Why Dr. Loo wants to hire 15 more employees at Algoma Public Health

Dr. Jennifer Loo will be at tonight's City Council budget meeting, arguing for a 10-per-cent increase in the public health levy that will end up slapped on our 2022 property tax bills.

Dr. Loo, medical officer of health and chief executive officer at Algoma Public Health (APH), says COVID-19 is taking up so much time and resources, she needs 15 new employees just to continue fighting the pandemic and clearing a massive backlog of other work needed to restore mandatory programs and ensure community health.

APH managers worked 3,427 hours in overtime from Jan. 1 to Sept. 18.

They've been foregoing accrued lieu time, even vacation time, trying to keep up.

Similiarly, callouts, overtime and lieu time by unionized staff is up 166 per cent over 2019.

It's not enough, Loo says.

She needs more staff.   

"Human resources must be strengthened to allow for catch-up on the backlog of services and the restoration of programming," Loo says in written materials to be presented at today's City Council meeting, livestreamed on SooToday starting at 4:30 p.m.

"Otherwise," she warns, "the backlog will become too large to overcome and the health of all will continue to be impacted."

Since the pandemic started almost two years ago, Loo has focused on minimizing serious illness and death, preventing societal disruption and preserving health care services.

A survey of APH staff done on Oct. 7, 2021 found that more than 51 per cent of all employees were working primarily on COVID-19, while another 15 per cent were spending about half their time on the pandemic.

Only 33.5 per cent of APH employees were primarily dedicated to what Loo described as "covering prioritized, highest-risk programs and services."

Algoma Public Health's 2022 budget totals $19.6 million – an increase of $470,197 from this year, and a 10 per cent hike ($380,838) in the levies apportioned among Algoma's 21 municipalities.

Public health operations made up about 2.2 per cent ($2.7 million) of the Sault's total municipal levy ($121 million) in 2021, Loo points out.

"Recovery from the pandemic, as a public health unit and broader community, will take several years and require appropriate resourcing."

"These health impacts will likely extend years into the future, highlighting the need for significant post-pandemic recovery support by public health."

"For example, despite limited evidence to date, we know that children and youth have been disproportionately impacted by pandemic measures. Reports have demonstrated reduced physical activity, increased screen time, increased food insecurity, and reduced free play and time outdoors, among other behaviours, which have been associated with negative implications to children’s mental health and healthy growth and development."

While Loo is seeking 15 new employees, she's also having big trouble filling 16 other staff vacancies.

That's 8.86 per cent of her workforce.

"The workload and contribution of extra hours worked by employees has depleted human capital, and impacted work-life balance and employee health and wellness. This is already being observed through over a dozen employees take unplanned leaves over the course of 2021, which saw employees off work for a range of 1.5 to 15 weeks," Loo says.

"One-time funding provided by the provincial government has been appreciated and critical to supporting COVID-19 response and immunization, as well as other pandemic needs (i.e., school support, infection prevention and control). However, one-time funding has been geared towards curtailing the pandemic, as opposed to annual funding for the hiring of permanent staff to restore long-term public health capacity to manage the emergency of today, and prepare for the public health emergencies of tomorrow."

"This comes at a detriment to northern Ontario, as when one-time funding is available, retention and recruitment continue to pose significant barriers to fulsome service delivery by public health."

"Without sustainable, increases to provincial base funding and levies to stabilize and strengthen the local public health workforce for the long term, with strategies for recruitment and retention that align to northern Ontario, APH will be unable to sustain the COVID-19 response and immunization program while restoring mandated public health programming to meet the needs of our communities and prepare for future health crises without further risk of exhausting existing human resources," Loo says.

"Recovery, as a public health agency and community, will be complicated and unpredictable given the potential for COVID-19 transmission to continue beyond 2021 and new public health emergencies to arise. COVID-19 will not go away indefinitely, but instead become a disease of public health significance that will require ongoing attention by public health."

"Recovery will be another marathon for public health, to not only to routinize COVID-19 response, but also to effectively restore programming and rebuild public health to face the many new community priorities that have arisen because of the pandemic and inability to sustain all programs and services. The pandemic has and will continue to challenge our communities and the work of public health moving forward."

Here, as listed by Loo, are some of the direct and indirect effects COVID-19 has had on our community and APH operations:

• increases in vaccine preventable disease (e.g. chickenpox)
• increases in sexually transmitted infections (e.g. gonorrhea, chlamydia)
• increased rate of opioid-related deaths in Algoma from 14.9 per 100,000 people in 2019, to 44.7 per 100,000 people in 2020
• delay in compiling a local opioid situational assessment to better identify needs, services, and gaps
• waitlist of 105 persons for smoking cessation support, which amounts to a one-year waiting period. Due to the length of the waitlist, clients currently seen are being prioritized based on risk (i.e., currently pregnant, recent heart attack, etc.)
• pause of the comprehensive tobacco communications campaign (cessation and prevention)
• suspended youth engagement work that was focused on smoking prevention, as well as efforts to prevent and address vaping among youth and young adults
• suspension of virtual prenatal classes
• backlog of routine food safety and safe water inspections
• backlog of 14,200-plus doses for school-based immunization
• backlog of 4,500 infant and childhood vaccines
• 18-month backlog in school dental screenings
• 200-plus clients awaiting seniors’ dental services
• incomplete climate change vulnerability and adaptation assessment requiring completion to inform emergency management and adaptation strategies for future climate-related events and impacts
• suspension of programs related to healthy eating active living, mental health promotion, falls prevention, road safety, vision screening, and healthy environment indicator development, requiring revisiting
• pause on the comprehensive school health promotion approach, due to COVID-19 school response prioritization. There is a need to collaborate with students, parents, and educators to promote health and wellbeing of school-age children, provide education and resources, support implementation of healthy school policies, and promote leadership and engagement, while supporting students to develop healthy coping skills and habits
• environmental health program diverted resources to focus to pandemic response activities, which resulted in modified routine program work and reduced premise inspections. Prior to the pandemic, inspectors strived to complete 95 to 100 per cent of inspections in each program area. As of September 2021, program inspection completion rates remain significantly reduced when compared to 2019 (pre-pandemic)
• 53 per cent completion rate for food safety inspections in 2021, as compared to 98 per cent in 2019
• 34 per cent safe drinking water system inspections in 2021, as compared to 96 per cent in 2019
• 56 per cent of recreational water (pool inspections) in 2021, as compared to 100 per cent in 2019
• 25 per cent of personal service setting inspections in 2021, as compared to 90 per cent in 2019
• in addition, APH did not offer any safe food handling courses in 2020 or 2021. For comparison, 41 courses were offered in 2019 that certified 1137 individuals
• catch-up to increase inspection completion rates and corresponding education, guidance and support is needed to return to pre-pandemic rates and ensure health protection
• a waitlist of 74 families for Healthy Babies Healthy Children home visits, with referrals addressed in 2021 based on highest risk. In fall 2021, the waitlist was suspended due to COVID-19 surge support needed, and clients have been referred to community supports
• a suspension of virtual prenatal classes in fall 2021, which will require in-person resumption when safe to do so, as online classes resulted in low uptake by community members
• pause on in-person visits to Garden River Wellness Centre, which needs to resume enhancing virtual supports that have continued through the HBHC worker at the wellness centre
• suspension of healthy sexuality promotion activities, with only one outreach initiative at Sault College supported in 2021. Addressing this backlog in education and promotion is needed, as an increase in sexually transmitted infections from 2020 to 2021 is projected in Algoma
• due to prioritization of the COVID-19 vaccine rollout, tuberculosis testing, vaccination promotion, and assessment of records and students missing Immunization of School Pupils Act vaccines have been suspended
• the annual influenza rollout has been modified, with increased reliance on primary care and pharmacy partners, and reduced public health-led clinics to sustain COVID-related programs
• COVID-19 disrupted both in-person learning and routine well-child visits for many individuals over the course of the pandemic; therefore, many children have fallen behind on receiving recommended vaccines per the publicly funded immunization schedules for Ontario
• the immunization program is experiencing a school-based immunization backlog of 14,200 doses of vaccine to complete Grade 7 catch-up along with 3,370 doses required among newly eligible Grade 7 students this fall 2021. Grade 7 immunizations included meningococcal, HPV, and Hepatitis B vaccines
• there's a backlog of 4,500 infant and childhood vaccines to complete, which include Tdap-IPV, MMRV, Var, MMR, Men-C-C, Pneu-C-13, and DTaP-IPV-Hib vaccines
• a backlog of 3,000 adolescent tetanus, diphtheria, and pertussis (Tdap) catch-up doses
• delayed review and updating of medical directives, policies, procedures, and other program work such as immunization records, due to COVID-19 immunization prioritization
• the oral health program has experienced a 15-month backlog in Healthy Smiles Ontario preventative clinics for low-income children aged 0-17
• an 18-month backlog in school dental screenings and service delivery, which may result in worse oral health conditions than pre-pandemic state, causing a growth in post-screening notification follow-ups to be conducted
• an 18-month backlog in the Healthy Smiles Ontario and Essential Services Stream. As a result, some children that qualified for the program have been lost to follow-up and will be difficult to bring back into clinic for re-assessment, leaving oral health status unknown
• an 18-month backlog in the Children’s Oral Health Initiative with Garden River, where children receive screenings and fluoride varnish. The relationship with Garden River was paused due to suspension of services during the pandemic and staff-turnover requiring new connections to be developed
• 200-plus clients are awaiting services, specifically treatment plans with a dentist, as part of the OSDCP. OSDCP clinics were paused for a total of five months during the pandemic
• reduced case management of sexually transmitted infections, with APH communication to health partners being limited and work with stakeholders in providing health care somewhat prevented due to COVID-19 response
• limited to no health promotion and communication efforts to influence health behaviours in regards to sexual practices and injection drug use practices
• reduced screening and testing of clients at APH, without any outreach services provided, such as HIV point-of-care conducted for priority populations
• reduced frequency in assessment and reporting of latent tuberculosis infections, as compared to the pre-pandemic period, due to reduced testing
• delayed STI surveillance, trends, and analysis were paused, requiring revisiting and catch-up, including annual reporting for 2019 to 2021 to highlight the work of public health and impacts to population health and wellbeing, as well as updating of the Algoma Community Health Profile previously completed in 2018 to identify public health issues and priority populations for public health action
• revisiting Bridges out of Poverty, a poverty cultural awareness program that was suspended during the pandemic
• updating and surveillance reporting on influenza season vaccination and healthy growth and development program indicators, alongside other data and indicator reporting to assess the health status of Algoma and underpin the targeted planning of program and services (i.e. Cancer Care Ontario data)