Body: Council Type: Agenda Meeting: Special Date: May 1, 2020 Collection: Council Agendas Municipality: Frontenac County
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Frontenac County Council Special Meeting Friday, May 1, 2020 – 9:30 a.m. Meeting to be held in Virtual Electronic Format and Available on the County of Frontenac’s YouTube Channel https://youtu.be/ydg882MfE1k
Agenda Page Call to Order Closed Session Approval of Addendum Disclosure of Pecuniary Interest and General Nature Thereof Adoption of Minutes Deputations and/or Presentations Proclamations Move into Committee of the Whole Briefings Unfinished Business Recommend Reports from the Chief Administrative Officer
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a)
2020-044 Office of the Chief Administrative Officer Advocacy for Regionalized Lifting of Restrictions Recommendation: Be It Resolved that the Office of the Chief Administrative Officer – Advocacy for Regionalized Lifting of Restrictions report be received; And Further That County Council authorize the Warden to co-sign a letter to the Province advocating for a regionalized approach to the lifting of restrictions related to COVID-19.
Information Reports from the Chief Administrative Officer Reports from Council Liaison Appointees Reports from External Boards and Committees Reports from Advisory Committees of County Council Return to Council Adoption of the Report of the Committee of the Whole Council Motions, Notice of Which has Been Given Giving Notice of Motion Communications Other Business Public Question Period By-Laws – General By-laws and Confirmatory By-law a) First and Second Reading Resolved That leave be given the mover to introduce by-law a) that has been circulated to all Members of County Council and that by-law a) be read a first and second time. b)
Third Reading Resolved That by-law a) be read a third time, signed, sealed and finally passed.
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Page By-Laws a)
To confirm all actions and proceedings of County Council on May 1, 2020
Adjournment
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AGENDA ITEM #a)
Report 2020-044 Council Recommend Report To:
Warden and Council
From:
Kelly Pender, Chief Administrative Officer
Prepared by:
Kelly Pender, Chief Administrative Officer
Date of meeting:
May 1, 2020
Re:
Office of the Chief Administrative Officer – Advocacy for Regionalized Lifting of Restrictions
Recommendation Be It Resolved That the Office of the Chief Administrative Officer – Advocacy for Regionalized Lifting of Restrictions report be received; And Further That County Council authorize the Warden to co-sign a letter to the Province advocating for a regionalized approach to the lifting of restrictions related to COVID-19. Background On April 27, 2020, the Ontario government released A Framework for Reopening our Province, which outlines the criteria Ontario’s Chief Medical Officer of Health and health experts will use to advise the government on the loosening of emergency measures, as well as guiding principles for the safe, gradual reopening of businesses, services and public spaces. The framework also provides details of an outreach strategy, led by the Ontario Jobs and Recovery Committee, to help inform the restart of the provincial economy. Comment The Warden has received correspondence from both Dr. Kieran Moore, Medical Officer of Health, KFL&A Public Health, and City of Kingston Mayor Bryan Paterson regarding regional planning for the lifting of restrictions related to COVID 19. Copies of this correspondence is attached to this report as Appendix A. The Warden has been asked to co-sign a letter to the Province alongside the Mayor of Kingston, Warden of Lennox & Addington and the KFL&A Medical Officer of Health. A
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copy of the draft letter is attached to this report as Appendix B. It should be noted that some of the language in the current draft letter will be modified slightly to better align to the recently released Provincial document “A Framework for Reopening our Province”. Strategic Priority Implications Priority 3: Champion and coordinate collaborative efforts with partners to resolve complex problems otherwise beyond the reach of individual mandates and jurisdictions. 3.1
Work with the townships, other municipalities and levels of government on broad infrastructure issues — ranging from environmental concerns to regional transportation strategies for residential, social and economic purposes, and access to funding.
3.2
Play a leadership role on communications to promote shared messaging for all regional initiatives such as economic development, tourism and lifestyle opportunities, and broadband and cell services.
Financial Implications There are no financial implications associated with this report. Organizations, Departments and Individuals Consulted and/or Affected County of Lennox & Addington City of Kingston KFL&A Public Health
Recommend Report to Council Office of the Chief Administrative Officer – Advocacy for Regionalized Lifting of Restrictions May 1, 2020
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COVID-19 Lifting Restrictions – Action Plan Organization: KFL&A Public Health Date: April 23, 2020 - v.1.0
Background This action plan provides an overview of emerging strategies for lifting restrictions imposed as part of public health emergency response measures to prevent the spread of COVID-19. The information is derived from a small selection of recently published and unpublished reports found through nonsystematic scanning of published and unpublished literature and media reports. A rapid literature search and corresponding research review and synthesis will be added to the information presented here, in the coming weeks. It must be acknowledged there is much additional information not captured in this document. As this is a rapidly evolving situation, the information will only be current as of the date the document was written. The information in this action plan serves to inform the development of an action plan to guide a localised public health strategy for easing restrictions in the KFL&A region. There has been a great amount of attention and detail to establishing public health policies and interventions to disrupt and slow the transmission of epidemic spread. Similarly, consideration must be given to identify transition points in order to mitigate risks related to reopening social activities, businesses and services and prevent a resurgence of infections. The interventions suggested are largely regulated at provincial level, and as such, this document helps guide advocacy from a municipal perspective as applied to the KFL&A region.
Current Status To help control spread and manage community transmission of COVID-19 in Ontario, a provincial Declaration of Emergency under the Emergency Management and Civil Protection Act was issued on March 17, 2020. This declaration was accompanied by orders to include a range of interventions including closure of non-essential businesses, public places, prohibition of events and gatherings of people, and others. This order was extended and expanded to close all outdoor recreational amenities, such as sports fields and playgrounds on March 30, 2020. These orders have been since extended to last until May 12, 2020 1 Models adapted to the local context in the KFL&A region predict that with moderate public health interventions, the number of COVID-19 cases requiring hospitalizations on any given day in the KFL&A area would peak at 1400 cases. As of April 23, there have been 59 total cases and 0 deaths. Since April 6, 2020, there has been one new confirmed case of COVID-19 indicating the success of these measures.
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Contents COVID-19 Lifting Restrictions – Action Plan……………………………………………………………………………………..1 Background…………………………………………………………………………………………………………………………………1 Current Status……………………………………………………………………………………………………………………………..1 Goals ………………………………………………………………………………………………………………………………………….3 Research Evidence:………………………………………………………………………………………………………………………3 Lessons from Other Countries ……………………………………………………………………………………………………3 Additional Health Outcomes of Pandemic-Related Restrictions ……………………………………………………..5 Modelling………………………………………………………………………………………………………………………………..5 Phased Approach rather than a single strategy (as depicted in the models) …………………………………….6 Risk Assessment……………………………………………………………………………………………………………………….6 Local versus whole population approach …………………………………………………………………………………….6 Ethical considerations……………………………………………………………………………………………………………….6 Community perceptions ……………………………………………………………………………………………………………6 Capacity implications………………………………………………………………………………………………………………..7 Regional Capacity: ……………………………………………………………………………………………………………………….7 Demographics of our region:……………………………………………………………………………………………………..7 Co-morbidities: ………………………………………………………………………………………………………………………..7 Priority Populations: …………………………………………………………………………………………………………………8 Surveillance Capacity ………………………………………………………………………………………………………………..8 Capacity for Testing, Detection, Case and Contact Tracing …………………………………………………………….9 Laboratory Capacity………………………………………………………………………………………………………………….9 Hospital System Capacity…………………………………………………………………………………………………………..9 Communications Capacity ……………………………………………………………………………………………………….10 Capacity Related to Specific Vulnerable Settings ………………………………………………………………………..10 Risk Assessment Capacity ………………………………………………………………………………………………………..11 Evaluation Capacity ………………………………………………………………………………………………………………..12 Proposed Response ……………………………………………………………………………………………………………………12 A Phased Approach for Lifting Restrictions ………………………………………………………………………………..13 Appendix ………………………………………………………………………………………………………………………………….14
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Goals The primary goals of this localized strategy are to:
Maintain a steady state of low-level transmission, to ensure sufficient public health and acute care capacity Reduce mortality due to COVID-19 and non-COVID-19 causes
The secondary goals of this localized strategy are to:
Minimize unintended consequences of necessary public health measures (e.g. negative physical and mental health impacts, economic impact to the community) Minimize societal disruption, maintain public trust and reduce public panic
Research Evidence: This section will be supplemented with research literature review results, currently in progress.
Lessons from Other Countries Multiple countries, mostly in Asia, have passed their first peak of COVID-19 and are starting to relax previous measures to contain or suppress the outbreak. Other countries, mainly in Europe, are still waiting to confirm whether or not they have passed their first peak but have nevertheless released their intentions for moving into the recovery phase of the pandemic. It should be acknowledged that the definition of “lockdown” varies across national responses with differences related to location, timing and duration of physical distancing measures, as well as businesses and services closures2. Below is a list of selected countries, and what they are currently doing or plan to do as they move into the post-peak phase. Country China3–5
Exit Strategy Lockdown on Wuhan has just been released Continued universal masking Continued isolation of mild-moderate cases Continued broad testing strategy Prepared to implement focal lockdowns Continued travel bans and quarantines for travellers
South Korea6–8
Relaxing physical distancing measures Tightening travel restrictions Continued universal masking School reopening postponed again (switch to eeducation) Prevented large outbreak from beginning Closed borders quickly; never had to physically distance Maintaining closed borders until other countries have outbreaks under control Expansive testing protocols Continued universal masking Singapore did not have to implement as stringent as
Taiwan6
Singapore6,9
Effect of Exit Strategy Continued small clusters of cases, not overwhelming healthcare system Effect of release of lockdown remains to be seen Continues to have clusters, mainly related to travel
Slowly increasing cases, in controlled fashion
Recent outbreak in 3|Page
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measures at first, and believed it was past peak, but now is increasing measures Continued universal masking Hong Kong6,10
Austria11
Denmark12
Italy3
USA13
“Suppress and lift strategy” based on case counts, in two week cycles Predicts that this will need to be continued for 2 years, until vaccine Continued universal masking Was one of the first countries in Europe to lockdown Currently 13 555 cases and 315 deaths Has announced plan to reopen small shops and garden centers on April 14 Will reopen things slowly, with 2 weeks in-between Continued physical distancing and universal masking Expect to allow mass gatherings in June Was one of the first countries in Europe to lockdown, and measures were not as severe Currently 5830 cases and 237 deaths Will start by reopening schools and daycares Continued physical distancing otherwise Continued lockdown now, but may be past peak Now designating hospitals as COVID or COVID-free Expanding contact tracing and testing, even of asymptomatic people To be implemented by states or regionally Outlines prerequisites or ‘gating criteria’ to proceed with de-escalation Includes: epidemiologic criteria, testing capacity, and healthcare system capacity Outlines 3 phases Throughout, encourage hand hygiene, physical distancing, staying home if ill, and wearing a mask in public
foreign worker dormitories Has had to increase measures, now in lockdown for 1 month Rising number of cases recently, mostly due to travel
Remains to be seen
Remains to be seen
Remains to be seen
Not yet implemented
Several lessons emerge from looking at the relaxation of measures in Asia and the plans for relaxation in Europe: Clusters of cases will continue; Travel will remain a concerning source of infection while other countries have not controlled their outbreaks; Relaxation of public health measures should be slow, considered and well-spaced; Universal masking and physical distancing should continue; Testing should be expanded to allow for enhanced surveillance; Case-contact tracing, and isolation and quarantine of clusters should be continued; Government and public should be prepared to return to more intensive public health measures. 4|Page
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Further lessons will emerge as these countries, particularly China and other Asian countries, implement their exit strategies.
Additional Health Outcomes of Pandemic-Related Restrictions Public health emergency response measures can also cause negative health outcomes, including social isolation, mental health strain, reductions in preventative medical care, and negative economic impacts. Economic status across a population is highly correlated with health status, and prolonged economic struggle may negatively impact the overall health status of a population14. Quarantine can have adverse psychological effects, including post-traumatic stress disorder, anxiety and depression. Factors that may alleviate the negative impacts included shorter duration of quarantine, providing clear rational, availability of adequate supplies and appeals to altruism 15. Children and adolescents with mental health needs are particularly vulnerable without access to mental health resources and peer support 16. Individuals with chronic health conditions may suffer increased morbidity and mortality following shortterm reductions in healthcare access. Several studies report that following decreased health care utilization during the SARS pandemic, there were significant increases in hospital admissions, and mortality from both diabetes and cerebrovascular disease 17,18
Modelling This section will be supplemented with research literature review results, currently in progress. Public health measures, including physical distancing measures that constitute a “lock-down” can be important in controlling an outbreak like COVID-19. There is risk in prematurely lifting these measures and returning to normal activities, as this could introduce a new wave of cases. There are a variety of lockdown strategies that have been modeled as population level interventions to explore the impact on epidemiological curves:
Data driven intermittent lock-downs: Using realworld and modelling data to trigger intermittent lockdown and release from lock-down. It does not have predetermined cycles 19
Cyclic lockdown strategy: Switching between enforced strict social distancing and relaxed measures, while accepting slow virus spread 19–21.
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Serological Testing/Immunity Certificates: Current estimates for the earliest availability of a vaccine are early 2021 22. To reliably understand population immunity levels, serological testing is needed in the absence of a vaccine. Immune individuals are provided an “immunity certificate,” allowing exemption from COVID-19 related restrictions.
Population scheduling: The population is split into a number of ‘bins’, and members of these bins alternate time in lock-down. Apart from the complexities of organising society around such a strategy, significant cross-bin leakage is likely, due to social interactions in households.
Regional scheduling: In successive parts of the jurisdiction (e.g. cities or municipal health services catchment areas) stringent interventions are released, accepting local viral spread. Controls remain in other jurisdictions until lifted successively23.
Population shielding: Physical (social) distancing of high risk individuals (e.g. age over 70 years, immunocompromised, medical comorbidities, etc.) while allowing lower risk individuals to return to activity 19.
Phased Approach rather than a single strategy (as depicted in the models) Risk Assessment Local versus whole population approach Ethical considerations
The key ethical issue in managing the COVID-19 pandemic is how to reconcile consent and civil liberty concerns of individuals with community benefit. There is emerging consensus that a graduated approach to restrictive measures will be needed — one that permits a return to some social and economic activity while avoiding undue stress on medical resources and allowing population immunity to build gradually. In developing this strategy, equitable and effective public policy strategies should be guided by ethical principles24,25. Broadly, the following ethical principles should be considered: Interventions should be evidenced based and proportionate Intrusion into people’s lives should be the minimum possible to achieve public safety The unintended effects of public health measures must be carefully assessed, as they relate to socioeconomic wellness of individuals and society. To promote justice, we must mitigate the differential impact of interventions on equity-seeking groups. People should be treated as moral equals, worthy of respect. While individuals may be asked to make sacrifices for the public good, the respect due to individuals should never be 6|Page
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forgotten in the way in which interventions such as quarantine and self-isolation are implemented. The public has a right to obtain key information that benefits its safety and security. The aims and evidence of the interventions being implemented should be clearly communicated. In communicating plans to loosen public health measures, the public should be aware of the criteria for loosening restrictions, and well as criteria for re-instating measures. Ethical decision making will guide many facets of the COVID pandemic, including human research, travel restriction, allocation of scarce resources, privacy in contact tracing, and inequitable impact of social distancing. This document will not discuss each in detail, however, it is relevant to consider the scope of our decision making.
Community perceptions This section will integrate results from Statistics Canada recent population based survey on perceptions and readiness to adhere to pandemic restrictions. Supplemental information will be added from the research literature review.
Capacity implications This section will be supplemented with research literature review results, currently in progress.
Regional Capacity: Important Population Characteristics (introductory Paragraph)
Demographics of our region: KFL&A Public Health serves three municipal organizations (the City of Kingston, the County of Frontenac, and the County of Lennox & Addington) with a total population of approximately 200,000 and land area of 6600 square kilometers. Most of the population resides within the City of Kingston (65%), with the balance split equally between the two counties. Approximately 20% of the population is age 65 years and older, making the population in the region older than the Ontario population with a median age of 44.5 compared to 41.3 (2016 Census). Given the known epidemiological evidence related to more severe symptoms of ARI in older adults, the region is vulnerable to surge that will impact and could quickly overwhelm the current primary and acute care systems. 97% of residents are Canadian citizens, 11% are immigrants, and 7% are visible minorities. Nearly 40% of the population has moved within the past five years, half of those being migrants. 96% of the population identifies that English is the language most often spoken at home, with French at 1% (compared to 2% of Ontarians). The most common other languages spoken at home are Portuguese and Mandarin. About 4% of the population identifies as Indigenous.
Co-morbidities: Epidemiological data shows the prevalence of comorbidities (e.g. hypertension, diabetes, respiratory system disease, cardiovascular disease) in severe presentations of COVID-19 patients is higher than in non-severe presentations 26. Hospitalization rates in KFL&A for respiratory disease and lower respiratory disease were significantly higher than Ontario in 2018 (763.8 vs. 625.2 per 100,000, respectively for 7|Page
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respiratory disease and 319.1 vs. 212.2 per 100,000 respectively for lower respiratory disease)1. For Chronic Obstructive Pulmonary Disorder (COPD), the KFL&A region showed significantly higher rates (251.8 vs. 173.3 per 100,000)27. Also, the region’s rates for asthma in 2018 were significantly higher compared with the provincial rate (61.9 vs. 36 per 100,000)2. Hospitalization rates for diabetes were significantly higher in 2018 compared with the province (132 vs. 102.8 per 100,000)27. Hospitalization rates for ischemic heart disease (ISH) and cardiovascular disease (CVD) were lower than province (227 vs. 300 per 100,000, respectively for ISH and 863 vs. 902 per 100,000, respectively for CVD) (DAD, 2017). The smoking rate in the KFL&A region was 20.2% (CCHS 2015/16).
Priority Populations: High-level priority populations in KFL&A region include Indigenous residents, low income residents, and our rural population. The 2016 Census revealed 4% of residents self-identify as Aboriginal (63% First Nations, 32% Metis, 1% Inuit), with 1% Registered or Treaty Indian. 27% of our population is rural (2016 Census). Using the INSPQ Deprivation Index and/or the Ontario Marginalization Index, it is evidenced that residents of more deprived/marginalized neighbourhoods have poorer health outcomes. Median income in KFL&A in 2015 ($69, 930) was similar to the province. Overall, the low-income percentage of the population is comparable to the province at 14%. In 2018, the United Way KFL&A, in partnership with the City of Kingston, conducted the Urban Point-inTime (PiT) Homeless Count for Kingston, Ontario (Results of the Urban Kingston 2018 Point-In-Time Count, United Way, 2018). The number of people found experiencing absolute homelessness (those who are unsheltered or ‘sleeping rough’ and those who are emergency sheltered) was 81, although a total of 152 people were encountered who are homeless (of various types) in 2018. Some of these individuals were using transitional housing, sleeping at someone else’s home, or in unknown situations
Surveillance Capacity To mitigate risk, it is crucial to have robust surveillance strategies in data. In the KFL&A region, there are many layers of data collection and surveillance that allow for the rapid and efficient sharing of data within the local healthcare systems. Unique strengths of the region’s surveillance system are defined by simplicity, stability, and capacity. The surveillance system is simple in the sense of its structure and ease of operation. Unlike many other regions, there are only two hospital systems in KFL&A, KHSC and LACGH. In addition, there is relatively limited amounts of traffic in and out of the region allowing for increased abilities of containment and management and tracing of cases and contacts. Active surveillance is simplified to the systematic detection of infection in sentinel groups such as health-care workers, long-term care residents, and patients presenting to emergency departments, COVID-19 Assessment Centres and admitted to hospitals. These groups each have protocols in place in place to minimize the risk of new outbreaks and risk of nosocomial transmission through effective early identification through testing appropriate cases and contacts.
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Stability is another key feature of the surveillance system. Existing infrastructure has been used for syndromic surveillance in the region for many years via the Acute Care Enhanced Surveillance (ACES) system that provides real-time situational awareness of admissions to hospitals in Ontario for reasons that may be related to COVID-19. ACES has a strong record of collecting, managing, and providing data in a reliable fashion. This type of monitoring system is especially important when progressing through phases as it can potentially identify an outbreak much faster than is possible using laboratory results alone. Capacity for Testing, Detection, Case and Contact Tracing. One of the main considerations in moving forward with a plan is ensuring sufficient testing supplies to meet demands. This includes being able to test all cases and have timely results (within 24 hours of identification and sampling), detection of cases quickly after symptoms onset, adequate case management through appropriate treatment and isolation measures, as well as capacity to perform contact tracing in a timely manner. Current testing facilities in KFL&A include the Community COVID-19 Assessment Centre, hospitals, and LTCs aimed at testing sentinel groups. These systems help implement the systematic detection of infection in sentinel groups such as health-care workers, long-term care residents, and patients presenting to emergency departments and admitted to hospitals. These groups each have provincially mandated protocols in place in place to minimize the risk of new outbreaks and risk of nosocomial transmission through effective early identification through testing appropriate cases and contacts. At this time, KFLA’s testing capabilities are being met due to low levels of COVID-19 transmission in the area, but this could change if significant demands in the form of outbreaks or clusters developed. It is important that we are prepared with adequate public heath supplies and workers to ensure we can respond effectively to higher rates of transmission if they do occur. It is also beneficial to have access to sufficient serological testing as this would allow us to conduct a seroprevalence study should be to better gauge the level of infection and immunity in the general public or specific populations.
Laboratory Capacity The KFL&A region also has capacity to test many samples in a timely fashion due to having a Public Health Ontario lab based in Kingston and the KHSC Microbiology lab. These labs in the community make it more likely that testing demand can be met even during a surge in cases, and additionally, that turnaround time is quicker allowing for more timely action if needed. To ensure that adequate testing is implemented we have a local Assessment Centre and Call Centre that report the daily number of patient assessments, swabs, and calls, and in addition we receive reported confirmed COVID-19 cases from the integrated Public Health Information System (iPHIS).
Hospital System Capacity The anticipated burden on the healthcare system due to COVID-19 is difficult to predict. Researchers at the University of Toronto have created models that project expected numbers of the hospitalizations based on type of public health (PH) measures put in place to combat COVID-1928. When adapted to the local context, these models predict that with low-to-moderate public health non-pharmaceutical intervention the number of COVID-19 cases requiring hospitalizations on any given day in the KFL&A 9|Page
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area would peak at 1400 cases. However, if more stringent non-pharmaceutical interventions are successful, a peak of around 500 hospitalized cases is predicted. There are several important caveats to note regarding these models. The intention of the models is not to confer absolute numbers, but to demonstrate the effectiveness of different public health interventions. Furthermore, the outputs are based on Provincial data, adjusted for local population size, but local demographic differences from the Province are not incorporated. It would be inaccurate to rely on the absolute numbers predicted by the model. Current assets include the region’s partnership across local hospital systems (KHSC and LACGH), close communication with local public health, and ongoing planning to accommodate capacity if it was to hit peak numbers as projected by models. This is further supported by the ability to access real-time bed capacity via an online tool Power BI which relays hospital capacities in real-time. Current plans for Alternate Health Facilities (AHF) are being developed to emergency capacity expansion.
Communications Capacity Draft section to match with municipal assets. Will need a communication development plans and risk mitigation strategy throughout a phased approach. To be developed in tandem with stakeholders.
Capacity Related to Specific Vulnerable Settings Congregate settings pose high risk for transmission of the virus, challenges in implementing mitigation strategies, and ethical considerations for these groups.
People experiencing homelessness o Estimated population in Kingston: 21329 o For individuals who are experiencing homelessness, there is much greater risk of contracting COVID-19 as they have limited opportunities to access washroom facilities to wash their hands and are unable to self-isolate or practice social distancing. The AMHS-KFLA, in collaboration with many local partners, has opened a Self-Isolation Centre which allows those experiencing homelessness to self-isolate while maintaining safe physical distance from others. The center has full protective equipment for staff. At present, demand has not surpassed available space, and there is ability to expand available beds, however, in fall and winter months there may be increased demand. Inmates at Corrections Facilities o Estimated population in KFL&A Federal Institutions: 2381 Provincial Institutions: 144 o Correctional facilities are recognized as vulnerable settings and are therefore implementing policies and procedures to limit the spread of COVID-19 based on provincial and federal guidance. Both provincial and federal correction centers are following jurisdictional screening criteria, implementing social distancing of inmates, and limiting people on the premises including visitors. Residents of Long-Term Care and Retirement Homes: o Estimated capacity in KFL&A 10 | P a g e
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o
12 LTC facilities with 1517 beds in KFL&A 15 Retirement Homes with 1097 beds in KFL&A Public health has worked closely with long-term care given the high-risk nature of these healthcare settings, with many older adults at risk of severe morbidity and mortality from COVID-19. Adequate supply of PPE has been an ongoing concern. A new directive on April 22 mandated that all workers and residents be tested, which will be logistically challenging, and we should anticipate shortages in testing supplies. As the pandemic continues, we should also plan for increasing staffing. To date, there has been one LTC outbreak in KFL&A. We are not presently in a place to lift restrictions for long-term care facilities. As outlined in the checklist extra precautions will be needed to protect this population for the foreseeable future.
Risk Assessment Capacity Decisions around reopening of society have potential for immense benefits to socioeconomic and individual wellbeing, but also carry possible harms from increased transmission of the virus. There is no universal approach for re-opening, so decision makers should be guided by risk assessments to protect the health and safety of the public. Risk assessments are formalized processes to evaluate risks and hazards. For the case of COVID-19, they would measure the likelihood of transmission and consequences thereof. In addition, there are mitigation measure that can decrease the extent and scope of impact (for example, physical distancing, wearing PPE, using technology to facilitate communication).The CDC has published guidance on implementing mitigation measures at various levels of society 30 Though there is still much to be learned about the pathogenicity of COVID-19, likelihood of transmission is certainly increased by prolonged and close contact. Congregate settings pose higher risks, and settings with minimal close contact are lower risk, but importantly, not risk-free. The primary consequence is increased community spread. The John Hopkins Bloomberg School of Public Health has released recommendations for phased reopening of American states. Similar principles can be applied when planning a phased reopening approach in Ontario. They recommend individualized plans for various settings. However, they apply a unified risk assessment approach based on the following principles31
Contact intensity (type and duration) Number of potential contacts Modification potential (degree to which mitigation measures can bring down those risks)
A primary role of governments and authorities during a pandemic is to inform citizens about risk. Significant evidence from meta-analyses shows suggests that risk perception drives behavioural responses32. When communicating risks assessments, it is important to avoid specific and extreme cases, which may increase the perceived likelihood of evocative outcomes. Information about coronavirus is evolving quickly, there are constant revisions to plans. To maintain public trust, we must acknowledge uncertainty and the measured taken to reduce it and foreshadow what information may lead to change in recommendations.
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Evaluation Capacity KFL&A Public Health has a comprehensive complement of staff with specialist evaluation skills and experiences. The Knowledge Management Division is comprised of research associates, epidemiologists and librarians. Additionally, there are three Foundational Standard Specialists in the organization. Staff participate in established advisory networks and channels of communication both internal to the organization, through a Community of Practice for Evaluation, and externally, through the Ontario Public Health Evaluation Network and the Shared Library Services Partnership. Staff have experience designing, implementing, analyzing and disseminating evaluations at service, programmatic, organizational, and policy levels, both within the organisation and through cross-agency collaborations. To date, the Knowledge Management Division has completed a draft version of a post-pandemic assessment and improvement plan. However, the proposed easing of public health emergency response restrictions will require the development of an evaluation approach to ensure rapid feedback related to the diverse range of activities rolled out as part of this proposed phasing for lifting restrictions. In addition to surveillance and monitoring, evaluation methodology will inform ongoing risk assessments. Real-time evaluation (RTE) uniquely manages risk during the first months of early emergency responses by assessing major operations, checking compliance with broader standards and policies, and informing real-time progress of regionalized initiatives33. RTEs offer a flexible methodology that assesses in real time, in the field, to influence initiatives or programs as they happen, to make key changes quickly (i.e., the same week or month). In the current dynamic efforts preventing the spread of infection, establishing such feedback mechanisms will enable tailored solutions to mitigate challenges, prevent unintended consequences, and maintain low risks of transmission. Indeed, delayed decision-making based on stakeholder considerations (i.e., political, economic), insufficient resourcing, or poor coordination (all factors related to public health emergency response measures not otherwise captured using surveillance methods) contribute to poor epidemic response34. Establishing a RTE approach, supported by an adaptive epidemic response framework, in parallel with the phases of lifting restrictions will support sustainability, inclusive coverage by flagging how population groups are impacted differently, emergency risk communication efforts, and coordination across the region33–35. Lessons learned from regionalized evaluation and surveillance efforts will inform approaches for other agencies, organisations or jurisdictions, as well as broader policy development.
Proposed Response Decisions about where and when to lift restrictions must be evidence based, data driven and applied incrementally, using a phased approach being sure to implement changes that are proportional to risk. It is important to establish criteria for moving through a gradual ease of restrictions and balancing both health and socioeconomic outcomes over the long term. In the current situation, the long term means until such time that a vaccine to prevent COVID-19 is made available or that national population immunity reaches a documented level of 70% or more. Ontario is uniquely positioned to implement innovative tactics for lifting restrictions as public health units command highly specialized workforces within established, localized, geographical boundaries. The regionalized workforce is well supported by cooperative advisory networks from across the province and 12 | P a g e
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Public Health Ontario. Just as the implementation of municipal emergency response measures corresponded to regional surveillance indicators of community spread, so too could a phased approach to ease restrictions. A localized approach will permit close monitoring in community context, matched with community capacity to mitigate consequences. A localized approach enables real-time evaluation activities at a smaller, more nimble scale. In turn, with regional evaluation measures in place, we will collect rapid feedback related to specific easing activities and inform risk assessments. A localized approach will accelerate research and knowledge sharing in order to tailor actions to other jurisdictions and/or scale up full policy responses at a provincial level. The proposed localised response acknowledges that the geography may have to be scaled to a region with sufficient capacity to fulfill surveillance, detection, case and contact management, critical care, communication and evaluation needs to prevent infection resurgence. Not all health units in the province will have sufficient capacity, therefore, localised responses could consider other possible boundaries, i.e., LHINs.
A Phased Approach for Lifting Restrictions At the time of this writing, key transition point criteria suggestions for developing a Readiness Checklist to be applied at a regional level (see Appendix #) were adapted from two source documents with additional suggestions from our municipal partners:
World Health Organization (WHO): COVID-19 Strategy Update (April 14, 2020)36 CDC: Guidelines – Opening Up America Again13
The checklist will be updated according to results form a completed research literature review, currently in progress. In Ontario, the slowdown in the number of cases is due to public health action, not herd-immunity. This means a significant portion of the population remains susceptible to infection. The phased approach builds on continued implementation of physical distancing efforts, gradually moving to ease restrictions in settings from strict, to moderate to light physical distancing policies. Without this fundamental prevention measure, the risk of COVID-19 resurgence, regardless of phase, is high. Continual risk assessments will be required to evaluate the epidemiological risks, health risks and benefits, as well as socioeconomic risks and benefits of lifting restrictions on different workplaces, institutions, educational settings, and social activities. The Readiness Checklist is comprised of four phases, each phase requiring action from local public health stakeholders and municipal stakeholders (see table #). The public health checkboxes are listed as criteria that must be met before moving to subsequent transition phase; the municipal checkboxes are settings where restrictions may be lifted, as long as they continue to meet listed policy criteria. PHASE CONTROLLED TRANSMISSION TRANSITION PHASE ONE TRANSITION PHASE TWO TRANSITION PHASE THREE
PUBLIC HEALTH ACTION Criteria and conditions
MUNICIPAL ACTION Criteria and conditions
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Once criteria and conditions within each phase are fulfilled, the regionalised stakeholders may decide to move into the next transition phase. In the event of a resurgence of infection, regionalised stakeholders will have to impose new restrictions and possibly return to the previous phase restrictions. Risk assessments will guide this movement. Examples of situations where regions may have to return to the previous phase13:
Substantial number new cases cannot be traced back to known cases Sustained increase in new cases x 5 days with lower thresholds for increases within high-risk groups based on modelling Hospitals no longer able to safely treat all patients (limitations in critical care capacity)
For a full list of criteria within each phase, see Appendix #.
Appendix Will append documents:
Readiness Checklist draft Proposed phasing documents by our municipal partners
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References 1.
Ontario Extends Declaration of Emergency to Continue the Fight Against COVID-19. Government of Ontario: News Release. https://news.ontario.ca/opo/en/2020/04/ontario-extendsdeclaration-of-emergency-to-continue-the-fight-against-covid-19.html. Published 2020. Accessed April 20, 2020.
Bin M, Cheung P, Crisostomi E, et al. On Fast Multi-Shot Epidemic Interventions for Post LockDown Mitigation: Implications for Simple Covid-19 Models. 2020:1-14. http://arxiv.org/abs/2003.09930.
Parker G, Hughes L. UK looks to Italy and China for clues on lockdown exit strategy. Financial Times. https://www.ft.com/content/68df722d-8e35-412a-8932-6a843d66cca5. Published April 6, 2002.
China’s Wuhan to keep testing residents as COVID-19 lockdown eases. Channel News Asia. https://www.channelnewsasia.com/news/asia/covid19-coronavirus-wuhan-testing-lockdown12630528. Published April 10, 2020.
China lifts 10-week lockdown on Wuhan after no new deaths reported for first time in former epicentre. National Post. https://nationalpost.com/news/world/as-covid-19-rates-fall-in-globalhotspots-hopes-that-the-virus-pandemic-might-be-slowing-down-on-the-rise. Published April 7, 2020.
White E, Hille K, Palma S, Liu N. Asia struggles to find coronavirus exit strategies. Financial Times. https://www.ft.com/content/04e9c5fe-52b1-4eb8-bf9c-793d71a0524d. Published April 9, 2020.
Bicker L. Coronavirus: How South Korea is teaching empty classrooms. BBC News. https://www.bbc.com/news/world-asia-52230371. Published April 10, 2020.
McCurry J. Japan and South Korea tighten borders as US faces up to 200 000 Covid-19 deaths. The Guardian. https://www.theguardian.com/world/2020/mar/30/japan-and-south-koreatighten-borders-as-us-faces-up-to-200000-covid-19-deaths. Published March 30, 2020.
233 new COVID-19 cases in Singapore, 7 new clusters including MBS restaurant and McDonald’s. Channel News Asia. https://www.channelnewsasia.com/news/singapore/coronavirus-covid-19moh-cases-clusters-mbs-mcdonalds-12635076. Published April 12, 2020.
Cheung E, Ting V. Coronavirus: With the smallest new infection count in weeks, Hong Kong’s Covid-10 situation “is improving.” South China Morning Post. https://www.scmp.com/news/hong-kong/health-environment/article/3079222/coronavirushong-kong-records-lowest-daily-count. Published April 9, 2020.
Fechner I. Austria’s COVID-19 Exit Strategy. Amsterdam; 2020. https://think.ing.com/articles/austrias-covid-19-exit-strategy/.
Baker S. Denmark rushed to lock down before almost every other country; Now its response is so far ahead that it’s starting to remove restrictions. Business Insider. https://www.businessinsider.com/coronavirus-how-denmark-reached-stage-of-easing-lockdownrestrictions-2020-4. Published April 10, 2020.
Opening up America Again. Washington, DC; 2020. https://www.whitehouse.gov/openingamerica/. 15 | P a g e
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Laurencin CT, McClinton A. The COVID-19 Pandemic: a Call to Action to Identify and Address Racial and Ethnic Disparities. J racial Ethn Heal disparities. doi:https://dx.doi.org/10.1007/s40615-020-00756-0
Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-920. doi:10.1016/S01406736(20)30460-8
Lee J. Mental health effects of school closures during COVID-19. Lancet Child Adolesc Heal. 2020;2019(20):30109. doi:10.1016/S2352-4642(20)30109-7
Wang SY, Chen LK, Hsu SH, Wang SC. Health care utilization and health outcomes: A population study of Taiwan. Health Policy Plan. 2012;27(7):590-599. doi:10.1093/heapol/czr080
Huang Y-T, Lee Y-C, Hsiao C-J. Hospitalization for Ambulatory-care-sensitive Conditions in Taiwan Following the SARS Outbreak: A Population-based Interrupted Time Series Study. J Formos Med Assoc. 2009;108(5):386-394. doi:10.1016/S0929-6646(09)60082-6
Ferguson NM, Laydon D, Nedjati-Gilani G, et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. ImperialAcUk. 2020;(March):3-20. doi:10.25561/77482
Karin O, Milo T, Katzir I, et al. Adaptive cyclic exit strategies from lockdown to suppress COVID-19 and allow economic activity. Preprint. 2020:1-18.
Bin M, Cheung P, Crisostomi E, et al. On Fast Multi-Shot Epidemic Interventions for Post LockDown Mitigation: Implications for Simple Covid-19 Models. 2020:1-14. http://arxiv.org/abs/2003.09930.
Thanh Le T, Andreadakis Z, Kumar A, et al. The COVID-19 vaccine development landscape. Nat Rev Drug Discov. April 2020. doi:10.1038/d41573-020-00073-5
Vlas SJ de, Coffeng LE. A phased lift of control: a practical strategy to achieve herd immunity against Covid-19 at the country level. medRxiv. 2020:2020.03.29.20046011. doi:10.1101/2020.03.29.20046011
Berlinger N, Wynia M, Powell T, et al. Ethical Framework for Health Care Institutions Responding to Novel Coronavirus SARS-CoV-2 (COVID-19) Guidelines for Institutional Ethics Services Responding to COVID-19 Managing Uncertainty, Safeguarding Communities, Guiding Practice. 2020;2.
Nuffield Council on Bioethics. Rapid policy briefing - Ethical considerations in responding to the COVID-19 pandemic. 2020;(March):1-11. https://www.nuffieldbioethics.org/news/respondingto-the-covid-19-pandemic-ethical-considerations.
Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95. doi:10.1016/j.ijid.2020.03.017
Snapshots: Chronic disease hospitalization –age standardized rate (both sexes). Ontario Agency for Health Protection and Promotion (Public Health Ontario). publichealthontario.ca/en/DataAndAnalytics/Snapshots/Pages/ChronicDiseaseHospitalization.aspx. Published 2018. Accessed January 31, 2020. 16 | P a g e
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Tuite A, Fisman DN, Greer AL. Mathematical modeling of COVID-19 transmission and mitigation strategies in the population of Ontario, Canada. medRxiv. 2020:2020.03.24.20042705. doi:10.1101/2020.03.24.20042705
Housing and Homelessness Report. Kingston; 2018. https://www.cityofkingston.ca/documents/10180/13882/HousingHomelessReport.pdf/61d0929 6-9329-430f-ac95-58036b53b107.
HHS, CDC. Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission. 2020:1-10. www.cdc.gov/COVID19.
Caitlin Rivers, Elena Martin, Scott Gottlieb, et al. Public Health Principles for a Phased Reopening During COVID-19 : Guidance for Governors.; 2020.
Lunn PD, Belton CA, Lavin C, McGowan FP, Timmons S, Robertson DA. Using Behavioral Science to help fight the Coronavirus. J Behav Public Adm. 2020;3(1). doi:10.30636/jbpa.31.147
Cosgrave J, Ramalingam B, Beck T. Real-Time Evaluations of Humanitarian Action An ALNAP Guide Pilot Version.; 2009.
Warsame A, Blanchet K, Checchi F. Towards systematic evaluation of epidemic responses during humanitarian crises: A scoping review of existing public health evaluation frameworks. BMJ Glob Heal. 2020;5(1). doi:10.1136/bmjgh-2019-002109
Seeger MW, Pechta LE, Price SM, et al. A Conceptual Model for Evaluating Emergency Risk Communication in Public Health. Heal Secur. 2018;16(3):193-203. doi:10.1089/hs.2018.0020
World Health Organization. COVID-19 Strategy Update.April 14, 2020.
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Transition Readiness Checklist for Regional Lifting of Emergency Response Measures Restrictions GOALS: Primary goals Maintain a steady state of low-level transmission, to ensure sufficient public health and acute care capacity Reduce mortality due to COVID-19 and non-COVID-19 causes Secondary goals Minimize unintended consequences of necessary public health measures (e.g. negative physical and mental health impacts, economic impact to the community) Minimize societal disruption, maintain public trust and reduce public panic NOTE: Minimum two weeks between phases and the time it takes to understand the risk of new outbreaks and to respond appropriately (WHO). Geographic region may have to be scaled to a region with sufficient capacity to fulfill surveillance, detection, case and contact management, critical care, communication and evaluation. Not all health units in the province will be able to do this. Consider other possible boundaries, i.e., LHINs. READINESS CHECKLIST (at current writing, this evidence is solely based on three documents: WHO COVID-19 Strategy Update 14th April 2020, and the CDC, Guidelines for Opening Up America Again, as well as the plan shared from our municipal partners - it is likely that as the formal research evidence review proceeds, sections of this draft checklist may be shifted and/or additional criteria added – there are a few suggestions added without evidence (yet), marked by an asterisk). The checklist will be updated according to results form a completed research literature review, currently in progress.
Suggested phasing steps from our municipal partners are indicated in Blue text. Where suggested phasing from municipal partners shifted to align with Public Health Evidence, it is indicated by double asterisk **.
AGENDA ITEM #a)
April 24, 2020
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PHASES
Public Health Criteria – can be scaled to a geographic region
Notes: KFL&A Current State of Readiness
Achieve a Sate of Controlled Transmission in the region (region = public health authority? Or city or province?)
Detectable downward trajectory of symptoms both influenza like illness and/or COVID-19 like symptoms within a 14-day period
KFL&A’s epidemic curve has been well below projections based on provincial modeling (insert date and appropriate model)
Downward trajectory of documented cases within a 14-day period (or do we want zero new cases if this is at the regional level?) CMOH said 100-200 cases per day in Ontario. Consider extrapolate to regional numbers
KFL&A’s cases have declined No deaths No ICU admissions No ventilator use
Sporadic cases and clusters of cases are all from know contacts or imputations (no community spread) within a 14-day period Incidence of new cases is maintained at a level that the health system can currently manage (all patients are treated without crisis)
COVID-19 Assessment sites have been established – capacity? Current numbers as well
Sufficient (definition needed) clinical care capacity in reserve (workforce, beds, equipment, PPE) (to match most current provincial epidemiological modeling)
Emergency critical care capacity is planned (workforce, beds, ventilator, PPE) – what is the potential turn around time to make this operational?
Sufficient PPE in high-risk vulnerable settings (e.g., LTC) in reserve
Lab requisition – average turn around time on testing
Robust testing program in place, such that there are sufficient test kits, and real-time accurate data on the testing of suspected cases (results received and acted on in less
Testing kits PPE Case and contact management
Notes: Municipal Partners Current State of Readiness*
Monitor workforce for indicative symptoms Do not allow symptomatic people to physically return to work until cleared by occupational health or a medical examiner Develop and implement policies and procedures for workforce contact tracing following COVID-19 positive test result (not sure if we want workplaces to do this or we do this…but in LTC I think they do this, for example, or prisons) Develop a plan for monitoring/police services that minimizes the imposition of a restriction of liberty and emphasizes the altruistic choice of physical
AGENDA ITEM #a)
April 24, 2020
Hospitals have created capacity (elective surgeries, bed space) (insert our evidence for this). Alternate healthcare facility planning underway
Public Health Criteria for Businesses, Employers, and Facilities – must be scaled to the same region Develop and implement appropriate policies in accordance with municipal, provincial and federal regulations and guidance regarding Social distancing Protective equipment Screening assessment to enter work (potential temperature monitoring) Sanitation Testing? Ensure employees vaccination is up to date, including influenza
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than 24 hours after testing)
capacity established – how efficient is it?
Robust testing program in place for healthcare workers, essential workers (is this just double from previous bullet?) Robust communication strategy is planned and communicated to the public well in advance of lifting restrictions in each subsequent phase – in the event of a new outbreak, all people must be ready to comply with restrictions implemented following an easing through subsequent phases. * Plan for the use of Ethical Framework when lifting restrictions in subsequent phases to mitigate unintended consequences (stakeholders identified for this too) *
distancing and self-isolation* Nurseries, garden centres, landscaping supplies are open. Stores currently restricted to alternative methods of sale under Section 15 of Schedule 2. (Hardware, vehicle parts and supplies, pet and animal supplies, office supplies and computer products/repair, safety supplies). Construction projects and services for the safe and reliable operations of infrastructure, including transit, transportation, energy, justice sectors and work within the public right-of-ways including day-to-day maintenance. providing landscaping care and other related outside maintenance activity, including that for lawns, gardens, trees, swimming pools, decks may operate
Once criteria of Controlled Transmission are fulfilled, may move to next phase, transition phase 1. Transition Detect and isolate all cases, irrespective of Phase One severity and origin All vulnerable individuals should continue to self-isolate at home.
April 24, 2020
Retail stores smaller than 800 sq.metres, provided main entrance is to outside (i.e. no indoor mall stores).open maintaining physical distancing**
AGENDA ITEM #a)
Members of households with vulnerable residents should take precautions, as able, to isolate from vulnerable residents within the home space if they are leaving the home for work or other reason.
Parks, community gardens and outdoor recreation areas open with physical distancing signage, with the exception of playgrounds, splash pads, play structures and equipment, outdoor recreational amenities**
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All individuals maintain physical distancing in public spaces Avoid gatherings of greater than 10 people where physical distancing is not possible
Encourage teleworking solutions whenever possible and feasible with business operations
Avoid non-essential travel Prohibit visitors to all long term care facilities
Return to work in phases and enforce strict physical distancing protocols (personnel report to work in shifts to allow distancing).
Elective surgeries can resume, as clinically appropriate, on an outpatient basis Outbreak risks in high-vulnerable settings are minimized Communities are fully engaged and adhering to behavioural prevention measures and understand that individuals have key roles to play to protect the community. Communities are aware that new control measures may be implemented in the event of a new outbreak.
Close common areas in workplaces if not able to maintain physical distancing in the space. Strongly consider special accommodations for personnel who are members of a vulnerable population. Schools and daycares remain closed. Large venues that permit physical distancing can operate under strict physical distancing protocols (restaurants, theatres, religious centres, sporting venues)
April 24, 2020
AGENDA ITEM #a)
Gyms can open with strict physical distancing and sanitation protocols
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Businesses entailing primarily item drop-off and pickup, such as repair shops (e.g. watch repair, appliance repair, shoe repair) may operate.** Businesses performing work on the exterior of buildings and structures (e.g. masonry repointing, window cleaning, exterior painting, gutter cleaning, siding installation) my operate.** Construction projects for which permits were granted on or before April 4, 2020 may proceed with strict physical distancing and sanitation protocols. ** Boat ramps and docks for the purpose of launching and landing boats and other watercraft may open, but not including marinas.**
All individuals maintain physical distancing in public spaces
April 24, 2020
Strongly consider special accommodations for personnel who are
AGENDA ITEM #a)
Bars remain closed Maintained controlled transmission, no evidence of resurgence, and satisfied criteria of transition phase 1, may move to transition phase 2. Transition All vulnerable individuals should continue Encourage teleworking solutions Phase Two to self-isolate at home. whenever possible and feasible with business operations Members of households with vulnerable Return to work in phases and enforce residents should take precautions, as able, strict physical distancing protocols to isolate from vulnerable residents within (personnel report to work in shifts to the home space if they are leaving the home for work or other reason. allow distancing).
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members of a vulnerable population. Avoid gatherings of greater than 50 people where physical distancing is not possible
Schools and daycares may open.
Develop and implement measures to rapidly detect and manage suspected cases among travelers (including the capacity to quarantine individuals arriving from areas with community transmission)
Large venues that permit physical distancing can operate under moderate (?) physical distancing protocols (restaurants, theatres, religious centres, sporting venues)
Non-essential travel may resume.
Gyms can remain open with strict physical distancing and sanitation protocols
Prohibit visitors to all long term care facilities Elective surgeries can resume, as clinically appropriate, on an outpatient basis Outbreak risks in high-vulnerable settings are minimized Communities are fully engaged and adhering to behavioural prevention measures and understand that individuals have key roles to play to protect the community. Communities are aware that new control measures may be implemented in the event of a new outbreak.
Bars may open with standing-room capacity, where applicable and appropriate Businesses performing work on the interior of buildings and structures may operate (e.g. plumbing, electrical, painting for renovations and home improvements). Maintenance, repair and property management services for buildings and properties may operate.
All outdoor picnic sites, benches and
April 24, 2020
AGENDA ITEM #a)
Regulated health professionals for non emergency visits, including dentists, optometrists, chiropractic services, ophthalmologists, physical and occupational therapists and podiatrists.
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shelters in park and recreational areas. playgrounds, splash pads, play structures and equipment, outdoor recreational amenities (?)**
Maintained controlled transmission, no evidence of resurgence, and satisfied criteria of transition phase 1 and 2, may move to transition phase 3. Transition All vulnerable individuals may resume All retail stores may reopen. Phase Three public interaction, but continue to practice Large venues that permit physical physical distancing, minimizing exposure in distancing can operate under limited (?) social settings where distancing is not practical, unless precautionary measures physical distancing protocols (restaurants, theatres, religious centres, are observed. sporting venues, galleries, exhibits and Low-risk populations should minimize time museums.)** spent in crowded environments. Gyms can remain open with standard Visits to long term care facilities and sanitation protocols hospitals can resume. Personal services (e.g. fitness facilities, Communities are aware that new control salons, barbershops, spas). measures may be implemented in the event All construction with permits issued of a new outbreak. after April 4th may proceed. Bars may operate with increased standing-room capacity, where applicable
April 24, 2020
AGENDA ITEM #a)
Definitions: Vulnerable Individuals (CDC)
- Elderly individuals.
- Individuals with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised such as by chemotherapy for cancer and other conditions requiring such therapy.
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April 24, 2020
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Original Message From: Paterson, Bryan bpaterson@cityofkingston.ca Sent: April 28, 2020 12:56 PM To: Moore, Kieran Kieran.moore@kflaph.ca; mayor_smith@centralfrontenac.com; Marg Isbester mayorisbester@greaternapanee.com Cc: Denis Doyle denisdoyle@kos.net Subject: RE: draft documents Hi Kieran, Thanks very much for sending along these drafts. I think this proposal fits well with the provincial government’s roadmap for reopening Ontario announced yesterday. I’d like to offer three suggestions for your consideration, and for Warden Isbester and Warden Smith to consider as well.
- I think it would be a strong statement if this letter was co-signed by myself, Warden Isbester and Warden Smith. That would show the strong partnership between the municipalities and public health in KFL&A.
- I would recommend some language in the letter that makes the case for a regional approach. We demonstrate that we are capable of a strong regional approach, but it would be great if we can explain to the province why it it is in their interest to allow a regional approach. I think we could leave it open to discussion for what a regional approach should be (for example, perhaps all of southeastern Ontario as one of 4 or 5 sub regions in the province?) If everyone else is in agreement, I would suggest we also copy AMO on this letter. AMO is a consistent champion of regional approaches with the province. Their mantra is consistently that the province cannot apply a one size fits all approach.
- If everyone is agreeable to this letter, I would say the political timing is perfect if we can send this letter out this week. I guess I feel our best chance to influence decision making at the provincial level is right now. Anyway I offer all of this input for your consideration and I would welcome feedback from all of you. Thanks and have a great day, Bryan.
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[please format addresses as per our usual style –] MINISTRY x 2 and others? Dr. Kieran Moore, MOH, KFL&A Public Health 221 Portsmouth Avenue Kingston, ON K7M 1V5 Re: Learning the new normal: balancing a public health and socioeconomic approach for lifting restrictions at the regional level in Ontario. Dear Ministers [insert who this goes to], The epidemiological models the Government of Ontario released on April 20th, 2020, showed the province may have hit the peak of the first wave of new community spread cases of COVID-19 and demonstrates the emergency response measures were effective. Instead, community spread is slowing, and, in some parts of the province, remains limited. It is sobering that the spread in long-term care settings is growing, pointing to the necessity of remaining vigilant in high-risk settings and maintaining enhanced public health measures. At the same time, the gravity and impact on socioeconomic health cannot be ignored. Consequently, the original short-term goals of reducing the number of deaths and flattening the curve must be expanded to include strategies not only to improve socioeconomic activities, but also to inject hope into the hearts of Ontarians for the long term while balancing population health needs. Decisions about where and when to lift restrictions must be evidence based, data driven and applied incrementally, using a phased approach being sure to implement changes that are proportional to risk. To that end, we have enclosed a briefing note and drafted checklist criteria for moving through a gradual ease of restrictions, balancing both health and socioeconomic outcomes over the long term. In our current situation, the long term means until such time that a vaccine or effective treatment for COVID19 is made available or that national population immunity reaches a documented level of 70% or more. We propose easing public health restrictions at a regional, as opposed to a provincial level in a coordinated balanced approach. Ontario is uniquely positioned to implement innovative strategies for lifting restrictions as local public health agencies command highly specialized workforces within established, localized, geographical boundaries. The regionalized workforce is well supported by cooperative advisory networks from across the province and Public Health Ontario. Just as the implementation of municipal emergency response measures corresponded to regional surveillance indicators of community spread, so too could a phased approach to ease restrictions. A localized approach will permit close monitoring in community context, matched with community capacity to mitigate consequences. A localized approach enables real-time
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evaluation activities at a smaller, more nimble scale. In turn, with regional evaluation measures in place, we will collect rapid feedback related to specific easing activities and inform risk assessments. A localized approach will accelerate research and knowledge sharing in order to tailor actions to other jurisdictions and/or scale up full policy responses at a provincial level. There is no risk-free way to move forward. Swift and decisive actions of pubic health have made a difference to the shape of the curve we are driving. We must be equally prepared to manage our defenses against COVID-19 in the long term. A regionalized approach will provide Ontarians with a road map so that responsibilities are clear at individual and community levels. A regionalized approach, coordinated in cooperation with the provincial strategy, will support the easing of restrictions systematically for the continuance. Most importantly, a regionalized approach will provide Ontarians with the courage and faith to follow public health measures for the duration of the long term. Dr. Kieran Moore, Medical Officer of Health (please insert regular byline info here]
CC List: Chief Medical Officer of Health Public Health Ontario
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