Recovring



left3200400047595371913678Recovering from COVID-19A Roadmap: Expansion, Contraction, Resilience and Re-ImaginingThis document was developed by the Toronto Humane Society for its own use and is a work in progress. Please feel free to use and change it as you wish.Last updated June 11, 20205850020000Recovering from COVID-19A Roadmap: Expansion, Contraction, Resilience and Re-ImaginingThis document was developed by the Toronto Humane Society for its own use and is a work in progress. Please feel free to use and change it as you wish.Last updated June 11, 2020Contents TOC \o "1-3" \h \z \u To Do List (last updated XXX) PAGEREF _Toc42006914 \h 2Original Authors [Just so you know. Feel free to delete this or any other content.] PAGEREF _Toc42006915 \h 2Scope PAGEREF _Toc42006916 \h 2Assumptions PAGEREF _Toc42006917 \h 3Key Considerations PAGEREF _Toc42006918 \h 3Regulatory framework PAGEREF _Toc42006919 \h 4Species Susceptibility And Pet To Pet Transmission PAGEREF _Toc42006920 \h 4Strategies To Maintain Physical Distancing PAGEREF _Toc42006921 \h 4Transmission of infection: Snapshot PAGEREF _Toc42006922 \h 5Phases of resumption and expansion PAGEREF _Toc42006923 \h 7Phases and Subphases PAGEREF _Toc42006924 \h 8Overarching Process And Protocol Adjustments PAGEREF _Toc42006925 \h 9Roadmap Planning Table: Overarching Changes Needed For The Shelter PAGEREF _Toc42006926 \h 10Phase 1: Currently Operational + High Priority/Low Risk PAGEREF _Toc42006927 \h 12Phase 2: Step-Wise Service Resumption Based On Priority vs. Risk PAGEREF _Toc42006928 \h 13Phase 2A: High Priority, Low Risk PAGEREF _Toc42006929 \h 13Phase 2B: High/Medium Priority, Medium/Low Risk PAGEREF _Toc42006930 \h 14Phase 2C: High Priority, High Risk PAGEREF _Toc42006931 \h 14Phase 2D: Medium Priority, Medium/High Risk PAGEREF _Toc42006932 \h 15Phase 2E: Low Priority, Medium/High Risk PAGEREF _Toc42006933 \h 15Phase 3: Resilience PAGEREF _Toc42006934 \h 16Appendix 1: NACA Recommendations For Continued Modified Operations Due to COVID-19 PAGEREF _Toc42006935 \h 17Appendix 2: College of Veterinarians of Ontario - Risk-Based Approach To Decision-Making In The COVID-19 Environment PAGEREF _Toc42006936 \h 19Appendix 3: Ontario Veterinary Medical Association COVID-19 Guide for Practices (April 17) PAGEREF _Toc42006937 \h 20Appendix 4: Owner Contact Guidelines PAGEREF _Toc42006938 \h 22Appendix 5: CVO Guidance For Ontario Veterinarians – Selected CVO Updates PAGEREF _Toc42006939 \h 23Appendix 6: Spay/Neuter Self-Assessment Checklist PAGEREF _Toc42006940 \h 24Appendix 7: Example Of A Morning Check-List PAGEREF _Toc42006941 \h 25Appendix 8: Staff Survey - Example PAGEREF _Toc42006942 \h 26Appendix 9: Examples Of Signage PAGEREF _Toc42006943 \h 27Appendix 10: FAQ For Clients (Partially Reproduced Below) PAGEREF _Toc42006944 \h 29Appendix 11: Suggested Approach to Use of PPE. PAGEREF _Toc42006945 \h 30Appendix 12: Building A Plan To Re-Open PAGEREF _Toc42006946 \h 31Appendix 13: The Future Is Here: Ten Steps Shelters Can Take Now To Build Better Animal Services PAGEREF _Toc42006947 \h 32Appendix 14: Provincial Government Lifts Urgent Care Provision For Veterinary Services (May 14) PAGEREF _Toc42006948 \h 33Appendix 15: Key Points - Ontario Workplace Safety and Prevention Services Guidance for Veterinary Clinics PAGEREF _Toc42006949 \h 34Key Resources PAGEREF _Toc42006950 \h 36To Do List (last updated XXX)xxxOriginal AuthorsLinda Jacobson BVSc MMedVet PhD, Senior Manager, Shelter Medicine AdvancementKaren Ward DVM ASPCA Shelter Fellow, Chief Veterinary OfficerPhil Nichols RVT CAWA, Chief Operating OfficerScopeCreate a roadmap for recoveryDefine prerequisites for implementation of each Phase and Subphase Monitor progressAssumptionsThe pandemic will persist at least for months and more likely a year or longer, necessitating medium- to long-term changes in mindset and operations.There will be advances and retreats as infection rates rise and fall, necessitating a nimble, flexible and adaptable strategy. There will be rising demand for PPE as businesses re-open. Infection risk is a product of exposure and time and is highest in confined spaces.Anyone might be contagious, whether they are symptomatic or not.Human error will put people at risk without behaviour change and robust, updated infection control systems. These will have unavoidable budgetary implications.All on-site services will need to be scaled back for foreseeable future, requiring a more streamlined and flexible approach to operations in order to help the maximum number of animals possible.New systems that allow contactless and remote service delivery must be maintained for the foreseeable future. Key ConsiderationsOn-site staffing capacity is based on the ability to maintain physical distancing as well as keep staff in reserve if teams are isolated/quarantined. All other on-site capacities to follow on-site staffing capacity.The number of animals housed in the building must remain as low as possible.Physical distancing is the single most important way to prevent human infections.Required PPE must be used consistently and correctly, while avoiding unnecessary use of PPE and reusing materials when possible.On-site processes will be considerably limited and slower than normal because of the need for physical distancing – it is therefore imperative to maximize efficiency by streamlining processes and quickly adopting appropriate technology.There is no need to invent the entire wheel, though some reinvention will be needed by each organization. We have quoted many sources here and should consult shelters further down the path and emergency clinics that have maintained operations throughout.Geographic considerations (higher infection rates in Toronto and the GTA) mean that we should be cautious about expansion of services and not feel pressured to reopen services too quickly. New infections in Toronto are stable but not yet consistently decreasing.Regulatory framework Ontario Occupational Health and Safety ActEmergency Measures and Civil Protection Act (EMCPA)Directives and guidelines from the Ontario Chief Medical Officer of Health and Ministry of HealthVeterinarians’ Act, directives from the College of Veterinarians of Ontario and guidelines from the OVMA and CVMA.Species Susceptibility And Pet To Pet TransmissionHumans >>>>>>>>>>>>>>>>> ferrets > hamsters > cats >> dogs It’s important to be aware of zoonotic disease risks but not to overstate or overinterpret them. This would result in a distraction, when focus is paramount.Strategies To Maintain Physical DistancingWork off-siteVirtual services and processesCurbside transferLimit numbers of people in the buildingPlan and prepare beforehand e.g. medical proceduresTransmission of infection: SnapshotSARS-CoV-2 is transmitted primarily via aerosol droplets during close, unprotected contact. Most reported cases have been contracted from close direct contact with individuals showing respiratory signs. Presymptomatic and asymptomatic people are also thought to be important sources of infection.Other likely sources of infection are fomite transmission and potentially aerosols/airborne spread. Note that there is no specific evidence for fomite transmission but it is assumed to occur. Risk = exposure x time“Skip one, and the ‘treatment’ won’t work. But, when taken together, and taken seriously, they shut down the virus.” – Atul GawandePhases of resumption and expansionWe listed THS services and scored each based on priority and risk. This classification determines the sequence in which to expand or resume services. PriorityCriteriaHighCore to our mission, essential shelter service, essential to animal welfareMediumImportant to our mission but not essentialLowCould still support our mission without these services or could continue them in a different wayRisk to peopleCriteriaLowCan deliver service virtually or remotely, or only 1 or 2 points of contact that can be curbsideMediumService delivery is in-person and in-facility, but able to maintain distancing or very brief breaks in distancing, 1-on-1HighService delivery is in-person or in-facility (or other confined space), unable to maintain physical distancing, extended process/procedure, groupsPhases and SubphasesPhase 1: Expansion. Expand existing services that have continued in a modified form. Resumption. Resume high priority/low risk services. Contraction. Stop and slow services as flare-ups occur.Phase 2: Resumption. Resume services that have been stopped or seriously curtailed. Staged based on a balance between priority and risk. Contraction. Stop and slow services as flare-ups occur.Phase 3: Resilience. Regroup, protect our staff and organization for the long term. Re-imagine ourselves through lessons learned during COVID-19.9486904169410Overarching Process And Protocol AdjustmentsA number of processes and protocols apply to all aspects of functioning during the months ahead. These need to be in place in the relevant departments and physical areas as a prerequisite for opening certain services. Some of these are already in place and some need to be put in place, expanded or modified. Key operational areas are:Physical distancingAlternative service deliverySelf-monitoringPersonal protective equipmentCleaning and disinfectionResponse to an infected employeeGeneral infection prevention and controlCommunication with staff and the publicRoadmap Planning Table: Overarching Changes Needed For The ShelterOperational areaRequirementsStatusNeededPhysical adjustments e.g. plexiglass shields, signage, decals, floor tapeDetermine what is needed in each area of the shelterOrder supplies and arrange instalmentAdministrative adjustmentsDetermine which staff functions can continue to function virtually.Determine which staff members who normally work on-site are high-risk, and re-purpose for off-site work.Safe work practicesScreening at entry (staff and the public)TeamsFor each area of the shelter, determine staffing capacity based on 60ft2 per personAvoid sharing workstationsPhysically move people or functions if neededAdjust use of shared space e.g. lunch roomDetermine feasibility and detail of unidirectional flow through the buildingCurbside transfer for shelterCurbside transfer for shelterPersonal protective equipment and infection controlUpdate infection control protocol or infection control section of COVID-19 protocol – to include tables for which PPE is needed in which situationsDetermine current stocks and anticipated needsAutomation and streamlining Streamline current processes to allow (1) facilitate contactless processes; (2) increase time efficiency in the face of inevitably slower processesDocumentationPlans and operational aspects must be easy to find and useTrainingStaff and volunteers need to understand purpose and operation of modified processesPhase 1: Currently Operational + High Priority/Low RiskExpansion. Expand existing services that have continued in a modified form. Resumption. Resume high priority/low risk services. Contraction. Stop and slow services as flare-ups occur. DepartmentServiceRecommendations or Prerequisites Beyond Overarching AdjustmentsResponsibilityFoster and Rescue ProgramsProgram AdministrationVirtual Behaviour and Training TelemedicineUrgent Care Foster SupportPublic ProgramsFood BankPublic Veterinary ServiceEuthanasiaShelterFoster CareAnimal CareBehaviour and Training SupportAdmissions, Urgent [CSA]Veterinary CareRetail e-commercePhase 2: Step-Wise Service Resumption Based On Priority vs. Risk Resumption. Resume services that have been stopped or seriously curtailed. Staged based on a balance between priority and risk. Contraction. Stop and slow services as flare-ups occur.Phase 2A: High Priority, Low RiskDepartmentServiceRecommendations or Prerequisites Beyond Overarching AdjustmentsResponsibilityAdvancement and ResearchShelter AdvancementFoster and Rescue ProgramsHome-to-Home and Facilitated Adoption Adopt from FosterPublic ProgramsVirtual Behaviour and Training SupportPet/Guardian Parent Support NetworkAdministration - not public-facingPublic Veterinary ServicePreventive Wellness TelemedicineShelter Outreach TelemedicineAdministration - not public-facingShelterAdoption - virtualPhase 2B: High/Medium Priority, Medium/Low Risk DepartmentServiceRecommendations or Prerequisites Beyond Overarching AdjustmentsResponsibilityFoster and Rescue ProgramsBehaviour and Training, In-personVeterinary Care, In-person (non-urgent)Phase 2C: High Priority, High RiskDepartmentServiceRecommendations or Prerequisites Beyond Overarching AdjustmentsResponsibilityPublic ProgramsTNRPublic Veterinary ServiceSpay/Neuter (includes all, healthy and not healthy)Preventive Wellness, In-personExpanded PVS servicesDentalSocial Exclusion (outreach trips, services)ShelterRescue TransportPhase 2D: Medium Priority, Medium/High RiskDepartmentServiceRecommendations or Prerequisites Beyond Overarching AdjustmentsResponsibilityPublic ProgramsTraining and Behaviour 1-on-1 in-personPublic ProgramsDog-walkingShelterAdoption, onsiteFoster & Rescue ProgramsFacilitated and Rescue Transport (transport to other locations)Humane EducationIn-Class Room Public SchoolPublic ProgramsTraining and Behaviour in person training groupsPublic Veterinary ServiceHVHQ Spay/NeuterPhase 2E: Low Priority, Medium/High RiskDepartmentServiceRecommendations or Prerequisites Beyond Overarching AdjustmentsResponsibilityHumane EducationReading BuddiesHumane EducationShelter ToursPublic ProgramsRetail In-shelterShelterAdmissions Other non-urgentShelterAdmissions Elective - healthy community catsPhase 3: ResilienceResilience. Regroup, protect our staff and organization for the long term. Re-imagine ourselves through lessons learned during COVID-19.In development.Appendix 1: NACA Recommendations For Continued Modified Operations Due to COVID-19 2: College of Veterinarians of Ontario - Risk-Based Approach To Decision-Making In The COVID-19 Environment 3: Ontario Veterinary Medical Association COVID-19 Guide for Practices (April 17) 4: Owner Contact Guidelines 5: CVO Guidance For Ontario Veterinarians – Selected CVO UpdatesHow to document consent without a signature: Acceptable during the pandemic: A note that the owner of the animal or a person on the owner’s behalf consented orally to the surgical treatment, and the reason why the consent was not in writing. and prescribing through telemedicine: services are essential, but urgent care only (April 3) what is urgent: No laundry lists. “How might you justify your decisions to a group of your peers?” Balance animal, context, competence, public safety and staff safety. cases and making decisions: “Please be assured the College is aware that these are unusual times. You must depart from your established procedures. Do know that any concerns brought to our attention at this time will always rely on facts but also on the realities of delivering care during a public health emergency.”Appendix 6: Spay/Neuter Self-Assessment Checklist 7: Example Of A Morning Check-List within 8: Staff Survey - Example link from ’t love this, what about risk factors??Appendix 9: Examples Of SignageDownloadable, from links in gentle local humour to messaging 10: FAQ For Clients (Partially Reproduced Below)from ; in 11: Suggested Approach to Use of PPE. Each clinic should develop and post tables appropriate to its specific needs. 12: Building A Plan To Re-Open 13: The Future Is Here: Ten Steps Shelters Can Take Now To Build Better Animal Services 14: Provincial Government Lifts Urgent Care Provision For Veterinary Services (May 14)OVMA E-NewsletterOn May 14, Premier Doug Ford announced the next set of businesses allowed to reopen under the provincial government’s Reopening After COVID-19 framework. As part of that announcement, the province removed the “urgent care only” limitation on veterinary services and has allowed pet groomers to open (by appointment only), effective Tuesday, May 19. As of that date, veterinary practices will be able to offer a full range of services, including preventive care. The extent to which practices choose to expand the services they offer as of May 19 will be up to each individual practice to determine.As veterinary practices contemplate expanding the range of services offered, they are reminded that social distancing measures are still in effect. Effective implementation of such measures will be essential to ensuring that employees feel comfortable working in the practice as it expands its service offerings. Practice owners and managers are encouraged to work with their staff to implement protocols to protect the health and safety of both employees and clients. To assist in that regard, OVMA has worked with Dr. Scott Weese to develop A Guide to Reopening Veterinary Medicine in Ontario. Members may also want to check out OVMA's webinar recording on Strategies for Dealing with Post-COVID Clients, Finances and Production.?OVMA has been in communication with the College of Veterinarians of Ontario and the Ontario Association of Veterinary Technicians throughout this pandemic. All three organizations have shared member concerns, stories, struggles and triumphs. We would like to extend our heartfelt thanks and commendation to Ontario's veterinary teams over the last two months. You have continually been thrown new challenges and reintegrating non-urgent care into practice is yet another one. We hope that veterinarians, registered veterinary technicians and the whole veterinary team can continue to work cooperatively to adapt once again as the province reopens.If you have any questions about the reopening framework in Ontario, contact Brandi Deimling at bdeimling@.Appendix 15: Key Points - Ontario Workplace Safety and Prevention Services Guidance for Veterinary Clinics: Extracts of the document are copied below; this is not the complete document.KEEP INFORMED AND COMMUNICATEUpdate the business’s voicemail, email, social media, website and other external communications, and create a visible sign for your door to inform customers of changes to the business operations. Screen customers and staff regularly for health issues. This may include reminders to customers on websites and via telephone messages. If anyone develops symptoms of COVID-19, implement procedures for reporting the illness and keeping the worker away from others.Ensure that illness reporting requirements are well communicated in the workplace through training and signage. People who are sick or have signs of illness (e.g. fever, coughing, sneezing, runny nose, tiredness, shortness of breath) must self-isolate, notify their employer and call a doctor or healthcare provider.Train workers on where COVID-19 transmission points may exist within the workplace, steps being taken to protect them from the virus and how they can protect themselves (including frequent hand washing or sanitizing, and not touching their face with unwashed hands).ELIMINATE OR MINIMIZE EXPOSUREProvide hand sanitizer or sanitizing wipes for customersto use if entry is required. Consider having them available near the entryway, waiting areas, at reception and other high-traffic areas. Have a safe place for proper disposal of wipes. Empty and clean waste containers on a regular basis.Consider ways to minimize contact between workers and pet owners during drop off and pick up, and inform customers of safe work practices: o Establish clear visuals to show where the designated pickup area is located and the boundaries of the pickup area Have customers schedule and call first before picking up and dropping off Consider having workers assigned their own pet leashes/leads and inform customers that their leads and other items such as pet clothes, harnesses, etc. will not be permitted to remain in the workplace.Where necessary, permit a maximum of one healthy adult to accompany the pet to a medical visit and for that person to wait in a designated area or their vehicle. Ask for verbal or electronic consent rather than requiring signatures on any authorization documents.PHYSICAL DISTANCINGDo not permit customers to hold animals during an exam or other procedures. Where possible, safely restrain the animal to avoid having multiple workers working in close proximity to complete grooming or other services.Install physical distancing markers throughout the reception area and other areas depending on the size of the facility, including the entrance area outside the premises if appropriate, to ensure customers maintain physical distance of 2 metres.DISINFECTING AND SANITIZINGConsider having disinfecting wipes and sanitizer at key areas for your workers, including their workstations. Provide a safe place for individuals to dispose of used sanitizing wipes and personal protective equipment. Empty and clean waste containers on a regular basis.Clean and disinfect all areas, instruments and equipment, including leashes/leads, grooming tools, tables, floors, etc. between each appointment.Main entrance area including door handles and counters need to be sanitized with each entry or exit. Where possible, assign a worker to ensure staff and customers are utilizing sanitizing materials, following physical distancing protocols and screening for customers presenting COVID-19 related symptoms.OTHER CONTROL MEASURES Pursuant to public health advice, cloth masks must be worn by workers to prevent droplet transmission from worker to patrons. Use high-efficiency particulate air (HEPA) filters in the ventilation system, increase fresh air intake, and open doors and windows where possible.Key ResourcesAmid the Coronavirus Crisis, a Regimen for Re-entry? Resources for Canadian Animal Shelters? – What We Know So Far About… Routes of Transmission??[28 April, 2020]??Physical Distancing, Face Masks, And Eye Protection?To?Prevent Person-to-person Transmission?Of?Sars-cov-2 And Covid-19: A Systematic Review?And?Meta-analysis?(20)31142-9/fulltext??COVID-19: A Guide to Reopening Veterinary Medicine in Ontario, Stage 2 (June 10, 2020)(June_10).pdfOntario Veterinary Medical Association COVID-19 Guide for Practices (April 17)? Veterinary Medical Association checklist?? of Veterinarians Updates and Guidance?See?bulleted text in document for specific links??College of Veterinarians of Ontario - Risk-based approach to decision-making in the COVID-19 environment (see Appendix)? measures to mitigate the spread of coronavirus disease (COVID-19) in Canada [page is archived and under review but is still a useful resource]? Self-Assessment Checklist? Spay/Neuter and Wellness Clinic Preparedness Guide? Recommendations for Continued Modified Operations? Cats:?COVID Resources for TNR and Community Cats?: A Guide to Reopening Veterinary Medicine in Ontario? Guidelines Ontario Businesses Need?To?Consider Before Reopening? Framework for Reopening the Province? Re-Opening Stages, Regional Re-Opening to Stage 2 (June 8)? Disease (Covid-19) Advice For The Public – Downloadable Posters Safety and Health Act Guidelines on Preparing Workplaces for COVID-19 Guidance for Veterinarians During the COVID-19 Response Future is here: Ten steps shelters can take to build better animal services Safety & Prevention Services: Guidance on Health and Safety For Veterinary Services (Pet Groomers/ Dog Walkers/ Pet Boarding/ Animal Care Providers) during COVID-19 ................
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