Conflict. It’s normal. It’s inevitable. Working through conflict is a skill, learned through knowledge and practice. These courses and resources will assist you in your journey.

Tips and tricks to help cope with life during COVID-19.

COVID-19 Hub: https://covid19hub.nshealth.ca/covid-19

Improving the quality of PCR swabs

When a person receives an indeterminate test result it means that the nasopharyngeal (NP) swab collected/tested did not detect a clear positive OR negative result and it was unable to accurately detect COVID-19. Indeterminate results show up on the COVID results portal.  

An indeterminate result could happen if:

• The person is currently infected with COVID-19 but the test was done too early to detect the virus; or
• The person was recently infected with COVID-19 and the test is detecting small amounts of non-viable (dead) virus; or
• There was a problem with their sample or the test itself.

Reminder to Regulated and Unlicensed staff collecting NP swabs for COVID-19 PCR that the first step in confirming COVID-19 is taking a quality sample.  Taking an inadequate sample can lead to false-negative or indeterminate results.  Check for expiry dates on swabs prior to collecting specimen.  Review the document and video to ensure proper technique and avoid having to repeat the test.

• Nasopharyngeal swabbing for respiratory viruses – the 4 D's (video)
• Laboratory - Swab Collection - Poster - The 4 Ds of Nasopharyngeal Swab

Rapid antigen test kits available to order

Nova Scotia Health continues to see an increase in health care worker absences related to COVID-19 infections/exposures which is impacting the delivery of essential services. Given the ongoing need to monitor COVID-19 related absences, Occupational Health Safety and Wellness (OHSW) has initiated health care worker access to rapid antigen testing for at home symptomatic testing and to support compliance to work isolation protocols.  Leaders can order through SAP with the Quidel Quickvue SAP order number SAP# 243074.

Please note: The expiry date for the Quidel QuickVue COVID-19 test kits currently being distributed to Continuing Care and Healthcare Worker symptomatic employee testing may appear like they are expiring soon. Some of these tests may have a printed expiry date indicating a 12-month shelf life from the manufacture date. However, the shelf life of these tests has been extended and the expiration date printed on the kits may not reflect this.

To determine the true expiry date of the tests, please use the Kit Lot number found on the box of the test kits and consult the “New Kit Expiration Date” table.

Health care workers living with a COVID positive household member

Health care workers who have received their primary series AND a booster dose of COVID-19 vaccine in the preceding 168 days, with the dose being administered 14 days prior to the last known high risk contact with the positive case, OR have had infection within 90 days, may report to work but they MUST:

• have no symptoms
• perform work isolation protocols for 7 days after the last known contact with the positive household member and,
• book a PCR test 72 hours after the date of the household members positive case

Work isolation protocols include performing twice daily active screening for symptoms, donning all personal protective equipment while in the workplace, frequent hand hygiene and ZERO unprotected interactions in the workplace (no eating or drinking in shared spaces, masks MUST be worn at AT ALL TIMES unless alone in a room).

Health care workers with a positive household member who do not meet the criteria above are NOT to report to work. They must book a PCR test 72 hours after the last known high risk contact with the positive case. Health care workers who obtain a negative result may return to work but they MUST:

• have no symptoms and,
• perform work isolation protocols for 7 days after the last known contact with the positive household member

Health care workers who receive a positive result from the 72 hour PCR test must return to the COVID-19 status or reason for work absence webform, report their positive status and follow the guidance for a positive case.

Adding Bivalent vaccine to vaccination record using immunization disclosure web form

Nova Scotia Health employees and physicians are encouraged to get a bivalent vaccine as soon as they are eligible and add it to their vaccination record with Occupational Health Safety & Wellness (OHSW) using the Nova Scotia Health COVID-19 Immunization Disclosure web form. It is important to get vaccinated even if you have previously been infected with COVID-19, as post-infection immunity is short-term (90 days or less), and infection from previous strains may not protect against current/future strains. Vaccine eligibility criteria and intervals can be found on the public Coronavirus Vaccine webpage.

Report and Support Screening Tool

Early detection is key when it comes to accessing medication for COVID-19. A reminder to all health care providers that the Report and Support Online Screening Form remains the most efficient and preferred way to identify Nova Scotians who may be eligible for COVID-19 medications. Delays in access may occur if Report and Support is not completed. We strongly recommend Report and Support form completion especially in long term care, emergency and inpatient settings where people who benefit from therapy may be present in particularly high numbers.

Those who do not have internet access or who need support with the form, can call 1-833-797-7772 to have the form completed. A reminder the form can be completed at the same time as PCR tests are done at Nova Scotia Health test centres; you do not need to wait for the results. A family member, friend, substitute decision maker or health care provider can also complete the form for the patient.

Treatment for mild COVID-19 may be recommended within five to seven days of symptom onset for people at high risk of progression to severe illness. Although treatment does not benefit everyone, early identification and treatment of people at high risk can improve outcomes and mitigate the impact of COVID-19 on health care settings. We are asking all people to test within 48 hours of noticing symptoms of COVID-19, such as sore throat, runny nose/nasal congestion, shortness of breath, cough, headache, fever (chills/sweats), nausea, vomiting or diarrhea.

How to Access COVID-19 Therapy for Hospitalized Patients with COVID-19 Infection

All patients admitted to hospital with COVID-19 infection should be assessed to determine whether they meet the criteria to receive early (non-severe) drug treatments or COVID-19 medications indicated for those with moderate to severe disease.

For Non-Severe COVID-19 disease:

• ASSESS criteria for early drug treatments as per referral criteria, to prevent disease progression
• SEND REFERRAL to COVIDTREATMENT@nshealth.ca or Fax to 902-492-5604
• CONTACT the COVID-19 Non-Severe Therapy Pharmacist Consult Service at 1-833-714-2784 if you have questions

For Moderate to Severe COVID-19 disease:

• CONTACT the clinical pharmacist in your zone by calling 1-833-519-2442 for all COVID-19 patients
• ASSESS criteria for drug treatments by reviewing NS Health COVID-19 Medication Recommendations
• For drugs requiring a designated prescriber, send referral to COVIDTREATMENT@nshealth.ca or Fax to 902-492-5604

As a reminder, Remdesivir for moderate-severe COVID-19 is now recommended for use as part of routine care and is no longer used in the context of pragmatic research (the CO-VIC study). Please note: Remdesivir for patients with moderate-severe COVID-19 is to be ordered by a Moderate-Severe COVID-19 Inpatient Designated Prescriber. Remdesivir for non-severe COVID-19 is to be ordered by a Non-severe COVID-19 Designated Prescriber.

Please provide information about the applicable referral criteria to the COVID-19 Non-Severe Therapy Pharmacist Consult Service and designated prescriber team by sending an email referral to COVIDTreatment@nshealth.ca or by calling 1-833-714-2784 between 9 a.m. and 5 p.m., seven days a week. We have also added a new fax number for your convenience. Fax referral to 902-492-5604. The COVID-19 Non-Severe Therapy Pharmacist Consult Service will review for eligibility, contraindications to therapy, and drug interactions. For further details, please review: NS Health COVID-19 Medication Recommendations

Recovery letter request form now includes option for documentation for medical procedures

People who tested positive for COVID-19 in Nova Scotia and need documentation for travel or a medical procedure, can request a recovery letter through this online form. This is not an official public health record; it is based on self-reported information. For more information, visit https://www.nshealth.ca/i-have-tested-positive and select “I need a recovery letter for travel or a medical procedure.”

Post-COVID Supports

Over the summer months of 2021, the Primary Health Care and Chronic Disease Management Network, in collaboration with the COVID Network, clinicians, patients, and partners, established practice supports to build capacity of Nova Scotia primary health care providers and teams to care for patients experiencing post-COVID symptoms.

Support options available for you on demand include:

• A Resource Hub containing self-directed tools and resources for providers as well as patients
• Post-COVID in Primary Health Care webinars, which are available as CME-accredited self-learning modules
• www.MyCOVIDRecoveryNS.ca, information and resources to help Nova Scotians understand and manage their health after having COVID-19.

For additional information, visit PHCQuality.ca or email PHCPracticeSupport@nshealth.ca.

Update to Required Measures for Admission Testing in COVID Protocols for Safe Recovery

In light of the changes to the COVID-19 Risk Assessment tools (see message below), the Required Measures for Admission Testing have been updated in the COVID-19 Protocols for Safe Recovery. In addition, clarification regarding masking for Patients and Visitors has been added: Patients and visitors do not need to change their masks if already wearing a KN95, N95 or medical mask. Cloth or vented masks may either be changed to a medical mask or a medical mask may be put on over the cloth or vented mask.

Changes to COVID-19 Risk Assessment and Admission Pathway

Nova Scotia Health continues to see broad impacts of COVID-19 in our facilities and in addition, influenza and RSV are now also widely circulating in Nova Scotia. In response, we have transitioned our approach from a COVID-specific response to a system that mitigates the impact of acute viral respiratory infections more broadly.                     

The biggest change is a shift away from universal testing of all admitted patients to a risk-based testing strategy. As we would have done pre-pandemic, the decision to send a swab for COVID-19 PCR testing will now be made based on the presence of symptoms or non-symptom risk factors.  This change is necessary to optimize the use of resources while still ensuring that we identify patients who may benefit from treatment or who require additional IPAC precautions to prevent transmission. In addition, when a swab is sent for COVID-19 PCR in hospitalized patients or those in an Emergency Department, it will be tested for COVID-19, Influenza and RSV, since the clinical presentation of these viruses is indistinguishable and clinical management differs. 

This change has required the modification of some of our tools – notably, the Risk Assessment and Admission Pathway.

The following has been changed:

• A NEW, more streamlined Acute Viral Respiratory Infection Risk Assessment will be used in the Ambulatory Setting. This form focuses on identifying patients with symptoms and minimizes the collection of other data to help make screening in these areas more efficient. This form can be discarded after the appointment and should not be scanned to the medical record.
• A separate Acute Viral Respiratory Infection Risk Assessment will be used in Inpatient Settings and the Emergency Department. This form is similar to the one currently in use and must remain part of the medical record. 

In addition, two other changes are being made:

• The Admission Pathway has been modified to reflect the change in testing requirements.
• The Algorithm for use of Lucira Testing in Emergency Departments has been modified.  

You can review the updated documents on the COVID-19 HUB.

Continue to follow current public and occupational health recommendations

Influenza season has started earlier this year, and in addition, Nova Scotia is seeing several respiratory viruses circulating amongst our community, including COVID-19, influenza, and Respiratory Syncytial Virus (RSV). It is important that health care workers continue to follow current public and occupational health recommendations, especially during the upcoming holiday season and while attending seasonal events:

1. Stay up-to-date with COVID-19 vaccines and get your annual flu vaccine.
2. Stay home when sick, or mask if you cannot stay home.
3. Be thoughtful about your social activities. Wear a mask in crowded indoor spaces and other high-risk areas. Consider wearing a mask if you will be in close contact with people at high risk for severe illness.
4. Practice good hand hygiene and coughing/sneezing etiquette.
5. Adhering to these recommendations will minimize infection amongst healthcare workers and patients. It will also aid in the reduction of healthcare worker absences.

COVID-19 Infection and Treatment Provider Reports (sick leave benefits)

Within terms and conditions of employment and collective agreements team members are required to provide a Treatment Provider Report (TPR) when an absence period extends beyond 37. 5 consecutive work hours, prorated to designation. A TPR may also be required to support modified/transitional work or permanent accommodation and must be completed by an appropriate regulated health professional, such as but not limited to a; physician, physiotherapist, chiropractor, counsellor, social worker etc.

Throughout the COVID-19 pandemic sick notes have NOT been required for staff with confirmed (PCR or POCT) COVID-19.  Staff are to self-report their absence via the COVID-19 Status and Reason for Work Absence form and they will receive communication directly from an Occupational Health Safety and Wellness professional. Team members struggling with symptoms beyond 14 days should contact their local Occupational Health Safety and Wellness department to discuss support options.

Rapid Antigen test kits available to order

Nova Scotia Health continues to see an increase in health care worker absences related to COVID-19 infections/exposures which is impacting the delivery of essential services. Given the ongoing need to monitor COVID-19 related absences, Occupational Health Safety and Wellness (OHSW) is initiating health care worker access to rapid antigen testing for at home symptomatic testing and to support compliance to work isolation protocols.  Leaders can order through SAP with the Quidel Quickview SAP order number SAP# 243074.

This video produced by Impact BC describes three models of GMV.

These forms are required to verify licensing, training, and education of a practitioner. As you complete these items, please email or fax the documents to the Credentialing Office.

Email: credentialing@nshealth.ca

Fax: (902) 473-7433

This weekly newsletter is sent on behalf of the project leads, Dr. Joanna Zed and Graeme Kohler.