By Sue Tiffin
While confirmed cases of COVID-19 have remained low in Haliburton County, with 19 cases having been reported resolved since the pandemic was declared in March, Haliburton Highlands Healthcare Services teams have been working on pandemic response strategies on a daily basis, and planning for potential increases in community prevalence, surges and outbreaks as record numbers of infection are announced daily, according to a report from HHHS CEO Carolyn Plummer, which she presented at a board meeting held virtually on Oct. 29.

“We’re right in the middle of what seems to be a growing second wave, although hopefully things are levelling off, we have been seeing record-high numbers of new COVID cases across the province, as everyone I’m sure is aware, over the past few days,” said Plummer.
As the second wave of the pandemic in Ontario sees rising cases of COVID-19 across the province, HHHS has several increasing concerns.
“The first being hospital capacity, with the increasing number of hospitalizations related to COVID over the last few days, and weeks, we’re starting to see some hospital capacity issues across the province and a little bit regionally, but not in crisis situation quite yet here. We’ve also been seeing increases in ICU admissions across the province. This is happening particularly in the hospitals in the hotspot areas, but it does have the potential to have a ripple effect out to some of the more regional hospitals, and the ripple effects even to our hospitals. So we are continuing to monitor the situation every day and plan for potential surges in patient volumes as well as the potential for an increase in our community prevalence of cases here, and the effect that might have on our hospital services as well as our staff and our ability to staff the hospital.”

Plummer said one of the concerns was the possibility that, as hospitals were dealing with outbreaks in several hospitals in the Greater Toronto Area as well as the potential for flu season causing surges in hospital capacity, elective surgeries and other procedures might be paused again as they had been earlier in the first part of the pandemic.
“Hopefully that won’t happen but it’s certainly a risk as we see a rise in those hospital capacity numbers,” she said.
The other major concern for HHHS is related to the growing number of COVID-19 outbreaks in long-term care facilities.
“We have seen an increase in the number of long-term care homes provincially that have gone into outbreak, most of them in the hotspot areas, but still very concerning that that is still happening,” said Plummer. “We’ve been of course maintaining strict vigilance with all of the precautions we’ve put into place to try to ensure we keep folks as safe as we can possibly keep them here at HHHS. But it is a concern for us.”

In her report, Plummer noted the “province is continuing to rely on hospitals to provide Infection Prevention and Control (IPAC) support for LTC homes, and hospitals are continuing to provide staffing and other resources to homes that are experiencing shortages as a result of outbreaks.”
“One of the biggest concerns we have in relation to that is that some of the hotspot areas, when they get into staffing crisis, are relying on hospitals to provide staffing for long-term care homes,” Plummer said during the board meeting. “At least one of our regional partner hospitals has had to send staff out to a couple of the LTC homes in hotspot areas to help with their staffing crises. As we see our regional partners do that, that raises concerns about their ability to help out at our organization if we were to run into a staffing crisis. Again, we’re watching that very closely. Our partners are aware of our situation as a small hospital. We have had great success recruiting people over the last several months however we are still in a situation where it wouldn’t take much for us to move into a staffing crisis if we were to see an outbreak locally.”
She noted that HHHS teams were working on planning strategy and reprising plans, adding that it “seems like pretty much every day there’s a revision to our plans.”  

Long-term care facilities remain COVID-free
HHHS staff continues to closely monitor the second wave of COVID-19 and evaluate the various safety measures put in place to keep long-term care residents, staff and visitors safe.
“We continue to have ongoing concerns about the rising number of long-term care home outbreaks in the province, and the possibility of an outbreak locally,” said Plummer in her report. “If an outbreak was to occur, our rural location puts us in a vulnerable position due to our limited staff availability and limited external resources upon which to rely for help.”

Locally, HHHS manages Hyland Crest in Minden, and Highland Wood in Haliburton.
“The concerns that we have around what we’re seeing in the province with the increased cases in long-term care and the increased number of outbreaks has prompted us to tighten up some of the visiting policies that we had put into place when the province opened visiting back up to long-term care [facilities],” said Plummer. “We have put a few additional restrictions in, just knowing that, because of our small size and our small number of staff, and the challenge of not really having easy access to back-up staffing given the current situation regionally, we have tightened up some of the restrictions.”
With the exception of certain compassionate care situations and essential caregiver visiting, all indoor visits will be restricted to a designated space outside of each LTC home, near the main entrance to each facility, reads the CEO report. Residents may have up to two visitors at a time in the designated area; visitors must attest to having a negative COVID-19 swab within the past 14 days, and they must wear a surgical mask provided by the home during their visit. Alternative methods of visiting via Skype and FaceTime are available.
Essential caregivers are still permitted to enter the home, Plummer said, but they’re restricted to visits with their loved one inside of the resident’s room and not out in the common areas.

One of the biggest risks identified was residents leaving the home’s property for a short stay or temporary absence, reads Plummer’s report. Requests for these absences must be submitted and approved by the home. Residents taking short-term absences for social and other reasons that don’t include an overnight stay, must be actively screened but are not required to be tested or self-isolate, while those absent for one or more nights must be actively screened and self-isolate for 14 days. Residents who leave for medical reasons do not require testing or self-isolation upon their return, with additional steps for the facility to follow upon their return if the resident is admitted to hospital. Individuals accompanying residents are instructed to comply with provincial guidelines regarding social circles, hygiene and PPE, but the ministry does not currently require them to attest to having a negative COVID-19 swab within the past 14 days.

“We are committed to keeping our residents safe, and are actively advocating our concerns to the Ministry of Long Term Care,” said Plummer in her report. “In order to protect our vulnerable residents, even before a large prevalence of COVID-19 is seen in our community, we have been working closely with the Ministry and with Public Health, and are taking proactive actions to reduce the risk of our residents and staff contracting COVID-19.”
Similar to other long-term care facilities throughout the province, HHHS staff are tested for COVID-19 every two weeks.

Haliburton County holding steady at 19 cases
Plummer told the board there had been “a little bit of a spike,” over the month since the last meeting, with an additional four cases added in the county.
“Percentage wise it’s a bit of an increase but number wise the cases here do remain low,” she said.
Her report noted the importance of remaining vigilant in part due to the concerns faced by the HHHS teams.
“All of what’s going on in the rest of the province is a huge reminder for everyone I think that, exhausted as we all may be and as frustrated as we all may be, with all of the precautions and the way that life has changed, we do still need to maintain that vigilance in order to get through,” she told board members. “Lots of people talk about this being like a marathon, we were quick out of the gate at the beginning but we’ve reached that wall part-way through the marathon where we’re getting tired, and we have to work through that tiredness and keep on going to reach the finish line, and I think that’s a good metaphor for how things feel right now.”