By Kaitlyn Clark
The Haldimand Press
HALDIMAND—Cases of COVID-19, also known as novel coronavirus 2019, are on the rise in Haldimand and Norfolk counties. HN Medical Officer of Health, Dr. Shanker Nesathurai, expects the region will continue to see an increase in cases similar to the rest of the province.
“My assessment is that we’ll see many more cases and we’ll have more deaths as we progress through the pandemic,” said Nesathurai on April 1. “The data changes almost every hour…. With the doubling time of COVID about every three days, and the long latency between when someone can get infected and actually present with symptoms, I would estimate there are many, many multiples of people that are currently infected than the (confirmed) cases would represent.”
April 6 Haldimand Norfolk Health Unit (HNHU) was able to confirm 81 positive cases, including five deaths and seven recoveries. April 7 HNHU reported 109 confirmed cases, including six deaths and 11 recoveries.
“To place this in context, the vast majority of people who have COVID-19 have mild to moderate symptoms. They will get better at home with supportive treatment. A smaller group will be admitted to the hospital, and a smaller group will require care in an intensive care unit, and some of them will ultimately succumb to COVID-19,” continued Nesathurai. “The people that are most at risk are elderly and those with concurrent medical problems, and that is the group that we’re doing our best to provide a public health management program for.”
As of April 6, Anson Place long-term care home (LTC) and retirement home outbreak had 39 positive cases among residents (27 in LTC and 12 in the retirement home) and 22 staff having tested positive. Among seven recent resident deaths, five had been confirmed to be related to COVID-19. HNHU noted that, as part of its public health management plan, “residents are in self-isolation in their rooms, and staff are wearing full personal protective equipment (PPE) to protect themselves and residents and prevent the spread of the virus.”
Any staff that have tested positive are not working at the facility. Thirty-five staff tested negative and continue to work, but “as an additional measure, all staff who are caring for residents at Anson Place are also in self-isolation, with the exception that they may travel to and from work at the facility”, said HNHU. Speaking on these measures, Nesathurai said he believes it is a “robust public health management plan … that will be an effective strategy” to end the outbreak. The remaining staff are reported to be working additional hours and a recruitment campaign is ongoing at the home to bring in new volunteers and temporary employees to fill the gaps left by staff who have contracted COVID-19.
HNHU also reported “that a significant number of positive cases at Anson Place can be traced to attendance at a funeral”, and they are addressing this information by testing attendees and formulating self-isolation plans as appropriate for the under 100 attendees. Nesathurai noted that they can’t be certain which direction the virus may have travelled, such as whether an attendee from Anson Place brought it to the funeral or if an attendee of the funeral brought it back to Anson Place. However, he said that knowing these links exist at all helps them “to manage the situation more assertively. When we know of a cluster, we can be more assertive in contacting people involved.”
HNHU is not releasing specifics of the funeral in order to protect patient privacy. Nesathurai noted that the remainder of cases outside of Anson Place are spread among the region, and as of April 6 they could not see any other clusters.
Norview Lodge in Simcoe has had one non-clinical staff member test positive, who is in self-isolation at home. As of publication, no residents have tested positive, but the home is following the public health management plan by isolating residents in their rooms and having staff wear PPE to minimize the risk of transmission. While Anson Place residents are eating meals in their rooms, Norview Lodge is continuing to bring residents to a central dining hall; however, those residents are being kept at a distance from each other when dining.
Nesathurai pressed the importance of minimizing risk to the elderly and urged them to voluntarily self-isolate: “There are about 25,000 people in this health district who are over the age of 70. It’s a large population…. One of our strategies is to encourage elderly people to live at home and self-isolate.”
He added that it is important to ensure those who are self-isolating have access to food and other supplies, along with socialization, but this should not include in-person visits. Supplies should be dropped off at the door, and socialization should be done over the phone or through other technologies.
A look at local hospitals
During interviews with Nesathurai, questions were raised on the ability of local hospitals to handle the pandemic. It was noted that there are about eight ventilators to service the region, which Nesathurai said was “a fair estimate”. He added that other machines can be used in a time of shortage to ventilate patients, and that the Province and both Haldimand and Norfolk counties are in the process of improving ventilator access. He said that ventilators are only needed for the “most ill patients”, which are often those who are already “frail, elderly, in the twilight of their life”, and that “independent of COVID” they should consider what their wishes are when it comes to ventilation, as they may still “succumb on a ventilator, and those who recover are in for a long recovery.”
“A ventilator in itself is not a treatment. You require all the professional staff – the nurses, the intensive care physicians, the respiratory therapist – (along with) the physical space, the PPE, and all of those are areas where there are potential lack of supplies,” said Nesathurai.
West Haldimand General Hospital (WHGH) noted that it has a working arrangement with Norfolk General Hospital (NGH) for patients requiring intensive care, such as those requiring use of a ventilator. The decision on whether or not to transfer a patient will be made through discussions between physicians at the two hospitals.
Haldimand War Memorial Hospital (HWMH) has made an arrangement with the Niagara health system, as they do not have any intensive care beds. Therefore, they are currently transferring all patients that test positive for COVID-19 to other hospitals in Niagara. However, the hospital is still working to discharge patients who are able to return home or be admitted to a long-term or interim care bed “in an effort to free up beds for possible future COVID-19 patients”, said an April 6 release. As of press time, two patients have tested positive at HWMH, one of whom was admitted and transferred elsewhere. These numbers were not provided by WHGH as of press time.
A drive-thru testing centre has been set up at WHGH, which is by appointment only. Haldimand has also set up an interim hospital at the Dunnville Memorial Arena if needed; Kyra Hayes, Supervisor of Corporate Affairs at Haldimand, stated, “The intent is that if needed, the Dunnville Arena would be used for non-COVID-19 patients to free up space in local hospital ERs. That being said, the County is prepared to adjust/adapt as directed.”
When asked about supply levels, Tom Thomson, Interim President and CEO of WHGH and NGH, stated, “What we’re finding is that, because of the worldwide shortage, supplies are low. We’re concentrating on conservation of supplies through risk assessment to determine the appropriate PPE for the circumstance and role.”
Thomson noted that staff safety is paramount in conservation efforts and they are particularly in need of N95 and surgical masks. Penny Banks, West Haldimand Hospital and Healthcare Foundation Director, listed other needed supplies: eye goggles, gloves, gowns, coveralls, face shields, protective eye glasses, booties, hand sanitizer, disinfectant, wipes, baby monitors, commodes, wheelchairs, basins, unused urinals, and unused briefs. They are unable to accept hand-made PPE. Those with items to donate can call 905-768-3111 ext. 1236 or email penny.banks@whgh.ca to discuss donation.
“Thank you to the community for all the support you have provided so far,” said Thomson.
HWMH is also accepting donations of masks, gloves, and baby monitors. Contact Jessica Gordon at 905-774-7431 ext. 1227 or jgordon@hwmh.ca to discuss physical donations. Monetary donations can also be made to the hospital’s foundation, which will be used for equipment and supplies, along with food for frontline workers. Call 905-774-2529 or visit dhhf.ca for information.
As of April 6, HWMH reported that both they and Edgewater Gardens “have adequate PPE supplies to last into next week”.
“We are a small and mighty team, and everyone here has had to completely redesign the hospital in a two-week period,” said HWMH Interim President and CEO Sharon Moore. “I’m so grateful for the dedicated and tireless work of our staff to ensure the safety of our patients, residents, staff, physicians, and the wider community.”
Increasing restrictions to slow spread
Both the local Medical Officer of Health and the Province have added or increased temporary orders that are designed to limit the transmission of COVID-19, including restricting the gathering of any groups to less than five people and the closure of additional non-essential businesses. Locally, short-term rentals of rooms, cottages, or recreational vehicles is also prohibited to discourage non-essential visits to the region.
“I recognize Haldimand County and Norfolk County are popular tourist destinations. However, we are in extraordinary times. In the context of the rapid increase in cases and resultant deaths, it is essential to reduce unnecessary travel,” said Nesathurai. “If you don’t have a compelling reason to visit – don’t visit. If your primary residence is in another city, don’t come to your summer home or cottage. It (travelling between regions) only contributes to the spread.”
Ontario ordered the closure of all outdoor recreational facilities, including sports fields, pavilions, skate parks, beaches, piers, docks, etc. While Nesathurai said it is “perfectly fine” for those who are not self-isolating to take a walk or ride their bike, they should not be attending the closed recreational facilities and should not be congregating with people they do not live with, even if they stay six feet apart. He added that “it’s different for people who are self-isolating”, who are not allowed to leave their homes for any reason, which he admits “is hard”.
Ontario also extended the closure of public schools to May 4, and Grand Erie District School Board has announced the cancellation of all extra-curriculars, events, and field trips for the remainder of the school year.
Additionally, along with Nesathurai instituting a required 14-day isolation for migrant farm workers entering Haldimand from other countries and limiting the number of farm workers who may live in a bunk house to three, every farm in the region must create a farm-specific plan and have it reviewed prior to the arrival of any migrant workers.
“We want to support agriculture because food is also a priority,” said Nesathurai. “Migrant workers are particularly difficult because you potentially have a large number in one facility with a shared bathroom and kitchen, like a college dormitory.”
“I’m concerned that unless we take these assertive measures the plan will not be successful,” he added. “If there was an outbreak on a farm, if you had a bunkhouse with 50 people, more than likely every one of those workers would be quarantined for at least 14 days. It could be very averse to the function of an agricultural enterprise. Secondly, considering the chain of transmission, many farmers have multi-generational homes…. If we don’t have excellent self-isolation plans the chain of transmission could affect entire families.”
Enforcement of new regulations
HNHU has launched a hotline to report people who are not following the orders currently in place, which received over 300 calls in one week. Nesathurai said that the first step is always to contact those involved to “remind them gently of the requirements”, but that repeated offences will be met with penalties if required. Local orders carry a fine of up to $5,000 for every day that the violation occurs. Provincially, violations can carry punishments of up to one year in jail or a fine of up to $100,000 for an individual, $500,000 for a director of a corporation, or $10 million for a corporation itself. Additionally, the Province now requires those being charged with an offence under the Emergency Management and Civil Protection Act to identify themselves if asked by police officers or by-law enforcement officers; failure to do so carries an additional fine of $750.
Both Norfolk and Haldimand counties are increasing their by-law control enforcement capacity in response to the new regulations, specifically in “key spots” where high traffic is usually seen, said Matt Terry, Director of Corporate Communications for Norfolk County.
“We’ve increased patrols significantly at the Port Maitland Pier/Esplanade and all parks, especially riverside ones,” said Hayes. “We’ve also re-deployed building inspectors to assist with enforcement.”
“Both Council and staff continue to receive reports of people violating provincial orders and disregarding instructions from public health authorities,” said Haldimand County Mayor Ken Hewitt. “We’ve had to barricade the Port Maitland Pier/Esplanade Park because people just aren’t listening. There is absolutely no excuse for this behaviour and we will be acting within the fullest extent of our authority to penalize violators.”
Ultimately, Nesathurai said the fundamental goal of their public health management plan is to “break the chain of transmission, and that is why we’re making these very assertive measures.” However, public health cannot succeed in this alone: “We need the support of the people that we serve…. We have to work together to get a better control of COVID-19.”
The information provided is accurate as of press time. For updates, check below or visit haldimandpress.com/covid-19 or follow The Haldimand Press on social media.
Updates
Anson Place Numbers – 04.07.2020
“A total of 42 residents in our long-term care and retirement homes have been diagnosed with COVID-19,” said Executive Director Lisa Roth in an email to CTV News. “22 staff have also tested positive for COVID-19 and are off work.”
Confirmed COVID-19 Cases for Haldimand-Norfolk – 04.08.2020
Lab-confirmed, negative cases: 402
Lab-confirmed, positive cases: 110
Recovered: 11
Deaths: 6
Anson Place Numbers – 04.09.2020
From HNHU: “42 residents have tested positive with COVID-19, and nine residents have unfortunately died. 28 staff members have tested positive, and 52 have tested negative.”
Anson Place Numbers – 04.11.2020
The Haldimand Norfolk Health Unit, in collaboration with Anson Place staff, continue to take steps to contain the COVID-19 outbreak. Anson place is a both a long-term care facility and retirement home.
As of April 11, the facility reported that 51 of its residents had tested positive for COVID-19. Thirteen residents had died.
Thirty staff have also tested positive for COVID-19. These individuals are not working at the facility.
As part of the Health Unit’s public health management plan, residents are in self-isolation in their rooms, and staff are wearing full personal protective equipment to prevent the transmission of COVID-19. All staff who are caring for residents at Anson Place are in self-isolation, with the exception that they may travel to and from work at the facility.
