March 31, 2020
To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus
COVID-19 Physician Information Update
March 31, 2020
A Message from Dr. Nicole Boutilier, Vice President of Medicine
Updated Clinical Documents
Funding for COVID-19 Response
NSHA has been working with the DHW to develop common funding approaches to support the overall COVID-19 Response. The following has been approved:
 
  • ICU Coverage: A process will be established for adding physician coverage in ICUs to meet increased demand.
  • COVID Inpatient Sites: Pre-approval to expand all sites by up to two hospitalist lines to support 24/7 physician coverage of these units. NSHA will update DHW (on a daily/weekly/bi-weekly schedule) regarding the COVID inpatient activity at each site and document how the newly approved funding is being used to at each site to meet demand. Any unused funds related to the COVID unit approvals and coverage will be returned to DHW. Medical Affairs will follow up with each site individually to provide approval specifically based on the details of their individual proposal, and inform them that a tracking sheet will be developed for reporting back to DHW. Any expansion beyond the pre-approved two lines will need to be approved specifically by the DHW. 
  • Secondary Assessment Sites: Sessional funding to support all proposed Secondary Assessment Units on a 24/7 basis. Each site will have a Sessional Claim form and physicians will be paid for the hours provided. 
  • Access Clinics: Work is under way to further define and arrange access clinics. Agreement is in place to provide sessional funding for these clinics, if required.

Mandatory Assessments in
Hospitals and Long Term Care Facilities
IPAC strategies to prevent or limit transmission of COVID-19 in healthcare settings
Infection Prevention and Control strategies to prevent or limit transmission of COVID-19 in healthcare settings include prompt identification of all persons with signs and symptoms of acute respiratory infection (e.g. fever and/or cough) with the immediate application of Droplet and Contact Precautions (in addition to Routine Practices). 

A primary objective for managing the COVID-19 outbreak is the early detection of cases and slowing the spread of COVID-19 in order to flatten the epidemiological curve. With the increasing number of COVID-19 cases reported in Nova Scotia, active screening of patients, residents, and clients in our acute care hospitals and long term care facilities is imperative to ensure early identification of COVID-19. 

Effective immediately, all patients, residents, and clients located in NSHA hospital or long term care/residential facilities will be assessed 2 times per day for fever, respiratory symptoms, and change in health, which could reflect a respiratory infection. This assessment must be documented on this form that will be placed on each patient/resident/client’s chart.

Immediate management of patient/resident with symptoms is to include:
  • Implement Droplet and Contact Precautions 
  • Report the suspect case to Infection Prevention and Control
  • Test patient for viral respiratory infection ie. Send flu swab
Receiving patient’s belongings from home during COVID-19 pandemic
During current family and visitor restrictions for the COVID-19 pandemic, patients, residents and clients may still require items from their home while in hospital. This guidance document was designed to offer suggestions as to how to safely receive these items while abiding by visitation restrictions in NSHA facilities.
Right PPE + right time = healthy providers
Using the right personal protective equipment (PPE) at the right time helps to ensure the necessary supplies will be there when you need them.
The COVID-19 virus is transmitted through droplets when you cough or sneeze, by:
  • prolonged personal contact such as touching or shaking hands
  • touching something with the virus on it then touching your mouth, nose or eyes before you clean your hands, or
  • having someone cough of sneeze in your face

To protect yourself:
  • Practice good hand hygiene with soap and water or an alcohol-based hand rub, even when a particular situation requires additional personal protective equipment (PPE)
  • Clean high-touch surfaces
  • Screen patients for fever and respiratory symptoms
  • When caring for a patient with COVID-19 or other respiratory infection, follow contact and droplet precautions, using the gloves, gown, mask and eye protection you would commonly use when caring for patients with diseases like influenza
  • Unless your patient has COVID-19 or other respiratory infection, or has been admitted to hospital while still on self-isolation, you do not need to use contact and droplet precautions
  • Because COVID-19 is not an airborne virus, in the spirit of making the best use of our PPE, N95 respirators should be reserved for aerosol-generating medical procedures
  • There may be specific situations where infection prevention and control does recommend additional precautions. These decisions will be made case by case

When in doubt about PPE, ask a supervisor about the right equipment to use and how to use it properly . Together, we can help protect each other today, and in the future by making the best possible use of PPE. Thank you for all you are doing to keep yourselves, your colleagues and patients healthy!
New peri-ECT Screening Tool
Click image to access full size tool.
Physicians Returning to Work after Isolation
Physicians who are completing their mandatory 14 day isolation after travel anywhere outside Nova Scotia will receive a request from Medical Affairs to confirm that they are asymptomatic and to discuss their return to work plans. Please complete this information request to enable a quick return to work.

If you require support for symptoms of an influenza like illness, Medical Affairs support staff will connect you to the appropriate Occupational Health resource for further screening.

NSHA would like to  reinforce that all staff and physicians experiencing  any respiratory/flu-like symptoms  should NOT be in the workplace. If you are unwell, please stay home and report your symptoms to the  Occupational Health line at 1-833-750-0632.
 
While you are in the workplace, respect the physical distancing of six feet as much as possible, avoid gathering in groups greater than five and ensure proper hand hygiene and wiping own of high touch surfaces.
 
Please see the attached resource for your Occupational Health and Safety Resource and common questions and answers on COVID-19 screening, self-isolation requirements, self-monitoring, and returning to work after 14-day isolation.

OHS FAQ for Health Care Workers (updated March 30, 2020)
Upcoming DNS Webinars
Webinar: Virtual care - Join us April 1 for the webinar “Diving into virtual care: Tips for getting the most out of virtual care” with Drs. John Ross, Ajantha Jayabarathan (“AJ”), David LaPierre and others. Each presenter will share their tips for success followed by a question and answer session. When: Wednesday, April 1 at 6-8 p.m. Register here.

Webinar: Public Health Update and PPE Education – Join Drs. Claudia Sarbu, Maria Alexiadis, Lynn Johnston and Ian Davis for a two-hour webinar focused on providing you with the latest information and protocols from Public Health. You’ll also gain an understanding of the appropriate use of personal protective equipment (PPE) and how the supply of PPE will be managed in Nova Scotia. The webinar will take place Thursday, April 2 from 6 to 8 p.m. Register here . The webinar will be recorded and posted to www.doctorsns.com.
In home Specimen Collection
Continuing Care has released guidelines to provide in home specimen collection for clients who meet criteria for COVID-19 screening but are unable to attend Primary Assessment Centre for.

These documents are available below and on the physician resource site
Supporting Patients' Mental Wellness
We've heard that many of your conversations with patients and clients are focusing on the emotional toll that COVID-19 is having on their life. Supporting mental well-being using effective communication strategies is especially important during these times of uncertainty.
Primary Health Care has created a document that provides some key tips on how to have these conversations, and provides links to mental health and wellness resources. Click here to read.

Provincial COVID-19 Status Update
As of today, March 31, Nova Scotia has 147 confirmed cases of COVID-19. 

Twenty new cases were identified Monday, March 30. Most cases are connected to travel or a known case. As reported yesterday, public health has concluded that one case is the result of transmission within the community. To date, four staff and two residents of long-term care facilities have tested positive for COVID-19. Appropriate infection prevention and control measures are in place for both residents and staff. 

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. 

The individuals affected range in age from under ten to over 80. Four individuals are currently in hospital. Ten individuals have now recovered and their cases of COVID-19 are considered resolved. Cases have been identified in all parts of the province. 

Public health is working to identify 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. If they are concerned about COVID-19 they can go to https://811.novascotia.ca/ and use the online assessment tool. Anyone referred to an assessment site by 811 will be tested. 

To date, Nova Scotia has 5,763 negative test results and 147 confirmed cases. 

Nova Scotians can find accurate, up-to-date information, handwashing posters and fact sheets at https://novascotia.ca/coronavirus.
Daily Physician Wellness Check In
Dr. Jackie Kinley, a NS psychiatrist with experience in health care workers and trauma, and Dr. John Chiasson of Doctors Nova Scotia Physician Support Services, are offering regular open drop-in sessions for physicians working with COVID.

This week's sessions (M-F)
CoVID – 19 What’s normal? Dealing with stress, anger, fear and anxiety - Tips and strategies.
1pm-2pm