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

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

Version: December 2, 2020

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.
• Minimize the impact of the epidemic on health systems, social services, and economic activity.


Being able to quickly test for COVID-19 is an essential part of managing and containing COVID-19 outbreaks. However, current access to rapid testing in NAN communities is extremely limited. As rapid testing devices become more accessible, the ability to detect and respond to COVID-19 cases will continue to improve. The turnaround time for these tests can range from two to three days to over a week. Improved testing will allow for increased flexibility in COVID-19 preparedness and response.


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.
• Ensure that the space, supplies, and necessary personnel are in place to respond.


Every community should prioritize all essential 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.

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.
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 Indigenous Services Canada-First Nations and Inuit Health Branch (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.
Maintaining Safe Pathways to Medical CareDevelop a community protocol to ensure that community members can continue to access essential medical care, including protocols for escorts.*
Protocols should consider the COVID-19 case levels in the communities where they are accessing health care.
Assess COVID-19 risk in all urban hubs.
Follow protocol developed for community members to access essential medical care, including escorts.
Assess COVID-19 risk in all urban hubs.
Implement a testing protocol for community members who must travel for medical purposes.
Continue to follow protocol developed to access essential medical care; see if escorts from the receiving community can be used.
Assess COVID-19 risk in all urban hubs.
Implement a testing protocol for community members who must travel for medical purposes.
Continue to follow protocol developed to access essential medical care; see if escorts from the receiving community can be used.
Assess COVID-19 risk in all urban hubs.

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