Public Health and Healthcare Information

by Dr. Justine Taylor

Federal

August 6th – PHAC and AAFC webinar

Please see the following links for the slide decks from the webinar with the Public Health Agency of Canada. Also attached is the checklist document mentioned by PHAC during the webinar. While developed primarily to address outbreaks affecting temporary foreign workers on farms, it is a useful tool for all ag and food sector businesses.  It can help individuals determine actions that can be taken to mitigate the spread of COVID-19 in their facilities and develop their own COVID-19 control plan. It is currently only available in English, but will be made available in both English and French and posted on the AAFC COVID web page for industry shortly. Questions and answers from the session will be provided shortly.


May 22, 2020 – Public Heath Agency of Canada Updated Guidance

  • Updates currently being made to “Workplace guidance for sector employers and employees” on the AAFC website.
  • PHAC noted that it is vital that industry is provided with accurate, science-based information during the COVID-19 crisis as it evolves. There are a few specific areas that PHAC highlighted, the first related to updated guidance on the use of non-medical masks or face coverings:
    • Wearing a homemade non-medical mask/facial covering in the community is now recommended for periods of time when it is not possible to consistently maintain a 2-metre physical distance from others, particularly in crowded public settings, such as: stores, shopping areas and public transportation. In many work environments it can also be difficult to avoid close contact and maintain physical distancing.
    • Public health officials will make recommendations based on a number of factors, including the rates of infection and/or transmission in the community. Recommendations may vary from location to location.
    • If physical distancing and modifications to the workplace are not consistently possible, the use of non-medical masks or face coverings (constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) is recommended.
    • These masks can be used to minimize the opportunity for respiratory droplets to reach other people or contaminate common surfaces and should be replaced when they become wet, soiled, or otherwise visibly contaminated.
    • Wearing a mask alone will not prevent the spread of COVID-19 and the use of these masks does not replace physical distancing, rigorous and frequent hand hygiene and other measures taken in the workplace, wherever possible, nor should they replace the personal protective equipment used pre-COVID for occupational health and safety reasons.
    • Non-medical face masks or face coverings are not PPE. They are not appropriate substitutes for PPE such as respirators (like N95 respirators) or medical facemasks (like surgical masks) in workplaces where respirators or facemasks are recommended or required by occupational health and safety to protect the wearer.
    • Respirators such as N-95 masks must be conserved for health care workers and others providing direct care to COVID-19 patients and are not recommended for use in the agriculture and agri-food sector to mitigate against the risk of COVID-19. However, if prior to the COVID-19 pandemic, if an occupational health and safety risk assessment has determined that an employee is required to wear a N95 respirator or other PPE as part of normal operations to mitigate a specific workplace hazard, they should continue to do so.
  •  PHAC noted that establishing work teams or crews of people that work together on the same shift or in the same area of the business (“cohorting”) can help to limit transmission of the virus and identify who has been in contact with who if/when a COVID-19 case were to occur. In these cases PHAC indicated that employers should consider:
    • Scheduling the same workers to work together and/or take breaks at the same time each day and stagger starting times for crews.
    • Establish work teams or crews of people that work together.
    • Breaking your business into zones and limit the number of people working across zones
    • Arranging bus schedules or shuttles to carry the same groups of workers together.
    • Operations in the agriculture and agri-food sector may also have employees living together in bunkhouses and commuting to the same workplace together in company buses or carpools. In these circumstances, employers should also consider forming groups of workers into “cohorts” (also referred to as bubbles or work teams/crews).
    • This could mean:
      • Decentralizing accommodations as much as possible and accommodate work teams together: All workers living in a bunkhouse together also working together as part of the same work team or crew.
      • Minimizing mixing between teams as much as possible.
      • Work teams to start work and take breaks at the same time each day.
      • Limiting social activities to only those within their bunkhouse or work team.
      • Keeping numbers using common areas as small as possible.
      • Arranging bus schedules or shuttles to carry the same groups of workers to and from work together.
    • The use of cohorts reduces the risk of transmission of COVID-19 among employees and is also an important tool to trace potential transmission paths if a positive COVID-19 case is found in the workplace, which will facilitate a quick response to mitigate further spread of the virus.
  • Testing and screening are tools that can assist in preventing transmission of COVID-19 in the workplace when used along with the other important prevention measures, but they do have limitations. PHAC is updating guidance posted by AAFC to address these.
    • COVID-19 can be spread by infected individuals who have not yet, or who may never develop symptoms. Someone can be infected with COVID-19 and never show signs or symptoms while other people with COVID-19 may not show signs and symptoms right away but can still spread the virus before signs and symptoms start.
    • Strategies to prevent transmission and protect our essential workforce need to take into account the role of both symptomatic and asymptomatic individuals in spreading COVID-19.
    • Regarding screening:
      • Taking temperatures: Fever is not usually the first symptom of COVID-19 and many cases never develop a fever or can mask a fever with over the counter medicines like Tylenol. For this reason screening measures based only on fever detection (taking temperatures) are not recommended.
      • It is also important to note that screening will only identify people with symptoms. There are people infected with COVID-19 able to spread the infection to others who do not have any symptoms at all.
    • Testing:
      • While testing is an important tool, testing on its own will not be sufficient to eliminate all risk of transmission, even when testing becomes more readily available.
      • A negative test result does not mean someone has not been exposed. It may be too early on the day of testing to detect the virus. For this reason sometimes testing an asymptomatic person cannot confirm the individual is not carrying the virus. In addition, testing negative on one day does not mean an employee won’t test positive the next day, because sometimes the viral load is too small to initially detect.
      • Your local Public Health Authority will have information about access to testing.
  • PHAC noted that there is no single action or tool that will stop the spread of COVID-19 in the workplace. Each facility manager or employer should put in place a suite of measures based on identified risk areas to minimize the potential spread of the virus in the workplace.
  • PHAC is working to develop simple tools and checklists that can summarize guidance and assist in addressing this suite of measures.
  • It remains critical that industry continue to practice the set of behaviours that we know are effective in preventing the transmission of COVID-19 especially as we enter new phases of re-opening:
    • Physical distancing (staying 2m or 6 feet apart).
    • Staying home if you are sick, even if just mildly un-well.
    • Washing your hands.
    • Cleaning and disinfecting frequently touched surfaces and objects.
    • Covering your cough with tissues or your sleeve or considering wearing a non-medical mask to prevent spread of respiratory droplets.
    • Avoiding the touching of your face.
  • And in the case of workplaces:
    • Use of physical barriers such as transparent barriers, or other methods such as change of workflow, and taped floor spacing in public or work environments are also important and effective means of preventing the spread of COVID-19.
    • Limiting contacts among workers by creating teams, staggering breaks, assigning seating, etc.

Proper Use of PPE

The Canadian government has offered the following advice:

  • Guidance on re-using N95 masks: On April 8, 2020, Health Canada released a Notice on important regulatory considerations for the reprocessing of single use N95 respirators during the COVID-19 response. Health Canada is currently monitoring and assessing the acceptability of various decontamination and sterilization methods/strategies for the reprocessing of single use N95 respirators in the context of the COVID-19 outbreak.
  • Guidance on using N95 beyond their shelf-life: While most masks have a limited shelf life, in times of increased demand and decreased supply, consideration can be made to use these expired N95 respirators. Please consult Health Canada’s website to read this guidance.
  • Considerations on the use of homemade masks: Health Canada provides considerations in the use of homemade masks to protect against COVID-19. Wearing a facial covering/non-medical mask in the community has not been proven to protect the person wearing it and is not a substitute for physical distancing and hand washing. However, it can be an additional measure you can take to protect others around you, even if you have no symptoms. It can be useful for short periods of time, when physical distancing is not possible in public settings such as when grocery shopping or using public transit.

Hard surface disinfectants and hand sanitizers

Health Canada is working with disinfectant manufacturers and industry associations to inform Canadians of the products that can be used to help against the spread of COVID-19. Growers are encouraged to consult the Health Canada website for information that can help to prevent the spread of COVID-19 on farms and ensure the health of workers and the public.



Ontario

EMS: 911 poster for Employers, 911 Poster for Employees

The Ontario MOH recently released their Guidance for Temporary Foreign Workers. We urge you to review this document, especially the section on Occupational Health and Safety and Ontario Health Insurance Plan (OHIP) Q&A  which contains updated information. These sections are copied below for your quick reference.

Occupational Health and Safety

  • If COVID-19 is suspected or diagnosed for an employee, return to work should be determined using the Public Health Guidance on Testing and Clearance, or in consultation with their health care provider and the local public health unit.
  • The staff member must report to Occupational Health and Safety prior to return to work. Detailed general occupational health and safety guidelines for COVID-19 are available on the MOH COVID-19 website.
  • Client-contact surfaces (i.e., areas within 2 metres/6 feet of the person who has screened positive) should be disinfected as soon as possible.
  • If the employee’s illness is determined to be work-related: In accordance with the Occupational Health and Safety Act and its regulations, an employer must provide a written notice within four days of being advised that a worker has an occupational illness, including an occupationally-acquired infection, or if a claim has been made to the Workplace Safety and Insurance Board (WSIB) by or on behalf of the worker with respect to an occupational illness, including an occupational infection, to the:
    • Ministry of Labour;
    • Joint health and safety committee (or health and safety representative); and
    • Trade union, if any.
  • Any instances of occupationally-acquired infection shall be reported to WSIB within 72 hours of receiving notification of said illness.
  • For more information please contact the Ministry of Labour, Training and Skills Development:
    • Employment Standards Information Centre: Toll-free: 1-800-531-5551
    • Health and Safety Contact Centre: Toll-free: 1-877-202-000

Ontario Health Insurance Plan (OHIP) Q&A

Question 1: There was a recent announcement that the 3-month waiting period for OHIP coverage to begin has been removed. Does this also apply to TFWs coming into Ontario under the Federal Government’s Temporary Foreign Worker Program?
Answer 1: As of March 19, 2020, the government has temporarily removed the waiting period requirement before OHIP coverage begins. The government removed the three month waiting period for OHIP coverage in direct response to the COVID-19 situation and the ministry will seek approval for the three-month waiting period to be reinstated when it is advisable to do so.

This applies to all new/returning residents to Canada who are eligible for OHIP
coverage upon their arrival to Ontario (including TFWs who meet all other criteria under law).

TFWs need to meet the OHIP eligibility requirements to be enrolled in the plan which include:

  • hold a valid work permit or other document issued under the Immigration and Refugee Protection Act (IRPA) that permits the person to work in Canada;
  • have a formal agreement in place to work full-time for an employer in Ontario
    • be working under that agreement; and
    • the work permit or other document or agreement must be for no less than six consecutive months.

Question 2: How do new TFWs obtain an OHIP card through service Ontario?

Answer 2: A TFW must hold a valid work permit or other document issued under the Immigration and Refugee Protection Act (IRPA) that permits the person to work in Canada. The person must also have a formal agreement in place to work full-time for an employer in Ontario and the agreement must be for no less than six consecutive months.

  • At this time, and until there is approval for the reinstatement of the three-month waiting period, there is no waiting period for anyone, including new TFWs in Ontario
  • Currently, TFWs must apply in person with required documents to support they are entitled to OHIP. Information about document requirements can be found at the following website: https://www.ontario.ca/page/apply-ohip-and-gethealth-card.
  • Service Ontario completes OHIP registrations on behalf of the Ministry of Health. Some Service Ontario centres remain open to the public.
  • Even if there is a registration delay, OHIP coverage will be backdated accordingly. Please note that the ministry has provided temporary funding for medically necessary physician and hospital services for all uninsured people in Ontario, including those who are currently unable to apply for a healthy care, who do not have an OHIP card.

Question 3: COVID-19 screening centres are not asking for OHIP cards but to access the laboratory results an OHIP number is required, will this be waived?

Answer 3: An individual who does not have an OHIP number cannot access their laboratory results online at this time. There are alternate paths for all users to access their results if they are unable to use the COVID-19 application. Please speak to staff at the testing centre to confirm how to receive test results.

Question 4: Do employers of TFWs still need private insurance to bridge any gaps?

Answer 4: The government has removed the three-month waiting period for OHIP coverage in direct response to the COVID-19 situation and expects to seek approval to have the waiting period reinstated when it is advisable to do so.
TFWs must meet all other requirements under law to be considered eligible for OHIP (see answer to Question 1 above). Please see the following link to identify what OHIP covers: https://www.ontario.ca/page/what-ohip-covers. The Ministry of Health cannot comment on what additional insurance these individuals may require while in Ontario.



Regional

Summary of Health Unit Section 22 Orders


Red Cross Isolation Support Donation Guidelines

Red Cross has issued their guidance for delivering donations to Temporary Foreign Workers under their care.


CMHA Mental Wellness Webinars

The Windsor Essex County Canadian Mental Health Association will be hosting free mental wellness webinars during the months of August and September 2020. These free webinars will focus on a variety of mental health topics such as:

  • Helping Others: Understanding & Responding to Emotional Distress
  • Building Resiliency: Managing Stress & Anxiety During COVID-19
  • Caring for the Caregiver: How to Reduce Caregiver Stress & Prevent Burn-out While Supporting a Loved One
  • Compassion Fatigue
  • Building Resiliency: Emotional Regulation

To register please visit https://windsoressex.cmha.ca/events/

View a complete list of topics, dates, and times.

eHealth+ Windsor-Essex

Website to find local healthcare services: Services, Virtual Walk-in Clinic, COVID Assessment tool


Windsor-Essex Community Health Center

Growers in Essex County can contact WECHC at 519-997-2828 ex. 503 with a list of employees who are exhibiting symptoms. Please provide the name of the employee, the farm name, a contact number, and the reason for consultation: either COVID Symptoms or Other.  Their staff can provide on-farm care if required provided that a private, unused space with a telephone line is available. The space will need to be cleaned between patients and patients should be a wearing a mask.

Poster: weCHC International Farm Workers (EN)    weCHC International Farm Workers (SP) 

Check out these great videos created by weCHC to help international farm workers understand COVID-19 best practices. Available in English and Spanish. Please make sure you share this widely with your workforce.

  • How to prevent the spread of COVID-19 ENG   SPA

Windsor Essex County Health Unit Information

  • June 26, 2020 Class Action Order: All owners or operators of a commercial establishment in Windsor-Essex to prohibit the entry of any person who is not wearing a face covering, unless the person cannot wear one due to medical reasons or age. 

    • Commercial establishments as defined in the order include any place that are open to the public and offer goods and/or services for sale including: Retail stores, Convenience stores, Malls/plazas, Restaurants, Personal service settings, Grocery stores and bakeries, Gas stations, Farmer’s markets & Mechanic shops and car dealerships.

  • June 12, 2020 Class Action Order
    • The following class action order applies to all owners and operators of agricultural farms in Windsor and Essex County who:
      • Employ migrant farm workers in any capacity.
      • Participate in the federal Temporary Foreign Worker program (TFW).
      • Operate any model of seasonal housing accommodations.
    • The order will require the following actions to be taken by included agricultural farm employers:
      • Ensure that all employees current or future are exclusively working within one workplace. Individuals who
        are employed at more than one facility must immediately limit this to one premise.
      • Ensure that any contracted employees current or future are exclusively working for one workplace.
        Individuals who have been contracted by more than one facility at a time must immediately limit this to one
        premise.
      • Ensure that accurate and updated contact information for all employees (permanent, temporary, or
        contract) is available to be produced to the Windsor-Essex County Health Unit within 24 hours of request in
        support of case management and contact tracing requirements.
      • Follow any directions provided to you by the Windsor-Essex County Health Unit pertaining to
        COVID-19 and the terms of this Order. This may include ensuring adherence to self-isolation orders issued to
        employees, ensuring that required public health measures such as active screening and physical distancing
        are maintained at all times within your workplace, and supporting all aspects of investigations related to
        communicable diseases, including COVID-19 conducted by the Windsor-Essex County Health Unit.
      • Ensure that meals are provided to Temporary Foreign Workers completing isolation requirements. Meals
        must be nutritious and well balanced. Employers must accommodate dietary restrictions for workers under
        isolation. Workers under isolation must also be able to store food in a safe manner.
      • Ensure that potable water is available at all times to migrant employees under isolation.
      • No Temporary Foreign Workers can be moved into a non-inspected living accommodation.
      • Ensure that the health unit is contacted for approval if renovations within pre-existing and approved living
        accommodations that impact floor space, number of faucets, toilets, showers, and/or bathtubs.
      • Ensure that all individuals that are under health unit supervision for case and contact management have
        ongoing access to communication devices (cellular phone or landline) and this contact information is made
        available to the health unit at all times. Individuals should not be sharing the device with more than 5
        people and should be disinfected between uses.
      • Ensure that all known instances of non-compliance with the Emergency Management and Civil Protections
        Act, Quarantine Act or isolation requirements are reported immediately to the appropriate agency.
    • Adherence to this order is required until the order is rescinded.
    • FAILURE TO COMPLY WITH THIS ORDER is an offence under section 101 of the Health Protection and
      Promotion Act for which you may be liable, on conviction, to a fine of not more that $5,000.00 (for a person)
      for every day or part of each day on which the offence occurs or continues.
    • OGVG clarity:
      • Under the above order a “workplace” is a single business entity. If the entity encompasses multiple locations all movement of staff (contract, full time, management, suppliers, etc. ) should be strictly tracked across locations.
  • COVID-19 Quick Guide for Hotels and Motels
  • Taxi and Rideshare Services during COVID-19
  • Safe Return to Business: Toolkit
  • Webpage for employers. The website will be updated daily and provide links to new and relevant resources.
  • Updates and alerts, join the WECHU’s Workplace Wellness Email group by signing up here
  • Temporary Foreign Workers

The WECHU has developed a set of resources to help farmers understand their responsibilities regarding the isolation of incoming international farm workers and ongoing on-farm protocols.

With regards to receiving new workers, all international workers must undergo the mandatory 14-day isolation period. The Health Unit wants to be notified of all pending arrivals and intends to inspect/approve all housing intended for the isolation period. Depending on the accommodations there are different requirements. See below for their guidance.

  • Hotels/Motels they would accept photos.
  • Trailers would be inspected and a water sample is collected
  • The health unit will be notifying the local municipalities of all temporary isolation bunkhouses. Growers are required to ensure bunkhouses comply with local building, fire and zoning requirements
  • An attempt to meet the minimum guidelines set out in the Seasonal housing inspection guidelines should be made, ensuring the isolation parameters are met. There will be some flexibility for temporary accommodations.
  • Inspections should be booked through their website.
  • A dedicated COVID19 contact number that can reach a live person 24/7 will need to be provided.
  • For bunkhouses that were approved prior to the isolation requirements, growers should contact the Health Unit before workers arrive.  They will need to be assured that the new isolation guidelines are being met. You should contact your area Public Health Inspector directly. If you have multiple properties, you should book an inspection as stated above.

In addition to the information below, OGVG has also developed the following checklist that can be used during the isolation period: OGVG Isolation facility preparation checklist

April 14, 2020 WECHU Press Release – Protecting our Farming Communities in Windsor and Essex County

Worker Information:

General Information about COVID (Ministry of Ontario)

Employer Information:

  1. Guidance Document from Ontario MOH
  2. Daily Health Check Log Sheet
  3. Self Isolation  Plan Checklist
  4. WECHU Seasonal Housing Program Migrant Farm Letter COVID-19 March 18 2020
  5. WECHU Temporary Foreign Workers – COVID19 – April 3, 2020
  1. WECHU Infographic on preventing COVID-19 (Please print English, Spanish and French)
  2. Cough Sneeze Etiquette Poster (WECHU)
  3. Daily Bunkhouse Cleaning Log Sheet 
  4. Mexican Gov Posters (Spanish)
  5. Jamaican Liaison Poster
WHO

Coping with Stress (English)

PHO Fact Sheets (only #1 and #2 below are available in Spanish)

  1. Self-isolation guide for caregivers, household members, and close contact (English and Spanish and Tagalong)
  2. How to Wash your Hands (English and Spanish and Tagalong)
  3. How to Self Isolate (English)
  4. How to Self-Monitor for COVID-19 (English)
  5. Cleaning and Disinfection for Public Settings (English)
 

 

 


Haldimand Norfolk Health Unit


Niagara Health Unit

  • Resources for farmers
  • Section 22 Order summary and FAQs
    • Conduct daily screenings
    • Organize employee cohorts of no more than 10 people
    • 2m distancing in workplace, bed separation, common areas
    • Cleaning and disinfection products should be provided
    • Supply medical grade masks when 2m not possible
    • Facilitate health assessments by Quest Community Health Centre or equivalent provider
    • Niagara Region’s Public Health’s Environmental Health team at inspect@niagararegion.ca or 905-688-8248 ext. 7590
  • Guidance on the use of physical barriers

As a reminder, in follow-up to the Section 22 Order and the frequently asked questions document that was shared, active screening is required for all employees who enter the property, including those that come from the local community, third party agencies and seasonal agricultural employers.

Please review the details below in regards to the requirement to implement screening and difference between active screening (e.g. asking questions) and passive screening (e.g. signage) measures:

Passive screening (visitor signage):

  • Existing signage should:
    • be clear, visible and able to be read by all;
    • warn individuals to not work if experiencing respiratory symptoms;
    • encourage individuals to practice hand hygiene; and
    • encourage individuals to follow proper respiratory etiquette.

Active screening

  • Instruct TFWs to self-monitor for symptoms such as fever, cough, or difficulty breathing (How to Self-Monitor);
  • All TFWs and employers are able to use the Ministry of Health’s online COVID-19 self-assessment tool if they need help determining whether they should seek further care;
  • Consider having a screener at farm to conduct active screening of TFWs and ensure the following conditions are in place:
    • screening tables are located in an area away from others and away from any high traffic areas;
    • there is an appropriate supply of hand sanitizer at the screening table.
  • If the screeners are able to maintain a distance of at least 2 metres/6 feet from those being screened, or if they are able to be separated by a physical barrier such as a plexiglass barrier, the screener does not need to wear Personal Protective Equipment (PPE) while screening, otherwise, the appropriate PPE must be worn:
    • surgical/procedure mask;
    • gown;
    • gloves;
    • eye protection (goggles or face shield).
  • Consult with local community partners to source PPE, if needed.
  • Ensure to protect all personal information in such a manner as to protect personal privacy of employees.
  • Symptomatic individuals should be instructed to immediately isolate.
  • If COVID-19 is suspected or diagnosed in a TFW or other staff, return to work should be determined in consultation with their employer, health care provider and the local public health unit.

Related Articles

Leave a Comment

8 + 4 =