Guidance for Funerals and Bereavement during COVID-19

Updated August 28, 2020

INTRODUCTION 

Funerals can pose a risk to public health during a communicable disease pandemic. They are public gatherings where mourners are often in close contact, as they acknowledge and comfort each other with hugs and handshakes. These conditions make it easy for a virus such as the one that causes COVID-19 to spread, especially if a mourner attends who is not even aware that they have the disease.

 As of August 24, current Government of Ontario restrictions allow the following for regions that are in Stage 3 of reopening:

·       30 percent of the venue capacity for an indoor funeral ceremony or reception.

·       100 people for an outdoor funeral ceremony or reception.

·       Those attending must follow all public health measures, including practicing physical distancing from people who are not from their household or their established 10-person social circle.

These limits can further burden families who are already grieving. Memorials and funeral services are important for the family to experience closure and begin to heal from their loss. The ceremonies and rituals associated with this time are also sacred in both traditional and Christian faith.

Members of NAN’s COVID-19 Task Team have prepared the following document to help NAN community members honour the lives of their loved ones safely during COVID-19. NAN acknowledges that different communities will have different practices, values, and beliefs. This document is offered to support community discussion and direction; it cannot replace it.

CURRENT FUNERAL HOME PRACTICES 

The following information comes from the Bereavement Association of Ontario (BAO). The BAO regulates and supports licensed funeral, burial, and cremation services across Ontario. If the funeral of your loved one will be held at a licensed funeral home, the funeral home will observe the following practices:

·       The maximum number of mourners at the funeral cannot exceed 30 percent of the capacity of the room where services are being held and only if certain conditions, including the number of staff on-site, can be met. Otherwise, the funeral home may still need to restrict attendance. 

o   The funeral home hosting the service will be able to provide specific guidance on the number of mourners they can have at the service under BAO directives.

o   Anyone planning a funeral service should consult with the funeral home about how many mourners will be allowed at the service and plan accordingly.

o   Each baby or child counts as one person.

·       Every person attending the funeral must stay at least two metres apart from each other and from persons conducting the funeral unless they are members of the same household.

o   This also applies if people are waiting outside (for example, while waiting to go in if multiple visitations have been scheduled).

·       Every person attending an indoor funeral is required to wear a mask or face covering.

·       The persons conducting the funeral must ensure that it is conducted in compliance with the advice and instructions of public health officials, such as those that involve physical distancing, cleaning or disinfecting.

·       The persons conducting the funeral must ensure that any washrooms are cleaned and disinfected frequently.

·       The Funeral Director is responsible for ensuring that the persons conducting the funeral follow all BAO measures and guidance; if you have questions about COVID-19 measures while planning or conducting a funeral, you should discuss them with the Funeral Director.

·       A coroner’s certificate and all required and proper documentation is still necessary.

o   The Chief Coroner of Ontario is working on an electronic death certificate and Coroner’s Cremation Certificates are already issued electronically.

·       Pallbearers should wear personal protective equipment (mask and gloves).

·       Some funeral homes have started to install live-streaming capabilities for mourners who are unable to attend the funeral in person.

Mourners should also bring their own hand sanitizer or the persons conducting the funeral should ensure that handwashing or sanitizing stations are in place during the service.

FUNERALS AND SERVICES IN THE COMMUNITY 

Planning for funerals and memorials should be considered during pandemic planning. This applies to both deaths from COVID-19, as well as deaths from other causes, which will unfortunately continue during the pandemic.

To limit the potential spread of COVID-19 and to safeguard the health of community members, communities should consider similar limits on funeral services as those outlined by the BAO.

Some cultural, social and religious practices may need to change to reduce community risk during the pandemic. What that will look like will be different in each community; here are some suggestions NAN has heard from speaking with Elders and community workers:

  • Streaming services and memorials online are options. Appropriate privacy settings should be discussed and set up prior to the service.
  • If something must be placed in the casket, such as cedar or sweetgrass, a container could be provided during the ceremony. The container could then be placed in the casket after the service by someone wearing appropriate PPE (gloves and a mask).
  • Communities can hold a larger ceremony after the COVID-19 pandemic ends to honour everyone who passed away during that time.
  • Elders can work with family members to offer ceremonies during COVID-19. The family member at the service can make offerings, while the Elder does the ceremony in their (the Elder’s) home.
  • After a funeral or service, community members can drive by the family’s house to acknowledge their loss and show support.
  • If it is important to touch the deceased as part of ceremony, consult with Elders and traditional knowledge keepers on how to reduce your exposure as much as possible if you are concerned that the deceased was in any way exposed to COVID-19.
  • Consider holding funerals outside where there is more space and better ventilation, though physical distancing rules should still be followed.
  • Mourners should practice good hand hygiene and either bring hand sanitizer (where available) or frequently wash their hands (where possible).

SAFE PRACTICES AROUND THE DECEASED – DEATH FROM COVID-19 

  • Doctors and researchers do not know enough about COVID-19 to know how long the deceased remains infectious.
  • Until we know more about COVID-19, the recommendation is to treat the deceased as if  they are still infectious and take all reasonable precautions.
  • The owner or driver of any vehicle used to transport the deceased should be informed that the deceased is suspected or confirmed to be infected with COVID-19. The vehicle should be disinfected afterwards.
  • A deceased person suspected or confirmed to have COVID-19 should be placed in a body bag before transportation, and a disinfectant applied to the outside of the bag.
  • Anyone who will be handling the deceased’s body should follow best practices to reduce infection:
  • Practice proper hand hygiene before and after contact with the deceased.
    • Avoid any unnecessary movement of the deceased that may expel air from their lungs.
    • Wear appropriate PPE while handling the deceased.
      • ISC-FNIHB PPE requirements for care of the deceased, as of May 4, 2020: gown, gloves, face shield, and surgical mask.
    • Clean and disinfect all surfaces after they are finished handling the deceased.
    • Dispose or disinfect any equipment or supplies used during this time.
  • At the service, families should not touch the body of a person who has died from COVID-19 and should maintain at least 2 metres (6 feet) of distance between themselves and the deceased.
  • It is not recommended that an open casket funeral be held for someone who has passed away from COVID-19.

SAFE PRACTICES AROUND THE DECEASED – DEATH FROM OTHER CAUSES 

  • It is not advisable to hug a deceased family member during this time if there exists any risk that they may have been exposed to COVID-19.  People should stay at least 2 metres (6 feet) away from the body of their loved one if this risk exists.
    • This is from an abundance of caution; it is possible that somebody who passed from causes may also have been infected COVID-19.
    • It may also be possible for one mourner to pass COVID-19 on to another; for example, someone who is infected may leave virus particles on a surface, such as a casket handle, that is then touched by another mourner.
  • Hand sanitizer should be provided (if available) to support good hand hygiene.
  • People who are able to wear a non-medical face covering should do so if the service is being conducted indoors or if physical distancing cannot be maintained outdoors.

PLANNING FOR THE WORST 

When facing a pandemic, communities should also plan for the worst-case scenario: a very high number of deaths from COVID-19 that overwhelms the community. These are very difficult conversations to have. However, it is easier to determine an appropriate response before it is needed. In the worst-case scenario, community members will be grieving, and community capacity will be exhausted. Elders and knowledge keepers can help with these difficult conversations and provide guidance on a plan that respects community beliefs and values.

SUPPORTING FAMILIES AND COMMUNITIES 

Family members and anyone who cared for the deceased will likely need special support during this time. They may feel lonely or experience guilt that they were not able to provide their loved one with the funeral service they wanted or the ceremonies they had expected. Some ways of providing extra support while following public health guidelines could include: 

  • Speaking to the deceased’s loved ones by phone or video chat.
  • Asking if they need anything, like food or supplies, and dropping them off at their house.
  • Sending them a card or letter.

These feelings of guilt may be experienced by the larger community as well. Mental health supports and services that can be offered virtually or through telemedicine should be shared with the community. One of these services is NAN HOPE, which offers 24/7 toll-free rapid access to confidential crisis services; navigation and connection to existing services; and rapid access to clinical and mental health counselling. NAN community members can access this service by calling 1-844-NAN-HOPE or connecting to www.nanhope.ca.

The NAN COVID-19 Task Team Elders have released two statements that provide guidance on mourning and bereavement during this time:

NAN Elders’ Statement on Funerals & Bereavement

NAN Elders’ Statement on Ceremonial Fires

Download PDF

Independent First Nations Alliance

The Independent First Nation Alliance was incorporated in 1989 to provide its member communities with technical advisory and community development support programs.             

The Home Away Safety Team at IFNA has prepared an Information Package and Letter of Understanding for parents and students attending the IFNA Home Away Student Dwelling or boarding in Sioux Lookout and Thunder Bay. All parents and students are asked to read through the information and sign and return the Letter of Understanding by Wednesday, August 19, 2020. The form and information on the program are available at http://ow.ly/cmy350AZQXo

Sioux Lookout, P.O. Box 5010, 98 King Street, P8T1K6             

(807) 737-1902

Sioux Lookout First Nations Alliance Website

Sioux Lookout First Nations Alliance Facebook Page

Norwestern Health Unit Dryden

Update from Norwestern Health Unit: Health Unit staff are immunizing 2019-2020 grade 7 students who missed their second dose of immunizations due to COVID-19 and school closures. Please contact your local NWHU office to book an appointment. Get caught up before school starts.  Link below for more information https://www.nwhu.on.ca/OfficeLocations/Pages/OfficeLocations.aspx

All 2019-2020 grade 7 students who missed their second dose of immunizations due to COVID-19 and school closures, please contact your local NWHU office to book an appointment.

Monday to Friday 8:30 a.m. to 4:30 p.m.

   807-223-3301 or 1-888-404-4231              

https://www.nwhu.on.ca/Pages/home.aspx

http://ow.ly/MStl50AFxZW

https://www.facebook.com/TheNWHU

Canadian Red Cross: Meals on Wheels Timmins

Update from Canadian Red Cross: The Canadian Red Cross will provide Meals on Wheels Monday through Friday.

Meals on Wheels will deliver affordable and nutritious meals to members of the community who are unable to prepare their own food. They target individuals who continue to live independently while maintaining a healthy diet. Frozen meals are available in a variety of homestyle cooked foods including entrees, soup, and desserts. Grocery delivery/essential supplies is also available through this agency during the COVID-19 pandemic by contacting 416-256-3010.

Monday – Friday: 8:30 a.m. – 4:30 p.m.  

60 Wilson Avenue, Suite 201,Timmins ON, P4N 2S7             

705-267-4900   

View Website

Anti-Hunger Coalition

Update from Anti-Hunger Coalition: The Emergency Food Hamper program is still running. Anyone in need can call 2-1-1 to register. Each person who is registered will be followed up with to arrange for a drop-off date for the boxes. The boxes contain a $25 grocery store gift card or $24 market dollars that can be spent at our farmers’ markets, non-perishables, as well as some fresh fruits and veggies — it’s meant to take the place of a monthly food bank run. The program is specifically for people who are stuck at home and can’t get out to a food bank.

Update May 11, 2020: Individuals in need of emergency food hampers are asked to call 211.  A 211 representative will go through the initial eligibility screening process (identification and registration). Those eligible include: seniors (65 and older), shut-ins, single parents with children who are unable to be left alone & have no supports, individuals with mobility challenges/illness, individuals who are self-isolating that require food.  Once qualification is established, a registration form must be filled out. This form can be found here: https://hipaa.jotform.com/AntiHungerCoalition/EmergencyFoodHamper

Anti-Hunger Coalition Timmins is offering a free home delivery service from now until June.

10-Week Meal Costing Model for Community Needs – expected to start Sat April 4, 2020

April box being delivered April 16

Anti-Hunger Coalition Timmins is excited to announce that from now to June, they will be offering FREE home delivery on all Good Food Box orders! The service will be the third Thursday of each month The deadlines for orders are: April – Orders Due: April 2 – Orders Delivered: April 16 May – Orders Due: May 7 – Orders Delivered: May 21 June – Orders Due: June 4 – Orders Delivered: June 18

View website below:

Anti-Hunger Coalition website

Sioux Lookout Meno Ya Win Health Centre

Update August 21, 2020:

At Sioux Lookout Meno Ya Win Health Centre (SLMHC), we continue to review how to best provide our services during this global pandemic.  Many outpatient and non-urgent services were suspended in the spring of 2020, and planning has been underway to re-introduce these services in a slow and steady manner.  During this time, we want to keep you well-informed and safe; especially as Ontario operates in stage three of re-opening the province under various restrictions.

Like many other hospitals across Canada, we know that we must remain vigilant and abide by provincial guidelines.  Below are links and guidelines on current restrictions and services.  We continue to work collaboratively with our partners to ensure a seamless transition to and from the hospital.  Please be aware that restrictions and services are subject to change if there are an increasing number of COVID-19 cases in our region. For the most up-to-date information, please visit our website.

Entrance to Hospital and Screening

We continue to maintain the Emergency entrance as the sole-entrance to the hospital for patients and visitors.  Screening staff are at the entrance 24 hours a day.  Anyone entering will be screened, asked to wash their hands, and reminded to put on a mask. We encourage all individuals to bring their own cloth mask.  Disposable masks are available if required, and additional masks are available for purchase in our vending machine at a cost of $2.00. 


Visitors (includes visitors, care partners, escorts)

Earlier in the pandemic we implemented visitor restrictions. As we are continuing to see low numbers of COVID-19 cases in the region, our restrictions are being adjusted.

Hospital Site

  • Inpatients at the hospital may now have two visitors at a time.
  • Outpatients are allowed one visitor. (Outpatients include anyone coming in for an appointment based at SLMHC as well as those coming in for Emergency care)

William A. George Extended Care Unit (ECU)

  • We are now allowing indoor and outdoor visits with residents and their loved ones at ECU. These must be scheduled ahead of time and can be arranged by contacting the Team Lead at (807) 737-3030 ext. 4577.

For questions about visitor restrictions and more information, visit www.slmhc.on.ca/covid19.

Masks

All of our staff, patients and visitors have been required to wear masks since the start of the pandemic. This continues and we are asking the public to bring their own cloth masks, in an effort to conserve our medical-grade supply. Fabric masks are available at many local and regional businesses, and we thank you for your commitment to health and safety.

Our Staff and Processes

Our staff continues to follow many strict protocols to protect themselves, and every patient and visitor, here at SLMHC. Some of our administrative staff continues to work from home, but all essential frontline staff continues to be onsite and deliver on our commitment to Excellence Every Time.

We thank each and every one of our staff and physicians for their dedication to health care services during this time, and thank all of our patients, clients and care partners for their patience.  We understand that the pandemic has affected many areas of our lives, and it is important that we stay strong, be kind, and be supportive of each other during this time.  We will get through this together!

Our Services

Some of our services were temporarily paused at the start of the pandemic, but many have also continued to operate. In efforts to ensure everyone has accurate information about each of our departments/services here, we are working to ensure our website is kept up-to-date on each department/service page.

Please view our Departments and Services pages for specific information on how each service is being operating at this time.  If you have any specific questions about a service or appointment, please call our main switchboard at (807) 737-3030.

Getting more Information

We have a dedicated COVID-19 page on our website. This provides information about our services, our COVID-19 Assessment Centre, and how COVID-19 is impacting us at SLMHC. This is all available online, anytime, at www.slmhc.on.ca/covid19.

Sioux Lookout Meno Ya Win Health Centre Website

Visit the SLMHC COVID-19 Resource Page

NAN COVID-19 Bulletin- August 20, 2020

Nishnawbe Aski Nation (NAN) COVID-19 Update                                                                                                                                           

Thunder Bay District Health UnitConfirmed Positive (August 6): 100
Active Cases: 0 (last reported on August 11)
Resolved Cases: 99
Deceased: 1
Porcupine Health UnitNumber of cases: 72
Active Cases: 0 (last reported case on August 5)
Recovered: 64
Deceased: 8
Northwestern Health UnitTotal Number: 45
Active: 1 (last case was reported on August 18 in the Kenora area)
Recovered: 44
Deaths: 0
Public Health Sudbury & DistrictsTotal Number: 93
Active: 3 (last case confirmed on August 19)
Recovered: 88
Deaths: 2
Timiskaming Health UnitTotal Number: 19
Active: 0 (last case reported on July 28)
Recovered: 19
Deaths: 0
  • Thank you to Bishop Lydia Mamakwa for joining us on today’s call and leading us in prayer.
  • SAVE THE DATE: NAN Chiefs Virtual Fall Assembly – October 20/21.
  • We need to ensure that messaging and recommendations around public health measures and physical distancing are still being followed in our communities. Each community must be as vigilant as ever and we still cannot afford to relax the measures that are in place.
  • We have made a decision to gradually re-open the NAN offices in some capacity on Monday October 5th. We are working hard to ensure that we do this in a way that is respectful of all the needs and concerns of our staff, while keeping in mind the important work that we are doing for NAN communities.
  • PLEASE SEND ANY NEW COMMUNITY GUIDELINES/ RESTRICTIONS THAT YOUR COMMUNITY HAS IN PLACE TO emergency@nan.ca.

Tele-mental Health Initiative

  • On August 10, the Mental Health and Addictions Pandemic Response Program went live at 1-844-NAN-HOPE (1-844-626-4673) and www.nanhope.ca.
  • This program is available to all NAN First Nations community members, whether they are living on or off reserve.
  • NAN HOPE can be accessed through phone, text, or live chat.
  • The program offers 3 services:
    • 24/7 toll-free rapid access to confidential crisis services.
    • Rapid access to clinical and mental health counselling.
    • Navigators who provide connection to existing mental health and addictions support services in home communities and the region.
  • NAN HOPE is currently receiving 5 to 10 calls/texts a day; the Task Team expects usership to increase as program partners SLFNHA, KO eHealth, and Dalton Associates continue to promote it.

NAN COVID-19 Task Team                                                                                                                                           

  • The Task Team continues to meet once a week to discuss issues related to COVID-19 in NAN territory, including community access to rapid testing; mental health supports for community members in urban areas; and the province’s Guide to Reopening Ontario Schools.
    • The Task Team is working with NAN’s Education Department to support communities as they determine how to safely reopen their schools during the COVID-19 pandemic.
  • Task Team Members are working with Meno Ya Win and local health units to develop a communications protocol for use during the COVID-19 pandemic and in other serious incidents, such as community evacuations.
  • Two members of the NAN Youth Council, Linden Waboose and Theya Quachegan, have joined the Mental Health and Substance Use Working Group.
  • NAN community members should continue to practice the measures that have limited the spread of COVID-19 in our communities so far, including physical distancing, good hand hygiene, covering your cough, and maintaining a 14-day self-isolation period when returning from travel outside of the community.
    • The Task Team also recommends that older children and adults should wear a mask or face covering in indoor public spaces or outdoor areas where physical distancing measures cannot be maintained.
    • This recommendation does not apply to children under the age of 2, anyone who cannot wear a mask for medical reasons, or those requiring other accommodations.
    • Anyone who is concerned that they may have been exposed to COVID-19 or who has any symptoms consistent with COVID-19 should seek testing.

NAN Critical Preparedness, Readiness and Response Action Document

  • The Task Team has reviewed and revised the NAN Critical Preparedness, Readiness and Response Actions document that we sent out a few months ago.
    • This updated document provides suggested actions communities can take to plan for and respond to different scenarios of COVID-19 spread in a community, from no cases to sustained community transmission.
    • This document was originally shared with communities on April 15, 2020.
  • The changes in the revised version include highlighting the importance of planning and preparation when there are no cases, information on non-medical mask use, and the importance of other public health measures as well as testing.

The revised Readiness and Response Actions is posted to www.nancovid19.ca and attached with this bulletin.

Ontario First Nations Limited Partnership (OFNLP)

  • Thank you for Brian Davey for coming on the call today to present the information to leadership.
  • On July 15, the Ontario government allowed the casinos to reopen with up to 50 people capacity per Ontario’s stage 3 reopening plan. Not many casinos took up this option, and as a result there is a major impact on casino revenues. We are estimating a 50% drop in First Nations revenue next year due to COVID-19 closures, and this should be considered when planning for future activities.
  • Virtual AGM will be held on September 17, 2020, and we encourage you to participate.

Canadian Rangers

  • Thank you to LCol Shane McArthur for joining us on today’s call.
  • Communities are asked to submit their request for assistance for the Canadian Rangers to PEOC. It is recommended that communities inform the patrol sergeant that a request has been submitted. Currently we are seeing that there is a communication gap between the two and we want to ensure that is mitigated.
  • On August 30, Class D patrols will end and return to normal operations.
  • The Canadian Ranger Instructors are ready to return to the communities when communities request them to come in for training. They will be strictly adhering to public health measures and any measures put in place by the communities.
  • September 21 – October 2 – Training for 30-40 Rangers. Strict public health measures will be followed at camp. Chief and council must give consent for members to participate.
  • Exercise Ranger Tracker – October 21-31.

NAN Education                                                                                                                                           

  • NAN submitted a proposal for education support to address health and safety concerns as related to the pandemic
    • NAN is yet to receive a response from Federal and Provincial governments on this plan.
  • The province has allocated $850 million to provincial schools, but so far, we have not seen anything committed for First Nation schools.
  • NAN understands that communities will have a varied response to schools reopening and encourages communities to contact our education team if assistance or supports are required.

Nishnawbe Aski Police Services (NAPS)                                                                                                                                           

  • NAPS officers responded to 18 major occurrences over the last two weeks.
  • Sexual assaults and domestic violence incidents continue to be regular occurrences.
  • NAPS is anxiously waiting to hear from the federal and provincial governments with respect to the proposal submitted to assist victims and survivors of violence. NAN continues to strongly advocate for this proposal to be funded through the trilateral table.
  • NAPS signed an MOU with the officer’s union to extend the 14-day schedule under the collective agreements, the extension is now in place until December 31, 2020.
  • Specialized officer positions have now been filled.
  • NAPS is in the process of developing priorities for funding agreement negotiations.

Communications                                                                                                                                           

  • Members of the NAN Executive Council will continue to appear on Wawatay Radio on Tuesday at 12 pm EST and on Friday at 1:05 pm EST.
  • COVID-19 Tools and Resources are being translated into Oji-Cree, Ojibway, and Cree to assist the communities in spreading awareness and public health messaging on COVID-19. They are posted on the NAN website under COVID-19 Tools and Resources.

Urban Communities 

  • NAN has posted specific information on the NAN website for members living off-reserve in urban centres across northwestern and northeastern Ontario.
    • This includes how to find shelters, food banks, social and mental health services, as well as Indigenous organizations that can assist.
  • Please continue to access our website as we are updating it daily with the most up to date information: www.nancovid19.ca.

You are aware that for the summer months we moved to our calls to once every two weeks to allow for some rest. In September, we will be reevaluating the timing of these calls and we may return to a weekly schedule. We will keep leadership updated on our plans.

NEXT CALL: Thursday, September 3, 2020 | 1p.m. EST | 12p.m. CST

Download PDF

Framework for Easing Restrictions

Memo- Masking Recommendations

NAN- Host Site Guidance Document

NAN Critical Preparedness Readiness and Response Actions for COVID-19 Transmission Scenarios

Version: August 18, 2020

It has been demonstrated that COVID-19 transmission from one person to another can be slowed or even stopped. Early actions can save lives and provide more time to:

  • finalize pandemic plans,
  • prepare and strengthen emergency response systems,
  • increase capacity to detect and care for patients; and
  • ensure that the space, supplies, and necessary personnel are in place to respond.

Every community should prioritize all necessary measures to slow the further spread of COVID-19 and to avoid having their health systems become overwhelmed as a result of needing to care for patients who are seriously ill with COVID-19.

NAN Critical Preparedness Readiness and Response Actions for COVID-19 Transmission Scenarios (NAN Critical Preparedness Readiness and Response Actions) aims to:

  • slow and stop transmission, prevent outbreaks, and delay spread,
  • Provide optimized care for all patients, especially the seriously ill; and
  • Minimize the impact of the epidemic on health systems, social services, and economic activity.

All communities should increase their level of preparedness, alertness and response to identify, manage, and care for cases of COVID-19 if they are detected. Communities should prepare to respond to different public health scenarios, recognizing that there is no one-size-fits-all approach to managing cases and outbreaks of COVID-19. Each community should assess its risk and rapidly implement the necessary measures at the appropriate scale to reduce both COVID-19 transmission and economic, public health, and social impacts.

Communities should adjust and tailor their approach to the local context. Be prepared to respond to all transmission scenarios, following the framework laid out in the NAN Critical Preparedness Readiness and Response Actions. Prioritization and focus of resources for each technical area will depend on which transmission scenario your community is managing.

The attached table (Table 1) is meant to be a living document and should be updated by the community as responsible partners and resources are identified and the on-the-ground situation develops.

Nishnawbe Aski Nation is working closely with local public health units and the federal and provincial governments to identify roles and responsibilities of each.  As these conversations progress, we will continue to provide updates so that there is a comprehensive and coordinated approach outlined that takes into consideration both community and regional considerations.

TABLE 1: NAN CRITICAL PREPAREDNESS READINESS AND RESPONSE ACTIONS FOR COVID-19 TRANSMISSION SCENARIOS

No Cases Sporadic Cases Clusters of Cases Community Transmission
Transmission ScenarioNo reported cases.One or more cases from travels or locally acquired.Entire households infected. Linked to local transmission.Inability to trace case origin through chains of transmission.
Primary GoalPrevent virus from entering the community.Stop further transmission and prevent spread.Stop further transmission and prevent spread.Slow transmission, reduce case numbers, end community outbreak.
Priority Areas of Work
Community ResponseDevelop/update pandemic and business continuity plans.
-Establish partnerships early and complete risk assessment.
-Include considerations for funeral and bereavement practices (see Care for Deceased Persons below).
Identify pandemic planning team, IMS structure, roles and responsibilities.

Receive EM training.

Limit nonessential travel through the implementation of a non-essential community travel ban.

Ensure adequate supplies of food and water in community.

Identify cross-trained staff to backfill essential roles.
Activate pandemic plan.

Implement public health measures, consider curfews.

Declaration of emergency at the community level.

Re-deploy cross-trained staff to backfill essential roles.
Scale up emergency response:
-strict enforcement of public health measures;
-implement curfews;
-ban social gatherings of 5 or more.

Maintain essential worker staffing pool.
Scale up emergency response measures.
-strict enforcement of public health measures;
enforce curfews;
enforce ban on social gatherings of 5 or more.
Public Health GuidelinesHand hygiene, cough/sneeze etiquette, physical distancing.

Mandatory 14-day isolation on return to community.
Implement airport and community checkpoint screening processes.

Enhanced cleaning and sanitization procedures.

Consider use of non-medical masks/face shields in indoor or outdoor spaces where physical distancing is not possible.

All individuals present within the community (members and non-members) should self-monitor for COVID-19 symptoms.
Hand hygiene, cough/sneeze etiquette, physical distancing.

Mandatory 14-day isolation on return to community.

Implement airport and community checkpoint screening processes.
Enhanced cleaning and sanitization procedures.

Recommend use of non-medical masks/face shields in indoor or outdoor spaces where physical distancing is not possible.

All individuals present within the community (members and non-members) should self-monitor for COVID-19 symptoms.
Hand hygiene, cough/sneeze etiquette, physical distancing.

Mandatory 14-day isolation on return to community.

Implement airport and community checkpoint screening processes.   Enhanced cleaning and sanitization procedures.

Require use of non-medical masks/face shields in indoor or outdoor spaces where physical distancing is not possible.

All individuals present within the community (members and non-members) should self-monitor for COVID-19 symptoms.
Hand hygiene, cough/sneeze etiquette, physical distancing.

Mandatory 14-day isolation on return to community.

Implement airport and community checkpoint screening processes.

Enhanced cleaning and sanitization procedures.   Require use of non-medical masks/face shields in indoor or outdoor spaces where physical distancing is not possible.

All individuals present within the community (members and non-members) should self-monitor for COVID-19 symptoms.
CommunicationEducate and actively communicate with the community membership using approved Public Health messaging.
-Consider how information is shared with the community and by whom.
-Communication with certain groups, such as Elders. should be given special considerations
-Include social media in community messaging.

Identify a communications lead within the IMS structure to manage messaging and ensure accuracy.

Develop a protocol for managing incoming and outgoing communications.
Educate and actively communicate with the community membership using approved Public Health messaging

Communications lead continues to manage incoming and outgoing flow of information.
Educate and actively communicate with the community membership using approved Public Health messaging

Communications lead continues to manage incoming and outgoing flow of information.
Educate and actively communicate with the community membership using approved Public Health messaging

Communications lead continues to manage incoming and outgoing flow of information.
Case Identification, Contact Tracing, and SurveillanceConduct active case finding and surveillance.

Train and engage community members for contact tracing.

Define roles and responsibilities of contact tracing team.
Enhance active case finding, contact tracing, and surveillance.Intensify active case finding, contact tracing, and surveillance.Continue active case finding and surveillance; contact tracing may no longer be possible/applicable.
TestingTest all individuals with COVID-19 symptoms.

Test Elders and vulnerable patients/people with atypical symptoms.

Share the messaging that all community members should continue to follow public health measures despite negative test results, especially any mandatory 14-day self-isolation period. Share education on the limits of testing, such as that it is just a snapshot in time.
Test all individuals with COVID-19 symptoms.

Community testing for contacts of confirmed cases.

Share the messaging that all community members should continue to follow public health measures despite negative test results, especially any mandatory 14-day self-isolation period. Share education on the limits of testing, such as that it is just a snapshot in time.
Test all individuals with COVID-19 symptoms.

Community testing for individuals in contact with cases and clusters.

Share the messaging that all community members should continue to follow public health measures despite negative test results, especially any mandatory 14-day self-isolation period. Share education on the limits of testing, such as that it is just a snapshot in time.
If testing capacity insufficient prioritize testing for:
-people at risk of developing severe disease;
-symptomatic health workers;
-andthe first symptomatic individuals in a closed setting (e.g. overcrowded houses).

Share the messaging that all community members should continue to follow public health measures despite negative test results, especially any mandatory 14-day self-isolation period.

Share education on the limits of testing.
Infection Prevention and ControlTrain nursing and community health staff on COVID-19-specific infection prevention.

Develop a tracking and auditing mechanism for PPE.

Develop a community PPE protocol.

Order additional PPE.

Ensure 14-day supply of PPE.
Train nursing and community health staff on COVID-19-specific infection prevention.

Track and audit PPE use.   Educate community membership on proper PPE protocol.

Ensure 14-day supply of PPE maintained.
Train nursing and community health staff on COVID-19-specific infection prevention.

Track and audit PPE use.

Educate community membership on proper PPE protocol.

Ensure 14-day supply of PPE maintained.
Train nursing and community health staff on COVID-19-specific infection prevention.

Track and audit PPE use.

Educate community membership on proper PPE protocol.

Ensure 14-day supply of PPE maintained.
Health Infrastructure All patients can be treated at nursing station.

Prepare nursing stations for isolation, patient flow, enhanced cleaning, etc.

Identify and prepare additional locations for COVID-19 care within existing infrastructure, including places for overflow and self-isolation.

Identify and prepare quarantine location in community.
Nursing station near capacity.

Patients with COVID-19 may require medivac to regional center.

Additional medivac supports required.   Continue preparation and/or complete additional locations for COVID-19 care.

Maintain quarantine location in community.
Nursing station at capacity.

Additional locations for COVID-19 care in use.

Operational supports are a necessity.

Additional medivac supports required.
Maintain quarantine location in community.
Nursing station and community infrastructure for COVID-19 care approaching capacity.

Additional operational support/relief will be required.

Additional cases sent to regional centers with surge capacity.

Maintain quarantine location in community.
COVID-19 Assessment and CareSet up screening and triage at all health care access points.

Prepare to care for COVID-19+ patients.

Set up COVID-19 hotline and referral system.

Develop list of community members at highest risk of complications from COVID-19 to inform future evacuation planning.
Screen and triage at all health care access points.   Care for suspected and confirmed patients according to clinical protocols.

Set up isolation facilities.
Screen and triage at all health care access points.

Care for suspected and confirmed patients according to clinical protocols.
Evacuate people exposed to COVID-19 who are at high risk of complications.
Screen and triage at all health care access points.

Care for suspected and confirmed patients according to clinical protocols.

Prepare family and community for grief and bereavement care.
Health Care CapacityReceive initial supply of oxygen therapy equipment.

In cases of delayed transport from the community, nurses may require additional training in oxygen therapy.

Develop surge plan, including considerations for medivac capacity.

Identify community health workers who could support the clinical response to COVID-19 and begin training.

Inventory critical supplies every week.
Demand additional health staff support from ISC/FNIHB, including infrastructure solutions for housing them.

Receive additional oxygen therapy equipment.

Implement surge plan.

Community health workers are trained and can begin supporting COVID-19 response.

Inventory critical supplies every day. Reorder and restock as needed.
Additional health staff arrive in community.

Scale up surge plan.

Identify and set up palliative care sites.   Inventory critical supplies every day.

Reorder and restock as needed.
Regional health centres provide surge capacity.

Inventory critical supplies every day.

Reorder and restock as needed.
Care for Deceased Persons Ensure procedures and supplies in place for safe handling of the deceased, including additional PPE.

Develop community guidelines for funeral and bereavement practices (including deaths unrelated to COVID).

Develop plan for repatriating those deceased outside of community.

Enforcing public health measures at funerals can be traumatizing for community members; consider plans to support their mental health and healing, or to minimize this trauma (through using outside crisis support).
Follow procedures for safe handling of the deceased   Ensure appropriate supply of PPE.

Develop surge plan.   Implement repatriation plan.
Follow procedures for safe handling of the deceased   Ensure appropriate supply of PPE.

Implement surge plan.
Follow procedures for safe handling of the deceased   Ensure appropriate supply of PPE.

Scale up surge plan.

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