Part one of a series of three articles: Michelle Crosby talks about administrative matters and how Island Health responds to a COVID situation.

Cortes Island responded to the first news of the pandemic with a series of ZOOM conferences, in which various sectors of the community reported on their preparations, status and plans. The last of these meetings was held on June 9th, a day when Island Health reported there were no COVID cases anywhere on Vancouver Island. That situation has changed. According to statistics released by the BC Centre for Disease Control, there were 16 new cases in the Greater Campbell River Health Area during November. Some of these were on Cortes Island, where there had not previously been a publicly acknowledged case. While there are currently no known active cases on Cortes, there were 31 throughout North Vancouver Island yesterday and Island Health does not identify specific communities, or islands, for individual cases. The virus is still spreading. On December 10th, Cortes Island’s Regional Director, Noba Anderson, convened a ZOOM conference of several key Cortes community and Island Health leaders.

Guest Speakers

There were two guest speakers.

Dr. Charmaine Enns is the Medical Health Officer for North Vancouver Island (GO 1), which consists of Courtenay, Comox and all the communities to the north.

Michelle Crosby, is the Director of Clinical Services Delivery for the Campbell River and Strathcona Corridor. This includes Cortes and the other Discovery Islands. 

Clinical Services Delivery

Ms Crosby explained that she is the administrator in charge of the Campbell River Hospital as well as community health services. (This does not include mental health or personal health care.)

“Because I am the only Director that is linked to Campbell River and Strathcona Region, I end up playing a role as coordinator of care. So if there are issues going on that involve multiple sectors, I can be the one to coordinate that, “ she said.

“As far as Cortes goes, the nurses that are working at the Mansons clinic fall under my direction through a manager, as well as I hold the contracts with the physicians that are there. Community health services comes to the island. There are home care nurses and support workers, Those fall under my jurisdiction. As well, I hold the contract for the home support workers that work with people with what we call IELs.” 

How Island Health responds

During the COVID outbreak on Cortes, Crosby has been holding a medical conference call about local operations on Tuesday and Thursday mornings. 

She also participates in a weekly call dealing with the issues that clusters rural, remote and indigenous communities, anywhere on Vancouver Island, are facing.  

“The one thing that everyone needs to remember is that we are building the plane as we are flying in it. This pandemic hasn’t happened before. We have never been able to anticipate this. We think we have a structure in place and then have to enact something and realize there are lots of holes and have to build it again. There is not a lot of precision or perfection because this is the first time we have done this …” said Crosby.

“The one fantastic thing about Cortes, as opposed to any other communities I would be interacting with, is the structure you already have in place, the relationships you already have with each other and the care that you already have for each other. So for me, dealing with a cluster that is happening on Cortes Island is going to be a whole lot easier than dealing with a cluster in let’s say ______, where they don’t have that connection to each other.” 

Testing for COVID on Cortes

Crobsy went on to describe the COVID testing procedures on Cortes Island. This currently takes place at the clinic twice a week. Should the need for more tests arise, one of the crucial components will be transporting the swabs to Campbell River Hospital.

“As samples arrive at Campbell River Hospital, we have two transports a day that take them down to Victoria. Once they hit Victoria, we expect a fairly fast turn around time for those results to come back.” 

If a result comes back positive 

“If a result comes back as positive, then a nurse within the the public health structure called a Communicable Disease Nurse – and we have two of them in the North Island – will get ahold of that person and start giving them instructions about self isolation and (also) start the process of contact tracing.” 

The Communicable Disease Nurse might reach out to local nurses for support. Face to face communications, going door to door, work better than over the phone. 

“If there is just an individual case, or a couple of cases, the community will not be alerted. It is a matter of privacy. If that person is in their home, the contact tracing has been done and those contacts are also in isolation, they may choose to do that quietly. As much as we do not want to, there is a stigma attached to people who have COVID and there are some outcomes that might not be good, especially in a small community,” said Crosby.

She added, “We give the order that everyone has to assume that everyone is infectious in our community … So things shouldn’t change when we actually do have an infectious person.” 

Supporting individual people in self isolation 

Self isolating people need support to get food, firewood and possibly transportation to the medical clinic or the hospital (to receive a higher level of care). A public health nurse phones every day: reminding them about self isolation, finding out how things are going. 

An intensive monitoring system is available for people who want more intensive care. They are supplied with iPads that can collect physical data like blood pressure, pulse or oxygen etc.

Community Cohort Centres

“People, especially in in remote communities, are also given the option that if they are not comfortable isolating in their home or there is a concern that their situation could change so that they need medical help quickly, we have set up an option called a community cohort centre. We basically rented a number of hotel rooms in Campbell River that have some infrastructure around food and primary care wrapped around them, so that people could leave community and do their isolation in Campbell River where they are close to the emergency department or close to Nanaimo where they might need an intensive care unit,” said Crosby.  

People with higher risk can also use the community cohort centre. For example: when a young person “who has COVID, but isn’t terribly symptomatic” lives with grandparents, either the grandparents and young person could choose to move to the centre. 

Isolating on Cortes Island

Director Anderson added that both Hollyhock and the Gorge Harbour Marina, on Cortes Island, are offering rooms for people who do not need to be close to a hospital, but want to self isolate or quarantine.

“That is fantastic. I think it is important that people do not have to leave their community. Having people leave Cortes and going to Campbell River is certainly not optimum. You’re scared and now in this situation where you are isolating in a hotel room with no one that you know and none of your familiar things around you. That is such a fantastic thing … to put that infrastructure in place … if their medical situation is stable enough that that is a safe thing for them to do,” responded Crosby.

Anderson explained, “That being said, both of those offerings are just rooms, they are not kitchen equipped. So they would need wrap around support, like a hotel room.”

To which Crosby added, “In Campbell River … they might have kitchens in them, but I believe … meals are being made and dropped off to the rooms.”   

Emergency Operations Centres

She went on to describe the conditions under which Island Health sets  up emergency operations centres. While this would not be for an individual case in a rural community like Cortes, the situation changes when a number of different households have been affected.

“We need to do more testing and serial testing, just to make sure we’re not missing cases. That is when we would pull this group together again and enlist the support of the community around what we need to do. It would be more of a forum, with reporting out and reporting in,” said Crosby.

She added that this would be dealt with quietly and take place outside of the public domain. 

There will be two more parts to this series:

• Dr. Charmaine Enns presentation
• Responses to specific questions

Top photo credit: A tidal channel separates the sand spit at Mansons Landing from northern Cortes Island by David Stanley via Flickr (CC BY SA, 2.0 License)