New Brunswick

Horizon quietly reverts to modified orange COVID-19 alert level

In the face of record case numbers, hospitalizations and deaths, the Horizon Health Network has quietly reverted to a "modified orange alert level," internal documents reveal.

Public Health implements several changes in testing at Horizon and Vitalité as they face backlogs, shortages

COVID-19 patients require more staffing than other diseases, Horizon's interim president and CEO Dr. John Dornan has said. A person with COVID-19 requires 24/7 monitoring in the ICU, taking resources from other parts of the hospital. (CBC)

In the face of record case numbers, hospitalizations and deaths, the Horizon Health Network has quietly reverted to a "modified orange alert level," internal documents reveal.

Horizon, along with the Vitalité Health Network, has also changed some of its COVID-19 testing protocols, under the direction of Public Health. Both organizations are struggling to deal with backlogs and staffing shortages, as intensive care beds fill up with COVID patients who require constant care.

One of the changes drops the requirement for health-care workers who have not provided proof of full vaccination to complete a standard PCR (polymerase chain reaction) test once a month.

It's unclear if any of the changes are related to concerns about future testing supplies, but one Public Health document indicates it's "essential" to preserve resources and another shows a move away from the "gold standard" swab for sample collection.

Neither Horizon nor Department of Health officials responded Tuesday to a request for comment on supply stocks.

On Wednesday, Chief Medical Officer of Health Dr. Jennifer Russell said, "We don't currently have any issues or reports around supply issues."

She failed to answer how supplies are expected to hold up in the weeks and months ahead.

Horizon sent staff, physicians and volunteers updated orange phase guidelines last Wednesday, two days before the province reinstated the state of emergency.

"With the recent increase in confirmed COVID-19 cases and hospital admissions, particularly ICU admissions, in New Brunswick, we are closely monitoring our health care system, notably our capacity to care for urgent and emergency cases, while maintaining essential services," interim president and CEO Dr. John Dornan wrote in a memo, obtained by CBC News.

The updated COVID precautions and protocols are based on direction from Horizon's infection prevention and control COVID-19 committee, he advised.

They cover a range of topics, including the continuous use of face masks and eye protection, inpatient passes and leaves of absence, the management of patients with exemptions from wearing a mask, as well as general and compassionate visitation.

"We are not reverting completely to the Orange Phase in our facilities," Dornan said in a clarification memo the following day. "Rather we are returning to a modified Orange Alert Level."

The distinction between the two is not detailed in the documents.

Although the province moved to the green phase and removed all Public Health restrictions on July 30 at 11:59 p.m., all Horizon facilities had remained in the yellow phase.

New Brunswick is no longer under the green phase of COVID-19 recovery, according to Department of Health spokesperson Bruce Macfarlane.

"We are not in any [colour]," he said in an emailed statement Wednesday afternoon, without elaborating.

The province has not announced a colour change. It reinstated the COVID-19 state of emergency and mandatory order last Friday, but made no mention of green being dropped.

Sentinel testing in hospitals stopped

Horizon and Vitalité have both stopped so-called sentinel COVID testing in their emergency rooms and hospitals.

"The purpose of ER and hospital admission sentinel testing is to detect asymptomatic transmission of COVID-19 when no exposure risk is identified," according to a Sept. 23 memo from the province's Deputy Medical Officer of Health Dr. Cristin Muecke.

"Given the current level of COVID-19 circulating across N.B., it is essential that we preserve lab capacity and resources to effectively manage COVID outbreaks across the province," she told the medical chiefs of staff, emergency room service heads and managers of both regional health authorities.

"Effective immediately sentinel testing in emergency rooms and hospitals will be discontinued," she wrote.

Horizon and Vitalité hospitals continue to screen for COVID-19 in patients presenting with compatible symptoms and/or those in whom COVID-19 symptom screening is not feasible, such as trauma cases, according to the memo.

Gold standard swab requires more certification to perform

Earlier this month, Muecke also sent new direction to the regional health authorities on the use of nasopharyngeal and nares/throat swabs for COVID-19.

Nasopharyngeal swabs, those inserted deep into a person's nostril, remain the "gold standard for COVID-19 sample collection," for both PCR tests and rapid tests, she wrote.

The nares/throat collection method, where either the anterior of the nostril or the throat near the tonsils is swabbed, was previously used only in children under 12.

But now, the assessment centres can use either method for any age.

The nares/throat swab will "continue to provide a high reliability of result," wrote Muecke, and "broaden the pool of professionals with the necessary skills to collect the sample."

Nasopharyngeal swabs remain the gold standard, but nares/throat specimens have a 95 per cent sensitivity, which is 'comparable,' according to a Public Health memo. (Kamran Jebreili/AP Photo)

It has "a 95 [per cent] sensitivity which is comparable to a nasopharyngeal specimen," according to the memo.

The swish and gargle method is another alternative for all age groups, but it is "not preferred given the additional time and preparation required," Muecke wrote.

Jean Daigle, Horizon's vice-president of community, confirmed nasopharyngeal swabs are considered the gold standard for COVID testing, but said all three methods are effective.

"The main benefit of the use of nares/throat collection method is that it broadens the pool of staff we are able to harness to build capacity in our assessment centres — particularly when demand for testing is high — as this method doesn't require the same level of certification to administer as nasopharyngeal swabbing," he said in an emailed statement.

No other details were provided.

Monthly test for unvaccinated workers dropped

As of Sept. 23, Horizon had 152 staff off work for COVID-related reasons.

On Sept. 24, Gail Lebel, Horizon's chief human resource officer, notified all staff, physicians and volunteers about "amendments to COVID-19 testing requirements," under the province's mandatory vaccination policy.

"Since its roll out, point-of-care testing (POCT) three times per week has proven itself effective given the level of virus circulation. Consequently, Public Health has requested that GNB amend the testing requirements," she wrote.

"Effective immediately, health care workers who have not provided proof of full vaccination are not required to complete a regular monthly PCR test."

Health-care workers still need to complete the rapid tests three times per week and schedule a PCR test immediately if they get a positive result or have two or more symptoms, Lebel advised.

"Additional information on the POCT testing process will be communicated next week."

Chief Medical Officer of Health Dr. Jennifer Russell has previously said rapid COVID-19 tests are useful for screening, but they're not diagnostic. PCR tests are considered the gold standard, she has said. (Brooklyn Currie/CBC)

On Wednesday, Dornan told CBC's Information Morning Fredericton that Horizon couldn't keep up with the monthly tests for its workers because so many other people in the community need them right now.

Under the circumstances, the at-home rapid tests are reliable enough to provide a safe workforce in hospitals, he said.

Under the mandatory vaccination policy, health-care workers must either show proof of vaccination or follow testing and masking requirements.

But Premier Blaine Higgs said Monday the province may not give health-care workers a choice much longer if the situation doesn't improve. Vaccines could soon become mandatory, he said during an interview with CBC's Information Morning Moncton.

"I'm not willing to wait any more than this week. If we find that we need to go further, we will go further."

New Brunswick reported one more COVID-related death and 84 new cases Wednesday, putting the total active case count at 657.

Forty people are hospitalized with the respiratory disease, including 16 in intensive care.

On Sept. 23, when the province had 574 active cases, with 27 people hospitalized, 12 of whom were in intensive care, Horizon's five largest hospitals were nearing or over capacity and the Vitalité Health Network's hospitals had reached 96.4 per cent capacity.

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