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Discussion Panel

Brian QuinnNurse Senior

EpidemiologistNorthern Population

Health Unit

Teddy ClarkeChief of Clearwater River

Dene Nation

Dr. James IrvineConsultant Medical

Health Officer, Northern Population

Health Unit

Jennifer AhenakewExecutive Director of

Primary Health Care, NNW,

SHA

Leonard MontgrandMétis Nation of

Saskatchewan, Area Director

Dr Moliehi KhaketlaMedical Health OfficerNorthern Population

Health Unit

Dr. Nnamdi NdubukaMedical Health OfficerNorthern Inter-Tribal

Health Authority

Dr. Rim ZayedMedical Health OfficerNorthern Population

Health Unit

Robert St. PierreMayor of La Loche

Jennifer ZelmerCEO, Canadian Foundation for

Healthcare Improvement

Saskatchewan Northwest North Outbreak - Lessons

Learned

June 29, 2020

COVID-19

saskatchewan.ca/COVID19


VISION

Healthy People, Healthy Saskatchewan

MISSION

We work together to improve health and well-being. Every day. For everyone.

VALUES

• SAFETY: Be aware. Commit to physical, psychological, social, cultural and environmental safety. Every day. For everyone.

• ACCOUNTABILITY: Be responsible. Own each action and decision. Be transparent and have courage to speak up.

• RESPECT: Be kind. Honour diversity with dignity and empathy. Value each person as an individual.

• COLLABORATION: Be better together. Include and acknowledge the contributions of employees, physicians, patients, families and partners.

• COMPASSION: Be caring. Practice empathy. Listen actively to understand each other’s experiences.

PHILOSOPHY OF CARE: Our commitment to a philosophy of Patient and Family Centred Care is at the heart of everything we do and provides the foundation of our values.

3


Northern Saskatchewan Administrative District

850 kilometers north of Regina

Northern Village of LaLoche – Dene / Métis population of about 3200

Clearwater River Dene First Nation - population 1039 – 10 km from La Loche

Denesuline language spoken by 89% of residents

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• La Loche, Sask, was incorporated as a northern village in 1983, with a population of around 2600 people.

• The Northern Village of La Loche lies on the eastern shore of Lac La Loche in northwestern Saskatchewan near the Saskatchewan-Alberta border.

• The settlement of La Loche dates back to at least the fur trade and Peter Pond’s "discovery" in 1778 of the Portage La Loche or Methye Portage, which crosses the height of land between the Hudson Bay and Arctic Ocean drainage basins. The MethyePortage played a significant role in the Canadian Economy.

• As a result of this, the people of La Loche have experienced a long history of colonization that resulted in intergenerational trauma which is still felt today and exhibited in the high rates of mental health and substance use in the community.

La Loche

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Clearwater River Dene Nation

• Bordering La Loche to the north and reached via Highway 955 is the Clearwater River Dene Nation (CRDN) with a population of 1039 people (on-reserve).

• The La Loche/CRDN population centre with about 4,000 people represents about 30 percent of the Denesuline speakers of Canada. The Denesulinelanguage is spoken by 89% of the residents.

• Originally from Fort McMurray area people and our treaty was signed in Fort McMurray in 1899. Back then people migrated along the Clearwater River, Christina River to Garson lake and to La Loche. CRDN didn’t receive it’s land until 1970. It’s was known as Portage La Loche Band later the name was changed to the Big C Band after years of negotiations to do a land transfer to be closer to modern amenities.

• In the early 1990s the bands name was changed to Clearwater River Dene Nation which really represented our history.

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Self Reported Indigenous Communities

7


Median After Tax Incomes

8


Crowding – Private Households With More Than One Person

9


Alcohol Related Hospitalizations

10


The La Loche Health Centre has 9 beds in Acute Care, 5 Long Term Care beds and 2 Alternate Level of Care beds.

The Emergency Room runs 24/7, with Emergency Medical Services and Emergency Air Medivac and ground transport.

Northern Medical Services contracts 9 Physicians covering 3.5FTE (4.0 during COVID-19 pandemic) and coordinates the delivery of specialist services (Psychiatry, Orthopedics, ENT, GI, etc.) through remote and in person consultations.

La Loche Health Centre

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IHICC -Commander

TBC

Logistics Chief

TBC

Supply Chain

TBC

Digital Health

TBC

Planning Chief

TBC

HR

TBC

Provincial Program/IIS

Directors

Finance Chief

TBC

Operations Chief

TBC

HR

TBC

PHC

Acute Services

Continuing Care

IIS

Directors

Physician Services

ACOS leads

Provincial Programs

Directors

Liaison Officer

TBC

Communications Officer

TBC

Documentation Aide

TBC

EOC Manager

TBC

Safety Officer

TBC

Medical Health Officer

TBC

IHICC -Commander

TBC

Logistics Chief

TBC

Supply Chain

TBC

Digital Health

TBC

Planning Chief

TBC

HR

TBC


Directors

Finance Chief

TBC

Operations Chief

TBC

HR

TBC

PHC

Acute Services

Continuing Care

IIS

Directors

Physician Services

ACOS leads

Provincial Programs

Directors

Liaison Officer

TBC


TBC

Documentation Aide

TBC

EOC Manager

TBC

Safety Officer

TBC


TBC

EOC Commande

r

Derek Miller

Logistics Chief

Shane MerrimanSupply

Chain

Colin KarstDigital Health

Chad Freeman

Planning Chief

Brent KitchenHR

Kevin Zimmerma

n

Pandemic Plan Annex

Leads

Provincial Program/II

S

EDs

Finance Chief

Ken Unger

Operations Chief

John Ash

HR

Blake McMullen

IHICC –Saskatoon

Suzanne MahaffeyIHICC –

Regina

Sheila Anderson

IHICC –North

Pam McKay or

Jennifer Ahenakew

IHICC –Rural

Jeannie Munro or

Jacquie Holzmann

811 Healthline

Rod McKenzie

Physician Services

Rob Gentes

ACOS lead

Liaison Officer

Jocelyn Bishoff


Kim McKechne

y

Documentation Aide

Tamara Bond

EOC Manager

Luiza Kent-SmithSafety

Officer

Cynthia Leschyshyn


Dr Julie Kryzanows

ki Provincial EOC (Government wide)

Health EOC (Ministry of Health)

EOC Command

er

Derek Miller

Logistics Chief

Shane MerrimanSupply

Chain

Colin KarstDigital Health

Chad Freeman

Planning Chief

Brent KitchenHR

Kevin Zimmerma

n

Pandemic Plan Annex

Leads

Provincial Program/II

S

EDs

Finance Chief

Ken Unger

Operations Chief

John Ash

HR

Blake McMullen

IHICC –Saskatoon

Suzanne MahaffeyIHICC –

Regina

Sheila Anderson

IHICC –North

Pam McKay or

Jennifer Ahenakew

IHICC –Rural

Jeannie Munro or

Jacquie Holzmann

811 Healthline

Rod McKenzie

Physician Services

Rob Gentes

ACOS lead

Liaison Officer

Jocelyn Bishoff


Kim McKechne

y

Documentation Aide

Tamara Bond

EOC Manager

Luiza Kent-SmithSafety

Officer

Cynthia Leschyshyn


Dr Julie Kryzanows

ki

IHICC -Commander

TBC

Logistics Chief

TBC

Supply Chain

TBC

Digital Health

TBC

Planning Chief

TBC

HR

TBC


Directors

Finance Chief

TBC

Operations Chief

TBC

HR

TBC

PHC

Acute Services

Continuing Care

IIS

Directors

Physician Services

ACOS leads

Provincial Programs

Directors

Liaison Officer

TBC


TBC

Documentation Aide

TBC

EOC Manager

TBC

Safety Officer

TBC


TBC

IHICC - Regina

IHICC -Commander

TBC

Logistics Chief

TBC

Supply Chain

TBC

Digital Health

TBC

Planning Chief

TBC

HR

TBC


Directors

Finance Chief

TBC

Operations Chief

TBC

HR

TBC

PHC

Acute Services

Continuing Care

IIS

Directors

Physician Services

ACOS leads

Provincial Programs

Directors

Liaison Officer

TBC


TBC

Documentation Aide

TBC

EOC Manager

TBC

Safety Officer

TBC


TBC

IHICC - Saskatoon IHICC - North IHICC - Rural

Integrated Health Incident Command

Centres

Cascading Command Structure– COVID -19

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Local EOC

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• Unique collaborative initiative in Saskatchewan - established in 1998• Efficient delivery of population health services across geographic

northern half of province• Provides support, expertise & specialized programming across the north

• Population health promotion • Health protection and disease control • Health surveillance • Emergency preparedness & response• Program planning and evaluation • Research etc.

• Team includes: Medical Health Officers, Epidemiologist, Public Health Nurse Specialists, Public Health Inspectors, Env. Health Protection Coordinator, Public Health Nutritionist, Dental Health Educator, Infection Prevention & Control Practitioner, Population Health Promotion Coordinator and others.

• Work closely with communities, leadership and First Nations partners

Northern SK Population Health Unithttps://populationhealthunit.ca/

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NITHA

33 First Nation Communities

37, 441 on-reserve pop

(INAC 2019)47.5% of SK on-

reserve pop; 3% SK total pop.


The Outbreak

Background

COVID-19


• The first case was confirmed on April 15, 2020, with contact tracing

demonstrating the case was related to an outbreak in Kearle Lake Oil

Sands, north of Fort McMurray

• MHO of the Northern Saskatchewan Population Health Unit led a CD team

to promptly initiate the case investigation

• The index case was a health care worker linked to a Kearle lake case

• Subsequent transmission in the long term care facility and community

First Case

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Long Term Care• The index patient was a health

care worker

• There were 6 LTC patients and 2 respite patients

• 21 HCW were identified as close contacts and were required to isolate for 14 days in addition to being tested for COVID-19.

• The outbreak was declared in LTC on April 17, 2020.

Long Term Care Outbreak

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Precautionary Travel Advisory

Long Term Care Facility Outbreak Declaration GeneXpert in

La Loche Operational Surge

Door-to-Door Active Case Finding

Apr. 18 Apr. 22 Apr 29 May 10-20Apr. 17

Public Health Measures - Milestones

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• Screening of 813 houses in La Loche, Garson Lake, Black Point and Descharme Lake

• The use of GeneXpert was helpful to guide the active case finding

• Household health risk assessment to support vulnerable population

• Working with the community EOC was key to support the isolation requirements

Door to Door Active Case Finding

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Active Cases by Community On and Off Reserve

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COVID-19 Epicurve by Off-Reserve Cluster, April 3 – June 5, 2020

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Door-to-Door Active Case Finding

Clear Water Dene Nation – NITHA

Number %

Number of homes in community 220 -

Number of home visited 213 97%

Individuals offered testing 288 -

Accepted request for testing 141 48.7%

Declined 138 47.9%

Previously tested 5 1.7%

Will get tested 4 1.4%

Tested at home 85 60.3%

Tested at the clinic 56 39.7%

Tested Positive 2 1.4%

Tested Negative 139 98.6%

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Modelling and Effective Reproductive Number

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Far North/Provincial

Effective Reproductive Number

25


Lessons Learned

COVID-19


What Worked well

• Strong collaborative partnerships with the SHA, Community Leadership, Medical Health Officers and local Emergency Operations Centre with additional support from:• Northern Intertribal Health Authority;• Saskatchewan Government Relations;• Saskatchewan Public Safety Agency;• Northwest Regional Emergency Operations Centre• Indigenous Services Canada

• Public Health Interventions: Public Health Orders, community engagement and ongoing communication, assisted self-isolation, enhanced testing, contact tracing and case finding in collaboration with NITHA. Implementation of door to door screening and testing.

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What Worked Well

• Deployment of voluntary staff from across Saskatchewan Health Authority Labour

Pool and Supplementary Workforce.

• Coordinated ongoing communication and education for community members in

English and Dene.

• Implementation of the Managed Alcohol Program in response to COVID-19

outbreak management, in a very short time frame

• Quick mobilization of operations and logistics with strong leadership to monitor

the operations on a daily basis

• Use of Modelling to guide strategic directions and allocation of resources

• Flow of information between different stakeholders

• Financial support from the Metis Nation - Saskatchewan

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What Worked Well

• Check points

• Curfew

• Closure of liquor sales

• Community engagement

• Strong community leadership

• No “cookie-cutter” approach to pandemic response

• Multi-jurisdictional approach

• Communication

• Culturally grounded, strength-based approach to public health measures

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Better If

• Support for Vulnerable Populations and Assisted Self-Isolation was lacking at the

outset

• Lack of PPE, hand sanitizer and disinfectants for community members was an

ongoing challenge.

• Initial communication gaps because of multiple agency involvement caused

challenges in the beginning - this improved throughout experience

• Little known about COVID-19 at the outset and created a lot of fear and anxiety in

the community

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Better If

• Invest in local capacity building to overcome the challenge of limited human

resources

• Develop innovative solutions to chronic problems

• Addressing stigma associated with COVID-19

• Lack of local infrastructure impacted on the ability to respond. i.e. no hotel for

deployed staff in La Loche

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Challenges

• Stigma and discrimination

• Fear and anxiety

• Social determinants of Indigenous Health had major impact on pandemic

response

• Contact tracing and compliance with mandatory isolation

• Sustaining public health measures

32


Next Steps

• Develop a multi-stakeholder taskforce driven by the community.

• Work on challenging community needs for long term objectives across the life span

• Preparing for potential second wave of COVID-19.

33


THANK YOUCOVID-19

Discussion Panel

Brian QuinnNurse Senior

EpidemiologistNorthern Population

Health Unit

Teddy ClarkeChief of Clearwater River

Dene Nation

Dr. James IrvineConsultant Medical

Health Officer, Northern Population

Health Unit

Jennifer AhenakewExecutive Director of

Primary Health Care, NNW,

SHA

Leonard MontgrandMétis Nation of

Saskatchewan, Area Director

Dr Moliehi KhaketlaMedical Health OfficerNorthern Population

Health Unit

Dr. Nnamdi NdubukaMedical Health OfficerNorthern Inter-Tribal

Health Authority

Dr. Rim ZayedMedical Health OfficerNorthern Population

Health Unit

Robert St. PierreMayor of La

Loche

Christine QuinnDirector, Canadian

Foundation for Healthcare Improvement

THANK YOU FOR JOINING US TODAY

[email protected]

mailto:[email protected]

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