A highway sign notifies drivers to stay-home as they make their way along the Queensway in Ottawa on Thursday, Jan. 14, 2021. (Sean Kilpatrick/THE CANADIAN PRESS)

Ottawa Public Health says it plans to make several recommendations to the provincial government about ways Ontario could better address issues that emerged during its pandemic response.

Reports prepared for the meeting next Monday outline several lessons OPH said it learned over the course of the COVID-19 pandemic. One report focused on lessons learned overall and a second focused solely on lessons learned from managing the pandemic in long-term care settings.

"[T]he pandemic has shone a light on gaps in how Ontario’s public health, health care and social support systems function, putting people at risk for poor health," the overall report says. "Improvements to close these gaps have been made over the course of the pandemic response, and this report outlines recommendations aimed at addressing ongoing systemic issues, with the objective of strengthening the public health, health care and social support sectors across Ottawa and the Province."

OPH listed several recommendations it plans to make to the province with the aim of improving public health responses as the COVID-19 pandemic continues and to protect the health of citizens should another medical crisis arise.

One message within the overall report was a lack of clarity and transparency in some of the messaging from the province. Cited as a challenge, OPH said it found that there was "a perception that restrictions and requirements were either inconsistent, contradictory, or not evidence-based." It also said that its ability to provide credible information to the public "has been challenged by competing voices throughout the pandemic response" and that there were "instances where residents and/or workplaces expressed confusion and frustration over what they perceived as conflicting guidance and messaging from the various levels of public health agencies, which can erode credibility."

Where the public health unit would like to see improvements is in providing evidence-based and clear rationale for decisions that could affect or close businesses and that the provincial government provide technical briefings in advance of major announcements "to ensure messaging is clear and concise for a successful communication roll-out."

When the Ontario government announced its provincewide shutdown, Mayor Jim Watson said the city was "blindsided" to learn Ottawa would be locked down for 28 days despite low COVID-19 figures at the time. It also took the City more than a day to clarify how it would enforce Ontario's stay-at-home order after it was announced on Jan. 12 because officials said they had yet to see information from the provincial government.

OPH said finding out about new restrictions or rules at the same time as the general public challenged their ability to field inquiries on guidance, expectations and enforcement. 

Sick pay key to reducing workplace spread

Paid sick leave was cited in both reports as an important tool for keeping the spread of COVID-19 and other communicable diseases to a minimum. 

"The fact that many workers do not have paid sick time or stable, full-time, employment posed challenges in terms of some workers facing a choice between staying home when sick and having enough income to cover essential costs, such as for food. Health authorities and buinesses were faced with the transmission consequences of workers with symptoms going to work and employers not consistently actively screening out such workers," the overall report states.

The report focused on long-term care also cited employment standards. 

"When employees can stay home when ill without financial repercussions, such as when they have access to paid sick leave, the risk of transmission of infectious illnesses within homes, and resulting costly outbreaks, will be reduced," the LTC report says. 

OPH is recommending that the province standardize and incentivize wages and benefits and improve working conditions for health-care workers in long-term care homes, possibly by creating a new minimum wage specifically for long-term care workers or having the Ministry of Long-term Care fund a percentage of positions in each home.

Outbreaks in long-term care homes and retirement homes in Ottawa are responsible for a majority of COVID-19 related deaths in the city and a significant number of cases. While conditions improved in the fall wave compared to the spring, the fatality rate was still disproportionately high.

OPH says there were 78 outbreaks in long-term care homes between March and December 2020 at 26 of Ottawa's 28 long-term care homes. This led to 1,540 people testing positive (906 residents and 634 staff) and 282 deaths. 

The fatality rate among long-term care residents in March, April and May was 38.5 per cent. It dropped to 17 per cent in September, October, and November.

OPH says the most successful homes had certain things in common: the ability to cohort or isolate on-site those who have tested positive, access to single rooms for residents, sound staffing practices, and 24/7 infection prevention and control (IPAC) oversight and accountability for implementing and monitoring IPAC practices.

OPH recommends the province review governance structures and accountability measures related to long-term care homes and examine and define appropriate staffing levels for the various types of positions among front-line LTC workers. The health unit is also recommending the province require each home to hire, train, and retain at least one in-house IPAC expert and to have a comprehensive IPAC/outbreak plan in place with the means to implement it.

The Board of Health meets Feb. 8 at 5 p.m.