VANCOUVER — Testing patients for COVID-19 before their scheduled surgery and transfer to wards from emergency departments could reduce hospital outbreaks in British Columbia as cases rise, the results of a pilot project in the province’s largest health authority suggest.
Fraser Health said that out of 5,681 patients who were booked for surgery, 65 tested positive for the virus but had no symptoms and would not have warranted a test based on a screening questionnaire. Of 2,969 patients booked for elective surgery, 11 were infected with the virus but were asymptomatic.
“Unidentified COVID-19 cases can lead to transmission and contribute to outbreaks,” the health authority says about its enhanced testing in a memo to staff.
Testing began in mid-November over three weeks for surgical patients and four weeks for patients who had been in emergency rooms.
“The triggers that led to the evaluation were two or more COVID-19 outbreaks in acute care and a testing positivity rate greater than five per cent. Both of these conditions still exist within Fraser Health,” the memo says, adding the health authority has continued testing for the virus.
The positivity rate, or the percentage of all COVID-19 tests performed that show infection, was 9.6 per cent when testing began in Fraser Health and is now at eight per cent, data from the BC Centre for Disease Control show.
The Northern Health Authority’s positivity rate shot to 16 per cent from 0.5 per cent in October, according to the centre’s data, which also show the Interior Health region’s rate has risen to 8.3 per cent, from a low of 1.7 per cent in November.
In the Vancouver Coastal region, the positivity rate is 5.2 per cent, from a low of 0.4 per cent in June. The Vancouver Island health region’s positivity rate is the lowest in the province, at just under three per cent.
In November, more than 500 doctors and nurses across B.C. sent a letter to provincial health officer Dr. Bonnie Henry and Health Minister Adrian Dix saying routine testing should be done at all acute-care centres because screening for symptoms was no longer sufficient in the second wave of the pandemic.
“Based on rising prevalence, we request an urgent reassessment of the issue of preoperative testing for surgical patients to ensure we prioritize the safety of our patients and maintain current levels of surgical productivity,” the letter says of the screening protocol put in place in May.
It says screening questionnaires don’t adequately identify risks for COVID-19 infection because they rely on patients to truthfully disclose all symptoms and some people arrive in hospital with symptoms, delaying surgery and putting others, including staff, at risk.
Henry said Monday that 10 facilities were currently experiencing outbreaks, affecting 1,364 residents and 669 staff.
They include two units at St. Paul’s Hospital in Vancouver, as well as the Cardiac Care Intensive Care Unit, all of which are closed to new admissions and transfers.
Seven patients and seven staff have tested positive for COVID-19 from that outbreak, Vancouver Coastal Health said.
Henry acknowledged Monday that Fraser Health is testing patients because of its high positivity rate and that Northern Health “has had a very challenging few months.”
However, she suggested there is not a need for more widespread testing of patients before scheduled surgeries or admission to hospital from emergency departments.
Dr. Shannon Lockhart, a Vancouver anesthesiologist who is among the physicians who signed the letter to Henry and Dix, said physical distancing isn’t always possible in hospitals and there are multiple reasons why patients may not be able to wear a mask, especially when a breathing tube is removed after general anesthetic and they may cough, raising the risk of transmission.
Health-care workers who constantly put on and take off personal protective equipment over long shifts are prone to make mistakes, creating further risk, Lockhart said.
“These constraints increase the risk for infections to become super-spreading events as we’ve seen in some of the hospital outbreaks,” she said, adding recent studies from around the world show that surgical patients with COVID-19 are at greater risk of death.
Parts of Ontario and Nova Scotia require patients to be tested for COVID-19 several days before their scheduled surgery.
This report by The Canadian Press was first published Jan. 13, 2021.
Camille Bains, The Canadian Press
Manitoba mulls easing retail and gathering restrictions for all but northern region – CBC.ca
Many Manitobans could soon have a small number of friends and family over to their properties and shop for anything they want at a store after enduring two months of the toughest lockdown since the start of the pandemic.
The province released a range of options it’s considering for private gatherings and the reopening of stores for all regions except the hard-hit north.
“The actions and hard work and sacrifices of Manitobans has continued to make a difference,” said Dr. Brent Roussin, Manitoba’s Chief Provincial Public Health Officer. “Overall our numbers are headed in a good direction, and that means that we can start looking at what a reopening might look like.”
The current household orders could be loosened to allow two additional people, family or friends, to visit a household, outdoor visits of up to five people in addition to members of the household on private property, and funerals up to 10 people, plus an officiant.
All stores could be allowed to re-open, as long as they maintain physical distancing and occupancy limits of 25 per cent up to a maximum of of 250 people. Eliminating the list of restricted non-essential items is also floated.
Non regulated-health services such as podiatrists and reflexologists, as well as personal services such as barber shops and hair stylists, could reopen as long as they also follow health precautions.
The relaxed orders, which are merely proposals at this point, could come into effect as soon as 12:01 a.m. on Saturday, when the current public health restrictions expire, and last three weeks.
Roussin stressed that the province is taking a “cautious approach,” saying that the more interactions people have, the more opportunity the virus that causes COVID-19 has to transmit. Manitoba case numbers began to increase sharply in late October and November, despite some health restrictions in place at the time, and Roussin said he doesn’t want to see that happen again.
“We don’t want to go back and forth. We want to have a slow cautious approach so that we can continue reopening over time and not have to go back and close certain things again.”
The proposed changes don’t include reopening businesses like restaurants or gyms. The reason stores are allowed to reopen, but not restaurants, is due to the fact people go in and out of stores without remaining in close contact for a long time, Roussin said.
“In restaurants, this is prolonged, indoor contact. So we know that this adds to the risk,” he said.
Winnipeg and several surrounding communities moved to the red level — the highest level on the province’s pandemic response system — on Nov. 2, and the rest of the province followed on Nov. 12.
Restrictions tightened further on Nov. 20, when the province reduced the number of household visitors allowed in most cases to zero and imposed an outright ban on the sale of non-essential items in stores.
The province says its options for relaxing restrictions were informed by a survey that received 67,500 responses between Friday and Monday. Manitobans are asked to provide feedback on on their preferences through the engagemb.ca website.
The proposed changes to Manitoba's code red restrictions – CTV News Winnipeg
Manitoba is proposing changes to the current code red restrictions, which may allow some friends and family to visit in homes, allow more stores in the province to reopen, and could allow Manitobans to get a haircut – but not all of Manitoba can expect to see relaxed restrictions.
Manitoba’s top doctor said the proposed changes, which were released Tuesday morning, would balance the needs of the health-care system and the economy, but protect Manitobans at the same time.
“Certainly, the overall theme is a cautious approach,” Dr. Brent Roussin, Manitoba’s chief public health officer. “We don’t want to go back and forth. We want to have a slow, cautious approach so we can continue reopening over time and not have to go back and close certain things again.”
More than 67,500 people completed the provincial survey on health orders over the past four days. The province said the feedback from this survey helped shape the proposed changes to the code red restrictions.
Roussin said the province is considering easing restrictions around three specific areas in this next round of health orders.
VISITING IN HOMES
Under the current public health orders, which are set to expire on Friday, Jan. 22, visitors to private residences are currently restricted, with the exception of support people, trades workers, and limited visitors for people who live alone.
The province proposed – for the sake of the personal connections and well-being of Manitobans – to allow two people, either friends or family, to visit a home. Roussin said this would mean any two people would be able to visit at one time.
“We want that messaging to be clear that these are close family members, close friends that you need that connection with,” Roussin said. “We still want to limit the amount of contacts we have.”
It would allow up to five people, plus household members, to visit outdoors on private property.
The province said 77 per cent of the people surveyed said the ability to gather with people outside their homes was important. Roussin said there is a concern that the eased restriction could lead to larger gatherings.
“A lot of this is going to depend on Manitobans’ actions. If we start seeing transmission of that virus again, we are not going to be able to further reopen,” Roussin said. “No matter what restrictions we have in place, it really comes down to Manitobans adhering to our public health messaging.”
The proposed changes could also see funerals allow up to 10 people in addition to the officiant.
SHOPPING IN STORES AND GETTING A HAIR CUT
The province is also proposing changes to retail sales, allowing stores to open with no restrictions in place on what they can sell. The physical distancing limits and occupancy limits would remain in place, and will still be enforced.
The province said 74 per cent of the people surveyed saw the ability to shop without any limitations as a priority.
The proposed changes also suggest barbershops and hairstylists can reopen at 25 per cent capacity, though they would be required to collect information for contact tracing – something 70 per cent of the people surveyed said they saw as being important.
Non-regulated health services, such as podiatrists and reflexologists, may also be allowed to open, though they too would be required to follow physical distancing and collect information for contact tracing.
Roussin said there are no proposed changes to restaurants – which are not allowed to open for in-person dining. He said people sitting and eating together might pose a greater risk of transmission.
There are no proposed changes to the restrictions on recreational and organized sports, gyms and fitness centres, places of worship, tattoo parlours, and nail salons.
“We can’t open everything at once,” he said. “There will be an end to this pandemic. We just have to ensure that we are reopening things in a very safe and cautious manner so that we can be ready for that end.”
NOT ALL OF MANITOBA TO SEE EASED RESTRICTIONS
While regions including Winnipeg, Southern Health, Interlake-Eastern, and Prairie Mountain Health are expected to see some restrictions eased when health orders expire on Friday, Roussin said the Northern Health Region is likely going to remain under the strict code red restrictions given the high case count.
As of Tuesday, the region had 1,459 active cases of COVID-19 – the highest of any region in the province.
Roussin said the proposed changes outlined are only considerations at this point. He said the province will make the final decision on the health orders later this week and will release more details on Thursday. The new health orders are set to take effect on Saturday.
He said this next round of health orders will likely be in place for three weeks.
Manitobans can submit their feedback on the proposed changes by visiting EngageMB.ca.
News Releases | COVID-19 Bulletin #319 – news.gov.mb.ca
Need More Info?
Public information, contact Manitoba Government Inquiry: 1-866-626-4862 or 204-945-3744.
Media requests for general information, contact Communications Services Manitoba: 204-945-3765.
Media requests for ministerial comment, contact Communications and Stakeholder Relations: 204-794-0732.
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