www.saskatchewan.ca/COVID19 Hosted by: Dr. Susan Shaw Physician Town Hall February 10, 2022 www.saskatchewan.ca/COVID19 Winter Night Camping – Missinipe, SK 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! 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! 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. Presenter Disclosure • Presenter: Dr. Susan Shaw • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: None • Memberships on advisory boards or speakers’ bureau: None • Funded grants, research and/or clinical trials: None • Patents for drugs or devices: None • Other: financial relationships/investments: None Disclosure of Financial Support • This program has not received financial support. • This program has received in-kind support from the Saskatchewan Health Authority in the form of logistical support • Potential for conflict(s) of interest: • The speakers in this Town Hall have received payment as employees/contractors of the Saskatchewan Health Authority • The Saskatchewan Health Authority does not benefit from any products that will be discussed in this program Mitigating Potential Bias • The planning committee reviews all content in order to identify potential sources of bias beforehand • Evaluation feedback will be reviewed regularly for biases reported by participants • Speakers who have been identified as biased, will not be invited to speak again Topic Speaker Objectives COVID-19 Offensive Update Informed by Epidemiology Dr. Johnmark Opondo • Comprehend Current Public Health Orders and Measures, as well as recent epidemiological trends related to COVID-19 Vaccine Strategy Highlights Dr. Tania Diener Dr. Kevin Wasko • Understand vaccine roll-out strategy, eligibility, safety and efficacy Defensive Strategy Highlights Dr. John Froh Dr. Sabira Valiani Dr. Satchan Takaya Lori Garchinski • Review data for hospitalizations, and ICU capacity related to COVID-19 Safety Updates Dr. Mike Kelly • Review updated safety guidelines for COVID-19 Physician Wellness Dr. Alana Holt • Practice techniques to boost and maintain mental health Q&A Ask your questions live! Agenda COVID-19 Health System Update COVID-19 Offensive Update Informed by Epidemiology Dr. Johnmark Opondo Medical Health Officer Presenter Disclosure • Presenter: Dr. Johnmark Opondo • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: None • Memberships on advisory boards or speakers’ bureau: None • Funded grants, research and/or clinical trials: None • Patents for drugs or devices: None • Other: financial relationships/investments: None Key findings • Very high Omicron infection rates continue to challenge us, reported case numbers underestimate the true number infections. • Indicators suggest this phase of the Omicron infection surge in community may have slowed or plateaued • Changes in testing create modelling challenges, but other methods of surveillance are being deployed. • Hospitals are now caring for the highest number of people with COVID- 19. Admissions are at highest levels across all age groups. ICU occupancy continues to be high. • Staffing in hospitals remains critical (due to unplanned absenteeism) • Multipoint surveillance will be important to detect changes in the trajectory of the pandemic. The Omicron surge has shifted PH Work • This transition represents for Offensive Strategy a shift this is a re-focus of effort not a step-down permitting public health to put resources into the interventions MOST likely to impact • Outbreak management, high-risk investigation, epi and surveillance • Population and public health has always relied on evidence-informed risk communication to support population behavior change and equitable health outcomes • The proposed shift in approach will rely on the public to take appropriate action including self-isolation in response to positive tests results and self-monitoring and isolation following exposure to COVID. • A province-wide communications plan to support this transition is necessary for public understanding and support for the shift in approach. • This plan will move the province of Saskatchewan to a more sustainable model of care that is clinically aligned with other communicable disease. Why: Transition from response to recovery Prevention Response Preparedness Recovery Why: Objectives • Reduce morbidity and mortality through vaccination • Optimize testing and surveillance strategies • Address unintended mental and physical health consequences and health equity • Promote positive individual health behaviours and sectoral/institutional changes • Ensure readiness and capacity to respond to new risks and manage residual risks • Support recovery and mental health of pandemic responders • Document lessons learned • Foster public understanding of ongoing risk, manage expectations, improve resilience • Rebalance resources to address COVID-19 and other public health risks • Support F/P/T and international response How: Approach Health Protection Interventions Health Promotion Interventions Monitor the situation Guide choice: disincentives or incentives Restrict choice Eliminate choice Guide choice: default policy Provide information Educate for autonomy Enable choice Adapted from: A balanced intervention ladder: promoting autonomy through public health action Citation: DataPublic Health, ISSN: 0033-3506, Vol: 129, Issue: 8, Page: 1092-1098 https://www.sciencedirect.com/science/article/abs/pii/S0033350615003261?via%3Dihub THE 5TH WAVE WHAT HAS CHANGED? • Omicron wave is the highest wave of the pandemic thus far this shift is a refocus of effort NOT a step-down of effort • High rates of omicron infections—which reached record levels in many countries—with relatively low levels of hospitalizations and deaths compared to previous variants, has revived the comparison to seasonal respiratory viruses. • The biology of Omicron is different: • Very infectious, highly transmissible • Shorter incubation period • Many cases will present with mild symptoms or be asymptomatic • Making tracking and testing difficult • Arguably, we now have better interventions e.g., vaccines plus booster doses and new therapies • So, the emergence of a new VOC with a shorter incubation period…this has changed the role and the efficacy of Covid Contact Management as a containment strategy for Covid virus follow-up. • Fatigue has taken it’s toll over the past 2 years however, I believe that Covid-19 challenges and innovation have laid the foundation for future reform on how we deliver care • With the passing of time, other threats to the wellbeing of the Saskatchewan Population have built, including the delay in diagnosis and treatment of other health problems. • There needs to be a shift in our Covid management to other interventions • Covid vaccination plus boosters • Self directed management of mild to moderate Covid symptoms • Reinstate community-based care and primary care for Covid • Develop an efficient pathway for the testing and management of those eligible for treatment with new therapies such as antivirals e.g., Paxlovid® • Fast-Track Access for Covid testing and management for those who live in, or provide care in high-risk settings • This is a shift form approaches used earlier in the Pandemic, BUT we are familiar with these measures as this is the way we approach other common seasonal reparatory viruses THE 5TH WAVE WHAT HAS CHANGED? Cont. • Omicron will NOT come with NO risk • There will always be patients that require COVID care and a health system that can support them • The more efficient we make the system, the better we do with the treating of patients • We, as individuals can apply ALL the layers of prevention to protect our loved ones, we all can • Screen ourselves daily for symptoms • Stay home if you are sick until your symptoms are resolved • The better we get at practicing prevention, the better we can get at anticipating COVID. THE 5TH WAVE WHAT HAS CHANGED? Cont. www.saskatchewan.ca/COVID19 Pandemic Response is shifting • Labor shortages • ↑ Illness Absenteeism • Potential supply chain glitches • Tightening PPE and Testing so • How do they do this? • Learning to “Live with Covid” • Shift from zero Covid Strategy to seasonal respiratory pathogen approach • More emphasis on other health promotion and self-directed care strategies • vaccination plus boosters, • ↑access to new Covid therapies and • Covid Care builds on primary care infrastructure • A more “sustainable” way to deal with the COVID-19 Pandemic and future variants of the virus Omicron Surge Now! Living with Covid-19 and it’s Future Variants COVID-19 Health System Update Epidemiology Update Omicron: “split-screen pandemic." • Labor shortages • ↑ Illness Absenteeism • Potential supply chain glitches • Tightening PPE and Testing supplies • Service re-prioritizing and conservation steps • ↓ Short supply Covid therapeutics • Impending acute care crisis • Prolonged school disruptions and closures • Misinformation and Social Disruption • Learning to “Live with Covid” • Shift from zero Covid Strategy to seasonal respiratory pathogen approach • More emphasis on other health promotion and self-directed care strategies • vaccination plus boosters, • ↑access to new Covid therapies and • Covid Care builds on primary care infrastructure • Further build Digital Care and more seamless interconnection of care data and information Omicron Surge Now! Living with Covid-19 and it’s Future Variants COVID-19 test positivity, 7-day moving average, by province/territory, February 8, 2022 SK has the 3 rd highest test rate among provinces & highest test positivity (34.3%) in Canada www.saskatchewan.ca/COVID19 COVID-19 cases, 7-day rolling avg and test positivity, Aug 1, 2021 – Feb 8, 2022 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 0.0 200.0 400.0 600.0 800.0 1,000.0 1,200.0 1,400.0 1-Aug-21 5-Aug-21 9-Aug-21 13-Aug-21 17-Aug-21 21-Aug-21 25-Aug-21 29-Aug-21 2-Sep-21 6-Sep-21 10-Sep-21 14-Sep-21 18-Sep-21 22-Sep-21 26-Sep-21 30-Sep-21 4-Oct-21 8-Oct-21 12-Oct-21 16-Oct-21 20-Oct-21 24-Oct-21 28-Oct-21 1-Nov-21 5-Nov-21 9-Nov-21 13-Nov-21 17-Nov-21 21-Nov-21 25-Nov-21 29-Nov-21 3-Dec-21 7-Dec-21 11-Dec-21 15-Dec-21 19-Dec-21 23-Dec-21 27-Dec-21 31-Dec-21 4-Jan-22 8-Jan-22 12-Jan-22 16-Jan-22 20-Jan-22 24-Jan-22 28-Jan-22 1-Feb-22 5-Feb-22 Test Positivity (%) New Case 7-Day Average Cases Test Positivity Current Test positivity as of Feb 8: 30.8% ↓ (33.4% Last week) Omicron wave has resulted in the highest burden of disease yet – preliminary evidence of slowing or plateau in COVID-19 cases in SK; however population mixing drives transmission; impact of COVID management change creates unknown trajectory “Stealth” omicron BA.2. A close relative of the omicron variant • known as BA.2 and called “stealth omicron” by some scientists • is more infectious than the original omicron variant and is rapidly overtaking it in some parts of the world. • It does not appear to cause more serious disease, as with the original variant, though experts warn it could lead to more hospitalizations and deaths with more people getting infected. CURRENTLY WHAT TO WATCH FOR OMICRON B2 Change in PHO announced Feb 8, 2022 Effective February 14 2022 - major changes announced: • Proof of vaccination or negative test results will be rescinded • Provincial mask mandate in all indoor spaces, including schools will NOT be extended beyond March 1, 2022 • This non-extension effectively ends SK Covid related PHOs on March 1, 2022 Effective February 7, Saskatchewan Health Authority (SHA) PCR testing is reserved for priority populations at elevated risk for severe outcomes, which include: • Hospitalized patients including newborns, if the parents are COVID-positive • Patients and residents transferred between facilities or upon entry to long-term care and personal care homes • High Risk Populations as ordered by the Medical Health Officers, such as long-term care homes, personal care homes, congregated living (corrections, etc.), travelers from areas of concern Priority Symptomatic persons: • Symptomatic HCW or Essential Workers who have a negative rapid antigen test (RaT) • Symptomatic People living or working in Indigenous communities with no access to Rapid Antigen Tests • Symptomatic Immunocompromised and those with chronic illness (diabetes, history of cancer, cardiac failure, Transplant donors and recipients, Oncology patients receiving chemotherapy) • Patients on a surgical waitlist with symptoms or a positive rapid antigen test, if scheduled or expecting to receive surgery within the next 90 days • Pregnant patients who are symptomatic and more than 30 weeks gestation Covid PCR Priority Testing Groups COVID-19 Health System Update Vaccine Strategy Dr. Tania Diener COVID-19 Vaccine Strategy Chief Dr. Kevin Wasko Physician Executive – Integrated Rural Health Presenter Disclosure • Presenter: Dr. Kevin Wasko • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: None • Memberships on advisory boards or speakers’ bureau: None • Funded grants, research and/or clinical trials: None • Patents for drugs or devices: None • Other: financial relationships/investments: None Vaccine Administration as a Percentage of Population Eligible (5+) Percentage of Eligible Population (5+) Vaccinated As of February 10, 2022 https://covid19tracker.ca/vaccinationtracker.html 92.0% Canada 89.2% 81.3% 84.0% 85.3% 92.6% 92.3% 91.8% 94.6% 82.8% 79.1% 84.1% 90.3% 86.3% 75.4% 91.8% Canada 83.8% 95.5% 89.6% 85.2% 87.2% 88.7% 88.7% 91.0% 99.0% 85.8% 85.0% 87.8% FIRST DOSES SECOND DOSES Booster Uptake At Least One Dose 85.3% Fully Vaccinated 79.6% Booster Dose (18+) 49.5% SK February 5 Vaccine Uptake: Presenter Disclosure • Presenter: Dr. Tania Diener • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: • SANOFI: Canadian Influenza Economic Advisory Meeting took place May 31, 2021, • Memberships on advisory boards or speakers’ bureau: • SANOFI: Canadian Influenza Economic Advisory Meeting May 31, 2021 • Funded grants, research and/or clinical trials: CIHR: Assessing the impacts of COVID-19 on routine school-based immunizations and investigating strategies to catch up on missed immunization opportunities in Canada • Patents for drugs or devices: None • Other: financial relationships/investments: None Recommendation – Immunocompromised 5-11 year old vaccine series • Children 5 to 11 years of age who are moderately to severely immunocompromised should be offered a three dose primary series of the Pfizer BioNTech Comirnaty vaccine (10 mcg), using an interval of 4 to 8 weeks between each dose. • • Children 5 to 11 years of age who are moderately to severely immunocompromised who have previously received two doses of the Pfizer BioNTech Comirnaty vaccine (10 mcg), should be offered a third dose of the Pfizer￾BioNTech Comirnaty vaccine (10 mcg) 4 to 8 weeks after the second dose. 5-11 Three Dose Series Info Booster Updates • As of February 8th, 2022 all SK residents aged 12-17 years are eligible for a booster dose of mRNA COVID-19 vaccine • The Pfizer vaccine will be offered at least five months following the completion of the primary series to all adolescents in this age cohort • Based on NACI’s recommendations, the Pfizer vaccine is preferentially approved for this age cohort. Moderna can be provided upon request Booster Dose Eligibility NACI Update – Interval between COVID Disease and Immunization February 4, 2022 : • Provincially, we will not be recommending these suggestions from NACI at this time • If individually approached, physicians can use those suggestions, but as a province we will not make that recommendation Full Statement COVID-19 Health System Update Defensive Strategy Highlights Dr. John Froh Defensive Strategy Co-Chief Lori Garchinski Defensive Strategy Co-Chief Dr. Sabira Valiani Intensivist, CCRAF committee Co-Chair Dr. Satchan Takaya Saskatoon ACOS - Pandemic Presenter Disclosure • Presenter: Lori Garchinski • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: None • Memberships on advisory boards or speakers’ bureau: None • Funded grants, research and/or clinical trials: None • Patents for drugs or devices: None • Other: financial relationships/investments: None Key Strategic Actions  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  Develop and implement ICU Out of Province Evacuation Transport process  Optimize low acuity care transfers from tier 5&6 (regional and tertiary) facilities to enhance load leveling and fully utilize acute care capacity.  Manage HCW vacancies (service disruption, service slow downs)  ICU Tiers of Service Expansion – to 110 beds  Develop and implement operational and staffing plan to maintain acute and ICU capacity and prepare for surges Presenter Disclosure • Presenter: Dr. Sabira Valiani • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: None • Memberships on advisory boards or speakers’ bureau: None • Funded grants, research and/or clinical trials: None • Patents for drugs or devices: None • Other: financial relationships/investments: None Overview Critical Care Resource Allocation Framework (CCRAF) • Developed in Spring 2020 to prepare for overwhelming surge in critically ill patients • In the face of an overwhelming surge, clinical decision-making changes to achieve the goal of maximizing benefit • Save the most lives possible • Process principles of transparency, consistency, accountability, proportionality, and responsiveness • Oversight and implementation provided by the Critical Care Resource Allocation Oversight Committee Experience Critical Care Resource Allocation Framework (CCRAF) • At the height of the 4th wave, criteria were met for escalation of triage stage, concurrently with decision to transfer patients out-of-province • Significant barriers to implementation • Reluctance to triage (concurrent transfers, idea of the “last bed”) • Operationalization difficult • Detached communication of Critical Care Status Indicator and CCRAF • Further Observations • Surge capacity beyond 140-150% severely limited by staffing • Majority of surge ability in tertiary care centers • Bedside triage and inadvertent triage • Significant moral distress Actions Critical Care Resource Allocation Framework (CCRAF) • Changes to CCRAF • Integration with Critical Care Status Indicator • Adjustment of Critical Care Triage Stages • Reflect ability to surge • Connect surge beds more closely to surge capacity in tertiary care • Critical Care Resource Allocation Oversight Committee • Meetings every 2 weeks • Continuing Medical Education • Broaden understanding • Each physician has a role to play Presenter Disclosure • Presenter: Dr. Satchan Takaya • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: None • Memberships on advisory boards or speakers’ bureau: None • Funded grants, research and/or clinical trials: None • Patents for drugs or devices: None • Other: financial relationships/investments: None Covid-19 Early Therapeutics where are we now? Sotrovimab uptake Dr. Satchan Takaya Sotrovimab Infusions Across SK Site October November December January Saskatoon 4 3 2 51 Regina 1 12 5 36 Prince Albert 1 10 Meadow Lake 1 Ile le Crosse Unity 1 Turtleford 1 Nipawin 3 Melfort 7 Swift Current 1 4 Yorkton 3 5 Estevan 1 Maidstone 4 TOTAL 5 17 11 123 156 (as of Feb 6, 2022) 0 10 20 30 40 50 Oct 25 Nov 1 Nov 8 Nov 15 Nov 22 Nov 29 Dec 6 Dec 13 Dec 20 Dec 27 Jan 3 Jan 10 Jan 17 Jan 24 Jan 31 Number of infusions Week of administration Paxlovid uptake Paxlovid Prescriptions in SK date number Jan 26 2 Jan 27 2 Jan 28 3 Jan 29 2 Jan 30 6 Jan 31 1 Feb 1 1 Feb 2 2 Feb 3 3 Feb 4 1 Feb 5 1 Feb 6 2 TOTAL 26 Key points: ★ Requests for Sotrovimab and Paxlovid remain centralized for now, please fax or email our central intake team. (Please do NOT fax the referral form or scripts directly to pharmacies) ★ Also accepting self-referrals from patients thru 811 ★ Sotrovimab and Paxlovid remain OUTPATIENT early covid-therapeutics for covid positive patients with risk factors only ★ Followup is through our therapeutics team and 811, but strongly encourage physicians with patients that have received sotrovimab or paxlovid to connect with the patient, make sure your patient is recovered. Referral Forms available here NEW! Remdesivir for Inpatients ★ Early studies limited with heterogenous study populations and guidelines for use mixed around the world. New data has emerged, and a potential signal for benefit is emerging for moderately ill patients (defined locally as low flow oxygen 1-6 L/min) ★ In fitting with the overall paradigm of treatment: early COVID treated with antivirals, later COVID with anti-inflammatories Give it to patients who have: ✓Confirmed COVID-19 Infection and Symptomatic for < 7 days ✓Low Flow Oxygen (1 – 6 L/min) or an Increase in Home O2 Do NOT Give: ➢ High flow oxygen, NIPPV, intubation, vasopressors ➢ AST/ALT >5x upper limit of normal ➢ Allergic ➢ Impaired Renal Function (<30 GFR or on Renal Replacement) Presenter Disclosure • Presenter: Dr. John Froh • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: None • Memberships on advisory boards or speakers’ bureau: None • Funded grants, research and/or clinical trials: None • Patents for drugs or devices: None • Other: financial relationships/investments: Base Medical Director for STARS (Shock Trauma Air Rescue Service). Currently on leave of absence. COVID-19 Related Illness (CRI) vs Incidental COVID-19 Infection (ICI) Flowchart • We are learning that Covid can be complicated in its presentation – heart arrhythmias, diabetic ketoacidosis, GI upset, thrombolytic events etc • Can be more subtle in presentation – important because we are shifting from cohorting patients with COVID in one area and now placing them on service appropriate areas. • Needed to create a guide for busy teams to follow in supporting the CRI or ICI decision making • This flow chart was adapted from Ontario • Revised in consultation with many key stakeholders from our Safety Task Team, Pandemic Leads, Digital Health team and Infection Control Practitioners. www.saskatchewan.ca/COVID19 PATIENT PRESENTS TO HOSPITAL Admitted for COVID￾like symptoms Not admitted for COVID-like symptoms TEST (PCR/NAAT) TEST (PCR/NAAT) CRI COVID Related Illness * Initiate Infectious Alert Positive PUI Patient under investigation * Initiate Infectious Alert REPEAT TEST @ 48 hrs (PCR/NAAT) * Positive Neg NOT CRI/ICI/PUI Manage admitting illness IF ANY REPEAT TESTING (PCR/NAAT) Neg ICI Incidental COVID Illness * Initiate Infectious Alert 1) Is the patient on new supplemental oxygen or has increasing oxygen requirements? 2) Is the patient receiving COVID therapies (e.g. dexamethasone)? 3) Is the patient’s COVID status contributing to or causing their ongoing need for hospitalization for medical, social or administrative reasons? Examples include: • COVID+ in last 21 days contributing to clinical presentation • Cardiac or thromboembolic diagnosis, e.g. MI/ACS, PE, DVT, HF, syncope, atrial fibrillation or other arrhythmia • Respiratory diagnosis, e.g. COPD, asthma • Febrile illness • Acute gastrointestinal illness • Acute kidney injury • Diabetic ketoacidosis • Acute functional decline • Delirium • Unable to isolate due to social circumstance. **List not exhaustive, conditions at MRP discretion NO to all 3 YES TO ANY NOT CRI/ICI/PUI Manage admitting illness *May need multiple repeat tests if suspicion of COVID remains Footnote: Important to NOT confuse CRI/ICI with infectious/non-infectious process. Those positive for COVID are considered infectious until isolation period is complete, and PUI are potentially infectious until an alternate diagnosis is found. Status Change NOT - Reassess CRI/ICI/PUI Manage admitting illness Version Date: February 4, 2022 Document Owner: SHA EOC ~ COVID-19 Related Illness (CRI) vs Incidental COVID-19 Infection (ICI) Flowchart ~ Positive Positive Neg Neg A wa Lr Ji z J TLL A, (ILI l= re gr www.saskatchewan.ca/COVID19 ICU SYSTEM EFFECTIVELY MEETS DEMAND ICU SYSTEM CHALLENGED; CARE IMPACTED ICU SYSTEM SEVERELY CHALLENGED; SIGNIFICANTLY ALTERED CARE STANDARDS ICU SYSTEM CRISIS; CARE STANDARDS SIGNIFICANTLY COMPROMISED 141% - 175% capacity 111- 138 beds (79 - 98 beds in Regina and Saskatoon) Up to 126 patients ventilated, 20%+ overtime usage - Human resources compromised Restrictive triage required-services limited to Emergency Care Only – Stage 3 Resource Allocation Framework invoked Standards of care significantly compromised, expected avoidable harm or death to patients 126% - 140% capacity 99 – 110 beds ( 71 – 78 in Regina and Saskatoon) Up to 100 patients ventilated , 10 - 20% overtime usage – Human resources challenged Baseline ICU RN:Pt Ratio significantly altered, contract nurse/upskilled staff being used Stage 2 Resource Allocation Framework invoked Widespread Service Slowdown & required use of non icu staff 90% or less capacity 71 beds or less in use ( 50 beds in Regina and Saskatoon) 66 or less patients ventilated, < 5% overtime usage – Baseline Human Resources Normal access to critical care surgical care, Baseline ICU RN:Pt Ratio No triage required No service disruption 91 – 125% capacity 71 – 98 beds ( 51 – 70 beds in Regina and Saskatoon) Up to 85 patients ventilated, > 5% overtime usage – Human Resources achievable ICU RN:Pt Ratio slightly altered with enhanced nurse/patient ratio at times No Triage required – Stage 1 Resource Allocation Framework invoked Minimal Service disruption ICU SYSTEM CRISIS; CARE STANDARDS LARGELY ABANDONED > 175% capacity 139 beds or > (98 + beds in Regina and Saskatoon) Over 126 patients ventilated, maximal overtime required where possible - Human Resource Crisis Standards of care abandoned, expected avoidable harm and death to patients Stage 4 Resource Allocation Framework invoked 74 Feb 10, 2022 False Peak? Non-ICU Demand Covid Care Non-Covid Care ICU Demand Covid Care Non-Covid Care • COVID non ICU cases at highest ever • Tier 2-4 facilities, many at capacity. • Tier 5 facilities at or near capacity. • Tier 6 facilities at or near capacity. • ICU case increases expected to follow this non ICU surge • PH orders are relaxing. Expect a false peak followed by a true peak in cases. Net result = longer and more severe peak • Non ICU System is at capacity • HCW illness, moral fatigue and injury COVID-19 Health System Update Safety Update Dr. Mike Kelly Pandemic Area Chief of Staff – Saskatoon Presenter Disclosure • Presenter: Dr. Mike Kelly • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: None • Memberships on advisory boards or speakers’ bureau: None • Funded grants, research and/or clinical trials: University of Saskatchewan, Site Principal Investigator for React, Rage, and Evolve Studies • Patents for drugs or devices: None • Other: financial relationships/investments: Consultant for Imperative Care PCR Testing Access – Surgical Waitlist • To ensure safety and to help mitigate the challenges posed when a patient with planned surgery tests positive for COVID-19 upon arrival, all surgical patients will be given access and prioritization for PCR testing when they call 811 • Patients must call 811 to book a PCR test if they have COVID-like symptoms or have a negative Rapid Antigen Test AND COVID-like symptoms • Patients must notify their surgeon’s office if they test positive Safety Guidelines in SHA Facilities • Safety for all is one of the SHA’s values • As health care professionals, our priority is the safety and wellbeing of both our patients and teams • As always, we will continue to review evidence and base our protocols on best practice Safety Guidelines: • All COVID IPC patient care management will continue • Universal Masking remains • Family and visitors must follow the same IPC rules in facilities as our Healthcare Workers (masking, screening etc.) • SHA Screening, and Proof of Vaccination policies are under review given this week’s announcement on Public health Orders. Any changes on policies will be communicated as they are made. • The recommendations that the SHA provides to external clinics remain unchanged at this point www.saskatchewan.ca/COVID19 COVID-19 Health System Update Physician Wellness - Processing Anger Dr. Alana Holt Co-Lead Pandemic Physician Wellness and Psychiatry Response Team Physician Health Program, SMA Student Wellness Centre, U of S Dept. of Psychiatry, College of Medicine Presenter Disclosure • Presenter: Dr. Alana Holt • Relationships with financial sponsors: • Any direct financial relationships including receipt of honoraria: None • Memberships on advisory boards or speakers’ bureau: None • Funded grants, research and/or clinical trials: • Patents for drugs or devices: None • Other: financial relationships/investments: None About Anger • State Anger • Trait Anger • Anger Expression- Out, In • Anger Control- Out, In Charles Spielberger, Psychologist, STAXI-2 What about Composure?? Composure - the state or feeling of being calm or in control of oneself. Between stimulus and response there is a space. In that space is your power to choose your response. In that response lies your growth and your freedom. Victor Frankl- Mans Search for Meaning and your happiness, and your health and your relationships. and your effectiveness, and your leadership and, and, and… Tips to Manage Anger with …Self Reflection, Wisdom, Ownership, Leadership 1. What emotion is underlying or coexisting with your anger? 2. Examine facts, consider the unknowns, identify solutions. 3. Create space before response- think before you speak. 4. Take a time out. Pause. Use the 24-hour rule. Breathe. 5. Compose yourself then communicate. 6. Avoid criticism, blame, shame, aggression, and violence. 7. Practice ownership, quality leadership and inspiration. 8. Let it go, don’t take yourself so seriously, forgive (another talk). 9. Practice self care, relaxation, compassion, connection. 10. KNOW WHEN TO SEEK PROFESSIONAL HELP. Thank you for you, and all you are doing . Saskatoon, NE, NW: Brenda Senger 306-657-4553 Regina, SE/SW: Jessica Richardson 306- 359-2750 Saskatchewan Medical Association Physician Health Program Town Hall Physician Wellness Webex Series available: Physician Wellness and Support webpage Health Care Worker Mental Health Support Hotline: 1-833-233-3314 8am – 4:30pm, Monday-Friday Your Physician Health & Wellness Supports “Anger is a catalyst. Holding on to it will make us exhausted and sick. Internalizing anger will take away our joy and spirit; externalizing anger will make us less effective in our attempts to create change and forge connection. It’s an emotion that we need to transform into something life￾giving: courage, love, change, compassion, justice. Brene Brown, Atlas of the Heart Partners Q&A Please enter your question in the Q&A section OR Raise your hand and we will unmute you so you can comment or ask your question live Please respond to the live poll! GOOD NEWS STORY – Our amazing Public Health Teams! • A huge thank you to the work of our central teams: Data Entry, 811, HR, Digital Health and nurse managers in their collaborative and efficient work to pivot at each step • Their nimble work supports patient and information flow at every step to ensure that no changes inadvertently impact other areas of patient care • A real “delicate and orchestrated ballet” that is NOT always visible. Photo by Oswaldo Ibáñez on Unsplash Join us this Winter Next Town Hall: March 3rd All town hall recordings and slides are available here!