COVID-19 PPE Recommendations
Infection Prevention and Control has provided a quick reference document for PPE Recommendations that can be used by different departments. Note that some departments may have their own guidelines for PPE that exist separate to this abridged version.

PPE Resupply News
A collective sigh of relief came from the new NSHA COVID Warehouse today as shipments of PPE were received as scheduled. In today's volatile supply chain, we are never able to count a product until it is in our hands.
 
1.7M surgical masks arrived today. There are now more than 2 million masks in the COVID Warehouse. Shipments of gowns and shields were also received today. Below are a few pictures. A dashboard for all parts of government will be available for the first time this week.
 
Last week we added another 240K gowns to the Stanfield order and we are about to sign a deal for a sanitizer provider. We ordered 200K gowns yesterday when an opportunity arose and we ordered another million masks today. We are working on a significant order for an N95 equivalent product.
 
While this is very encouraging news, we remind all staff and physicians to continue using the right PPE at the right time. This will help ensure your safety and maintain our supply of PPE throughout the pandemic.
 
Huge thanks to our PPE Working Group and our provincial supply chain team for being prepared and persistent in ordering and restocking critical supplies to support our pandemic response now and into the future. 
Zoom for Healthcare Privacy and Security Response
To support patient care and health care providers during the current COVID-19 pandemic, Zoom for Healthcare has been approved as a virtual care platform for use on an interim basis for all health care providers (physicians, nurse practitioners and allied health professionals).

The privacy and security of health care providers and patients/clients is our priority. Nova Scotia Health Authority, the IWK Health Centre and our government partners are working together to provide a secure on-line environment for those that are using Zoom for Healthcare to deliver care at NSHA, the IWK and in the community.

There are enhanced security features already activated in the Zoom for Healthcare application. For example, a meeting ID and password is automatically generated for every scheduled virtual meeting that only allows the health care provider and designated patient to join the meeting. Healthcare providers have also been given training and resources to support them in using Zoom for Healthcare securely.

To help individuals prepare for their virtual visit via Zoom for Healthcare, they will receive instructions from their health care provider in advance to ensure a secure online experience.

To stay up-to-date about any new concerns or issues, we are continuing to monitor information about Zoom for Healthcare as it becomes available. Additional details about Zoom for Healthcare privacy and security. If you have any questions, visit https://www.cdha.nshealth.ca/telehealth-zoom or email VirtualCare@nshealth.ca.
NS COVID-19 Health Research Coalition Update
The response to this funding opportunity over the past few days has been inspiring and we are grateful for the high level of interest that has already been shown.

Appreciating that questions have arisen regarding the application and review processes, we have been working with Research Nova Scotia and other coalition partners to compile and update a list of frequently asked questions and associated answers, available here: https://researchns.ca/faq-covid19-coalition.
This list will be updated on an ongoing basis. As with the call for proposals itself, we ask that you share this broadly within our NS research community.
NSHA Cafeterias Now Stocking Grocery Items
NSHA Food and Nutrition Services are working to help NSHA staff and physicians. It is a challenging time to get to the store or find time to cook. To make things easier, cafeterias are stocking everyday grocery essentials such as loaves of bread, 6 pack homemade muffins, cartons of milk and bunches of fruit. While you’re there, let us know what other supplies would be helpful!
Reminder: Seeking Physician Volunteers
for Redeployment
We continue to seek volunteers for redeployment. Family doctors are needed to support this site as we expand testing for all influenza like illness and provide first line treatment or referrals.

Please complete the following  short survey , so that we may collect your information and match your skills with areas of need.

Physicians can redeploy to services within their own town, zone, or other areas of the province.

All physicians will be supported to provide the level of service that they are comfortable with. All physicians are supported to do redeployment by CMPA and the College of Physicians and Surgeons (see above). NSHA Medical Affairs will support the administrative functions required for redeployment.

Medical Affairs team members are collecting this information to assist the redeployment opportunities.
If you have questions, please contact:  physicianrecruit@nshealth.ca
Moments of Gratitude
After the tragic events that are currently impacting our province, our care teams have shifted to showcase their gratitude and support towards the many policing partners we work with as part of our front line emergency response. We mourn the loss of Cst. Heidi Stevenson, our VON colleagues and the many other victims of this senseless tragedy, as one.
Provincial COVID-19 Status Update
As of today, April 20, Nova Scotia has confirmed 721 confirmed cases of COVID-19. Forty-six new cases were identified Sunday, April 19.

The QEII Health Sciences Centre's microbiology lab completed 874 Nova Scotia tests on Sunday, April 19 and is operating 24-hours.

As of April 19, there were nine licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 127 residents and 61 staff.

While most cases in Nova Scotia have been connected to travel or a known case, there is now community spread. That is why travel has been removed as a requirement for testing for COVID-19.

The list of symptoms being screened for has recently expanded. If you have two or more of the following symptoms, visit https://811.novascotia.ca to determine if you should call 811 for further assessment:
  • fever
  • new or worsening cough
  • sore throat 
  • runny nose 
  • headache 

To date, Nova Scotia has 21,769 negative test results, 721 positive COVID-19 test results and nine deaths. Confirmed cases range in age from under 10 to over 90. Twelve individuals are currently in hospital, four of those in ICU. Two hundred and forty-eight individuals have now recovered and their cases of COVID-19 are considered resolved. Cases have been identified in all parts of the province. A map and graphic presentation of the case data is available at https://novascotia.ca/coronavirus/data.

Public health is working to identify and test people who may have come in close contact with the confirmed cases. Those individuals who have been confirmed are being directed to self-isolate at home, away from the public, for 14 days.

Anyone who has travelled outside Nova Scotia must self-isolate for 14 days. As always, any Nova Scotian who develops symptoms of acute respiratory illness should limit their contact with others until they feel better.

It is now more important than ever for Nova Scotians to strictly adhere to the public health orders and directives - practise good hygiene, maintain a physical distance of two metres or six feet from others, limit essential gatherings to no more than five people and stay at home as much as possible.

Nova Scotians can find accurate, up-to-date information, handwashing posters, and fact sheets at https://novascotia.ca/coronavirus.

Quick Facts:
  • testing numbers are updated daily at https://novascotia.ca/coronavirus 
  • a state of emergency was declared under the Emergency Management Act on March 22 and extended to May 3


Government of Canada: https://canada.ca/coronavirus
Leadership and Wellness Poster
Updated for Week of April 20-27
This document is a list of helpful resources curated weekly for physicians by Medical Affairs’ Physician Leadership Development. Please reach out to Shawn Jolemore with your comments, questions, or suggestions for additional content.

View this week's edition here.
NSHA Physician Leadership Supports
Critical Thinking in the Time of COVID-19 - DNS Webinar
Join Drs. Pat Croskerry, director of critical thinking program at Dalhousie Medical School, and Sam Campbell, emergency medicine, for this two-hour CPD-accredited webinar to learn how COVID-19 can affect your ability to think critically. When: Tuesday, April 21 at 7–9 p.m. Register Here.

Individual Executive Coaching for Physician Leaders with Executive Coach Lorie Campbell
Are you struggling to lead yourself or your team(s) well during this pandemic?

Take advantage of 30 or 60-minute focused, one-to-one virtual executive coaching sessions for formal physician leaders only. Email Lorie Campbell to book a time for this free service, provided by NSHA Medical Affairs Leadership Development.

*New Dates Added*
Group Coaching Call for all Physicians
Open to all NSHA Physicians, this virtual group coaching call is an opportunity to connect with your colleagues to support one another and share your experiences and challenges during this unprecedented time.

Join Medical Affairs’ Leadership Development experts, Shawn Jolemore and Lorie Campbell for this 60-minute online check in.

Next available dates for this Zoom call:

Physician Wellness Supports
Checking Your Stress Level - How do you know and what to do?
Wednesday, April 22 at 4–5 p.m.
Dr. Joseph Sadek

Join Zoom Meeting Link Password is 050891
Addressing Grief within our Healthcare Community: Mine, Yours & Ours
Join Serena Lewis and Roy Ellis (NSHA Bereavement & Grief Coordinators) from 9:30 to 10:30 am April 23 as we begin the conversation of grief in our current and future workplace. This discussion will provide information on recognizing and understanding how loss is intertwined in our lives, as well as the current landscape of our community of care providing. Roy and Serena want to hear what topics will benefit you in the upcoming weeks that will support you - as you care for yourselves, your own families and within patient care.

Daily Physician Wellness Check In - COVID-19 What's Normal?
Join Drs. Jaqueline Kinley and John Chiasson for daily online meetings to chat about coping strategies and mental health concerns. Meetings are daily M-F at 12 NOON. and are open to all physicians. Click here for the *updated* Zoom

DNS Professional Support Program
Feeling overwhelmed or need to talk to someone? 
Contact the Doctors Nova Scotia (DNS) Professional Support Program at 902-468-8215 or 1-855-275-8215 (toll-free) or via email.
Physician Screening for COVID-19
Call 1-833-750-0632 to speak to Occupational Health and Safety for your screening options.