A discussion with Shared Health CNO Lanette Siragusa about Manitoba’s experience with COVID-19

Talk Tuesday - August 18, 2020

Presenter

Lanette Siragusa RN MN
Provincial Lead - Health Service Integration and Quality & Chief Nursing Officer

Lanette Siragusa has 25 years of experience working within the healthcare system and is committed to a provincial approach to quality and learning. Within Shared Health, Lanette participates as a member of the Transformation Leadership Team and is responsible for leading and coordinating Manitoba’s clinical and preventive services plan. She oversees the Nursing Strategy Steering Committee and is actively involved in pandemic planning. 

Prior to joining Shared Health, Lanette was program director for surgery with the Winnipeg Regional Health Authority. Her past experience includes working in high-risk labour and delivery, community health, teaching and research. Lanette also has published several articles related to improvements in clinical practice and service delivery.

Lanette holds a graduate degree in nursing administration from – and is an assistant professor at – the University of Manitoba’s College of Nursing in the Rady Faculty of Health Sciences.

Summary

The Association welcomed Lanette Siragusa, Shared Health’s Chief Nursing Officer. She started by sharing a bit about working on Manitoba’s Clinical and Preventative Services Plan which has been pushed down the priority list but is still happening in the background. 

Lanette then walked us along the pandemic timeline starting in December when there were some unusual pneumonia cases in China and through preparations for COVID-19 in Manitoba including the incident command structure. She shared many examples of what they considered while they planned. These considerations included protocols in hospitals and the community; public health tracking and interventions; supply management; diagnostics and testing; mental health support; systems capacity; and many more. She shared the strategies they used to collect information and how they made sure everyone was working with the same information. 

In addition to all the planning, Lanette shared lessons learned and spoke about how health is more than healthcare. She shared how useful Shared Health was as a provincial entity and the plans to strengthen communication going forward. 

Next steps for Shared Health and Manitoba include keeping the focus on excellent patient care; following infection prevention and control principles; maintaining a system for staff to escalate concerns, questions or ideas through their direct reports; supporting people in this new environment; and being deliberate about caring for ourselves and each other. 

 

Question and answer

1. When you talked about breastfeeding guidelines, were you talking about the Manitoba ones or Canadian ones?

    < li>Yes people can breastfeed if they have COVID-19

  • This was one of the first protocols we put in for COVID-19 positive moms delivering their babies. What kind of precautions they need to prevent transmission or minimize the risk of it. We have a physician, Dr. Vanessa Poliquin, she’s become a world leader in mother-child and COVID and we’re lucky to have her. She actually won an award this week with CMA. Protocols include masks, can you breastfeed, visitor protocol etc. It’s all on the Shared Health website.
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2. Does Shared Health have a plan to combat institutional racism and horizontal violence in healthcare?

  • That’s a big topic, bigger than the clinical plan. We did highlight populations like new immigrants to Manitoba and Indigenous populations to identify how we work with them and can work with them in co-design and ensuring access.
  • Public health, through COVID-19, has an equity table which contributes. These don’t address systemic racism, but I’d welcome a conversation about how we can do our part.
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3. How do you plan to address nursing staffing needs and shortages should many nurses be absent from work due to COVID-19 positive tests or symptomatic school age children?

That’s a real concern. Part of it might be the provincial recruitment and redeployment. Who can do what jobs, can we get more people into the workforce. We are actively working towards that. We’re working on recruitment, some needs may require redeploying people. There won’t be one solution for the province, it’ll feel different in different areas.

4. Could you highlight resources for healthcare providers to prevent burnout during the pandemic?

Yes there are so many online, there are several, some are virtual, there are multiple areas of focus and nonprofits that are asking to be involved,support and help out. The Shared Health webpage is the best place to access all of that information.

5. There are ongoing challenges related to adequate PPE for nurses. What’s the plan to keep them safe?

  • Throughout the pandemic that has always been top priority, we don't talk about PPE without talking about protecting staff. There was a time when there was a complete stoppage of PPE delivery. We didn’t have a good understanding of the supply chain and I was worried. Now I meet with logistics three times a week to go over what’s available and it’s looking really good.
  • That’s not to say there won’t be interruptions in the supply chain or shortages going forward but we’re planning for those. We’re stockpiling and have strategies to conserve PPE if that becomes necessary.
  • We’ve started to meet with MNU once a week regarding PPE shortages and what we’re hearing about is more of a local access issue specifically with the N95 masks. Getting Occupational Health and Logistics involved to identify a specific type of mask for that group in that area has been one strategy to ensure access.
  • It’s gotten tricky. We used to have two N95 mask suppliers and now we have several. This is good because if one vendor can’t deliver we have other sources, but when you think about each mask needing to be fit tested it becomes a lot to manage. If people have concerns, bring them up to your manager.
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6. What can you share about the feasibility of COVID-19 testing sites continuing to request that staff are redeployed there indefinitely rather than hiring specifically for each site?

We certainly would be willing and I think regions are looking into hiring people. It’s not always easy to find a nurse. If a nurse isn’t working now, some may be persuaded to come back but not all. There certainly isn’t any opposition to hiring, it’s just a matter of finding the nurses and getting them ready to go.

7. Can you give us a hint of what the position might be re: mandatory masks? If it’s important enough to recommend, why isn’t it mandatory?

Those discussions are definitely happening. We’re thinking about what needs to be done, the active caseload, etc. Dr. Roussin has always said no option is off the table but right now he’s comfortable with a strong recommendation. Mandating is a hard decision. There are equity issues, not everybody can afford to go out and buy a mask, not everyone has a place to clean their mask and masks are not the cure all of infection control. We need to wash our hands, maintain physical distance, stay home when we’re sick and masks are strongly encouraged for sure. I’m not sure what will happen in terms of a mandate but that will be a government decision.

8. If or when a vaccine is available, do you think there’ll be discussion about it being mandatory? Thinking about conversations we have every year around the flu vaccine.

Right now we’re talking about the strategy to implement and distribute a COVID-19 vaccine. I haven’t heard any conversation about mandatory immunization at this point. Taking influenza as an example, that isn’t mandated though some people think it should be. COVID-19 might set a different precedent I guess, but there isn’t any indication that’ll be the case now.

9. What can you say about communal living for Amish, Mennonite or Hutterite communities?

We certainly know that it increases risk. If someone is exposed to COVID-19 and you all eat together in a big group and live in big group settings and spend time in enclosed areas the chances of getting COVID-19 if exposed are higher. The communities we’re seeing outbreaks in now have been very willing to speak with public health and there is a lead that helps get the communication out and strategies in place. It’s really challenging, but all anyone can do is the best they can, I think everybody is trying to do what needs to be done.

10. Once a vaccine is approved, will essential workers, along with elders and the immunocompromised be the first to receive it?

Right now the planning is focusing on how we can offer immunization to every Manitoban. If we don’t get enough vaccine, then the strategy around prioritization will be Plan B and discussions are ongoing about that.

11. Are you anticipating changes in primary care outcomes because of delays and changes caused by COVID-19 and what is the plan for that?

The primary care and emergency departments didn’t halt. A lot of them transitioned to virtual services. One of the things we need to talk about is how do we change, to deliver services or organize our services differently. If there are critical incidents that come out of changes or delays those would be investigated through the quality teams.

12. How does the province & Shared Health plan to support students so they can safely continue their clinical placements and practicums and eventually join the healthcare workforce?

  • In the beginning of all of this we wrote letters of support. We need nurses to graduate too! We don’t want to stop education. This is such a unique opportunity for young, up and coming nurses to be part of working in a pandemic. We would certainly never want to put students in an unsafe situation so we need to make sure they have PPE and know how to don and doff it safely. We’re limiting visitors so we’ll have to think about how they can connect with their advisors virtually.
  • It's a useful experience to have if it’s safe and students are comfortable with it. If they’re not there are places that are lower risk like Health Links or other virtual care environments.
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13. Seeing our COVID-19 rates starting to increase, do you think Manitobans have let their guard down now that restrictions have been relaxed? Do those looser restrictions give people a false sense of security?

  • It’s interesting to consider that this surge in cases is a lot of younger people. I think those people who are at risk know what they need to do and are doing it. I think people are tired of the isolation, the PPE, the fear, the distancing and the disruption. I do think maybe people have let their guard down. I know we can’t keep the economy closed forever, not sure if we opened too late or too soon. We were one day away from 0 cases.
  • Dr. Roussin has always said that we need to learn to live with this virus. I know the numbers are higher now and that’s not a comfortable place to be. It will continue to be a nurse's role to lead by example and advocate for people to follow infection prevention and control, and public health guidelines.
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14. With different places requiring masks, will there be a public service announcement about using masks properly?

Not sure if this is on the radar but it’s an excellent idea. I will raise it with communications.

15. Are there any plans to maintain the decrease in elective surgeries going forward?

No that’s not the strategy. We’re working on catching up and then keeping up with the needed procedures. I guess as an absolute last resort if we needed the beds or the staff maybe… but definitely not high in the list of options.

16. What changes can we expect in the fall?

  • It won’t be much different, we’ll need to watch the volume of active cases. PPE protocols, visitation guidelines will likely remain unless we see outbreaks in certain areas, communities or districts. We’re still really in uncharted territory and continuing to learn.
  • Unsure how influenza caseload will turnout. It might be much better because of all the COVID-19 precautions, but might be really tough if people contract COVID-19 and influenza at the same time.
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17. Do you have a sense of when the influenza vaccine will be available?

End of summer or early fall I would expect.

18. Can you speak to the current testing capacity at Cadham Lab? As we approach influenza season will this capacity be increased? In my area, results are taking 48 hrs or more, this is making it hard to move patients through the facility.

We meet with our lab team regularly and for months they have been in pursuit of more capacity. They’ve developed some really great strategies that they’re sharing with the rest of Canada now. They’re looking at point of care testing, working with Dynacare to support capacity. The plan is to continue to grow capacity. Sometimes there is a limitation based on supplies. Early in COVID-19 it was reagent we were short on so this is another supply chain that is closely monitored.

19. What about our vulnerable clients who can’t get to a testing site? Will there be a way for them to be tested through home care or another route?

There is mobile testing available, not everywhere but in some areas. We haven’t received a lot of uptake. We’ve started doing it for immunocompromised people who we want to keep out of hospital. In some areas nurses with supplies were sent out to do the testing. As long as the tester has PPE and the ability to safely transport the tests it’s an excellent strategy. This is efficient to offer testing to a community experiencing an outbreak, it may be a less efficient strategy for individual testing.