April 1, 2020 COVID-19 report

As I went out today, April 1, 2020, for a twenty minute walk in the evening to clear-up my head, I reflected on this nightmare we are collectively experiencing. Suddenly, I heard a big noise, then another and another! Quickly I realized it was 7:30pm and these were neighbours in an adjacent street, responding to RNAO’s call to #cheer4healthworkers and prove that #togetherwecandoit  - meaning, together, and only together, we can get through this. As I walked back home, three teenagers were playing street hockey. They saw me and quickly moved to the other side of the street, so as to keep physical distancing, and waved to me. Cheered up, I waved back at them with thanks. I thought to myself: this is our Canada – a mosaic of collective good that, more often than not, fills us with pride. I come back to this theme in the policy corner below.

As yesterday and the days before, essential supplies and equipment remain a central concern. Earlier this week we heard the federal government is mobilizing industry to fight COVID-19, increasing Canada’s ability to respond to the outbreak with necessary medical equipment and supplies, boosting capacity to manufacture items such as portable ventilators, surgical masks, and rapid testing kits. It is also investing $2 billion to support diagnostic testing and to purchase ventilators and PPE, including for bulk purchases with provinces and territories. Today the Ontario government announced a $50 million fund to help businesses manufacture essential medical supplies and equipment, including gowns, coveralls, masks, face shields, testing equipment and ventilators. The government has recently placed an order with O-Two Medical Technologies who, with the support of Ontario's manufacturing sector, will produce 10,000 ventilator units.  Our response to both the prime minister and the premier is: FANTASTIC!!!! Now, we need breakneck delivery timelines as Canadians and healthcare workers’ lives are on the line. Months from now, no equipment or supplies will be of any help – there is not a single day to waste.

RNAO has been at the forefront, pleading to governments to procure PPE and ventilators to protect workers and save lives. We are glad to now see a sense of urgency and we deeply hope that it is not too late. Employers and staff need timelines. For now, they are doing their best to find PPE and arm their workers to carry-on the fight. Today, the Ontario Hospital Association added its voice to the plea for PPE with a statement regarding shortage of PPE.

RNAO has been also proactively leading expected – and now real - nursing human resource shortages related to the COVID-19 emergency. As RNs, NPs and PSWs are going into quarantine, falling sick, and staffing needs are growing. RNAO launched its COVID-19 ViaNurse on March 13 and it has already registered 149 nurse practitioners (NPs), 696 critical care RNs (who have experience and continued competency in the provision of critical care), 5,648 RNs for virtual/clinical care, and is actively staffing any nursing homes needing RN and needing PSWs. We urge CNEs, CNOs, and managers – in any and all sectors and regions of Ontario - to access this talent now - so you are not scrambling later on (see details below).

Every day we welcome new readers to this daily report: thank you deeply for the work you do during this health crisis, and also for keeping us well informed. You can see previous reports at RNAO updates and resources on COVID-19 for members and other health professionals. Feel free to share these updates with other health professionals at home or abroad. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here.

We continue to receive your emails. Here is a sample of topics:

• Many messages address PPE shortages in different sectors. There are concerns about hospitals still not allowing front line workers facing patients to use PPE, while other hospitals have moved to supply two surgical masks per day. Also community health organizations – home care and primary care – are suffering from dire shortages of PPEs, and some have lost hope and tried to obtain their own PPE. RNAO’s urgent recommendation is that all front line health care workers facing patients – in all sectors and settings – must wear a surgical mask.
• Nursing homes are a horrific unfolding crisis and there is a direct link between lack of proper protection and mounting infection clusters in at least 41 nursing homes. RNAO has been sounding the alarm bell on this fear for well over a month for fear of this happening. We will not stop saying it: The time is NOW, to ensure all nursing homes are provided with sufficient quantities of surgical masks and other essential PPE, so that all staff wear one at all times – to prevent outbreaks and NOT after an outbreak as it currently is happening. We must #flattenthecurveofNHoutbreaks! 
• Fourth year BScN nursing students are expressing concern, as they are eager to graduate and begin working as RNs to protect and care for patients during this difficult time. They share with RNAO that they face barriers to complete their studies and registration with the CNO, as well as application for temporary licenses. Many want to be in clinical placement to help with this crisis and are not allowed in.
• Should the public wear a surgical mask in public spaces, as many do in south east Asian countries? Given the shortages of regulated PPE for health care workers, the public should not be purchasing those. There is a live discussion on whether to wear home-made and other unregulated types of masks. The general advice has been to keep two meters physical distancing and thus no need to wear a mask. However, if you cannot avoid going to shop groceries, take public transit, or other activities where you cannot keep physical distancing, a surgical mask is a good idea.
• We reported in earlier updates about Michael Garron Hospital launching #MGH1000masks campaign. The hospital is challenging makers in the community to fabricate 1,000 masks a week, which will be worn by all approved visitors who enter the hospital, all discharged patients as they reintegrate into the community, and the broader east Toronto community to prevent the transmission of COVID-19.

While RNAO continues to call on federal and provincial governments to aggressively take measures to procure the required PPE, you can also donate PPE items. Please contact Heather McConnell .  

Today was day #14 of the #TogetherWeCanDoIt campaign (following is our pics for the day!). The noise is becoming louder and louder in streets, workplaces and social media to #cheer4healthworkers. Join-in this community building moment every evening at 7:30pm local time - until we defeat COVID-19! and post tweets from your communities and workplaces with your cheers, lights, claps, songs or pots and pans -- Because: #TogetherWeCanDoIt.

MOH EOC Situational Report #67 here  for Wednesday, April 1. 

Case count as of 8:00 a.m. April 1, 2020
Area	Case count	Change from yesterday	Deaths	Change from yesterday
Worldwide total	872,629	+72,549	43,191	+4,436
Europe	460,383	+33,915	31,015	+3,161
China	83,095	+1,577	3,312	+07
Middle East	73,274	+6,697	3,371	+191
Asia & Oceania	34,027	+1,880	662	+67
Africa	5,630	+348	192	+20
Latin America and Caribbean	19,084	+2,571	500	+80
North America	197,136	+25,561	4,139	+910
United States	188,588	+24,437	4,043	+903
Canada	8,548	+1,124	96	+07

EOC reports 426 new cases in Ontario which brings our province to a total of 2,392 cases (this includes 689 resolved cases and 37 deaths). In Ontario, a total of 57,874 people have been tested. There are currently 3,135 tests under investigation. EOC reports the following actions taken:

• The Command Table met today. A summary is here.
• Guidance for Paramedics has been updated and uploaded to the website.
• Three new guidance documents for Group Homes, Homeless Shelters and Long-Term Care Home Outbreaks have been created (see here and here and here).
• The Government of Ontario announced today that they are launching a new $50 million Ontario Together Fund to help businesses provide innovative solutions or retool their operations in order to manufacture essential medical supplies and equipment, including gowns, coveralls, masks, face shields, testing equipment and ventilators. This new Fund will support the development of proposals submitted by businesses and individuals through the Ontario Together web portal.

 

You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. These numbers are more updated than those of WHO. They report a total of 2,392 cases in Ontario and 9,731 total cases in Canada. There are 216,722 cases in the United States, topping China as the country with the largest number globally. Worldwide, there are 951,901 cases.

WHO has released a scientific brief on the off-label use of medicines for COVID-19. A number of medicines have been suggested as potential investigational therapies, many of which are now being or will soon be studied in clinical trials, including the SOLIDARITY trial co-sponsored by WHO and participating countries. More information can be found here.

WHO recognizes the importance of addressing the needs of refugees and migrants when preparing for or responding to the COVID-19 pandemic. WHO European Region has released a guidance document to assist healthcare working with refugees and migrants. More information can be found here.

Other Information Resources

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers. 

Ontario’s health provider website is updated regularly with useful resources here. An important reminder that the health provider website is for you – as a health professional – and not for members of the general public.

Ontario’s public website on the COVID-19 is there to inform the general public – encourage your family and friends to access this public website. The WHO has provided an excellent link for you to share with members of the public here.

Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. Data will inform Ontario's ongoing response to keep individuals and families safe.

Health Canada's website provides the best information capturing all of Canada. It contains an outbreak update, Canada's response to the virus, travel advice, symptoms and treatment, and resources for health professionals.

RNAO policy corner – COVID-19 and the US health care system – Important Read

I mentioned in my introduction a sense of collective good and pride in Canada. This is real when we talk about COVID-19, at least in one powerful sense: nobody in Canada has to worry about paying their test, medical bills and hospitalization if they become sick with the virus. That is not the case south of the border.

Before the COVID-19 pandemic, 27.5 million Americans had no health insurance, but now, many more are at risk of losing their current coverage plans as businesses lay off workers because of COVID-19 physical distancing. States, advocacy organizations and health care professionals are taking steps to ensure that the uninsured can still get testing and treatment, but that hasn’t dissipated the confusion. If there are people who are not getting the screening, testing and treatment because of fear of a bill, that not only endangers themselves but also spreads the virus. In addition to U.S. citizens who lack health insurance coverage, there are also millions of undocumented immigrants who are not eligible. Another 2 million people who live in the 14 states that did not expand Medicaid under the Affordable Care Act also fall into a coverage gap. They are not eligible for Medicaid, but are also ineligible for federal subsidies that make health insurance affordable through the national exchange. In the words of an expert, “A crisis like this, where everyone is at risk and everyone can be affected, highlights the gaps in our health care system in a way that we don’t often see.”

The cost of a test for an uninsured patient could be close to $500 at a doctor’s office, while one at a hospital would likely be at least $1,000. The cost of care if one were to test positive, varies depending on a person’s insurance and its various cost-sharing components. Most insurance plans have deductibles that could be around $1,500 to $2,000. Many plans also have coinsurance charges of roughly 15% to 20%. Individuals who don’t require hospitalization will likely incur relatively small out-of-pocket costs, but patients who do require hospitalization could expect a hefty bill. This could be between $75,000 and $100,000 for 10 days, including hospital stay, drugs and treatments. While insurance – for those who have it – would cover some of that, it almost certainly wouldn’t cover the full price tag.

An independent journalist without health insurance says: “I haven’t gone to the doctor since 2013… Like 27.5 million other Americans, I don’t have health insurance. It’s not for a lack of trying – I make too much to qualify for Medicaid, but not enough to buy a private health insurance plan on the Affordable Care Act exchanges. Since I can’t afford to see a doctor, my healthcare strategy as a 32-year-old uninsured American has been simply to sleep eight hours, eat vegetables, and get daily exercise… When you multiply my situation by 27.5 million, you end up with a country full of people who won’t see a doctor unless they’re extremely sick. And when you combine a for-profit healthcare system – in which only those wealthy enough to get care actually receive it – with a global pandemic, the only outcome will be unmitigated disaster.” 

RNAO’s ACTIONS

Health Human Resource Capacity – RNAO’s COVID-19 ViaNurse Program

RNAO started its Via Nurse program to recruit RNs, NPs and nursing students on March 13.

As we continue our strong advocacy on the need to expand the capacity of Ontario’s health system to meet emerging health needs in tackling COVID-19, we need your help. The knowledge and skills of RNs, NPs and nursing students are needed to meet a range of health-care needs. For those of you who have already responded to our surveys asking for help, we thank you for your enthusiastic and generous response. Working in collaboration with the Ministry of Health, we are reaching out to RNAO’s network of RNs, NPs and nursing students asking for your willingness and availability. Our surveys/registry remain open for:

Critical Care

Virtual and Clinical Care

Nurse Practitioners

Nursing Students

If you are available to help, please complete the appropriate survey listed on our COVID-19 webpage.

Critical Care survey

We asked for your help, and got it!  We released a survey a week ago to establish a registry of the available health human resources in the critical care areas of Emergency Rooms, Recovery Rooms, Intensive Care Units, Step Down Units or other relevant clinical area.  Your response was immediate, and strong.  We have received responses so far from 696 RNs with experience and continued competency in the provision of critical care. This response, while not unexpected, is truly heartwarming in these difficult times!  We are already addressing the needs from several hospitals approaching RNAO for HHR augmentation and connecting these with you so they can proceed with the hiring processes. We have also connected respondents with an indigenous health authority in Northern Ontario who was very appreciative of RNAO’s timely assistance. Many, many thanks for your enthusiastic and generous response. Please note: The survey remains open.

NP survey

The knowledge and skills of nurse practitioners are needed to increase Ontario’s capacity during the COVID-19 pandemic. NPs with experience, current competency and specialty certificates in primary care, adult care and paediatrics and who are able to return to work if retired or increase their hours of work, are asked in a survey RNAO launched on Friday, March 28 to share their availability in providing health-care services during this unprecedented emergency. Until now 149 NPs have filled out the survey to indicate their willingness and availability to work during the pandemic. The survey remains open.

Virtual and Clinical Care survey

RNAO’s survey on virtual clinical care and non-clinical services: As of today, 5,648 RNs and NPs responded to the RNAO survey with availability to provide virtual clinical care or non-clinical services. We continue to deploy colleagues as requested. We know that you are ready and eager to help and thank you hugely for it!  

PSW positions for nursing students

RNAO is helping to increase LTC Homes, Seniors’ Housing and Community Service Providers’ capacity to meet human resource needs to tackle the COVID-19 pandemic. The facilities listed in this registry are looking to fill personal support worker (PSW) positions. These are paid positions. They are looking for second, third or fourth year nursing students to fill these positions. The registry includes 293 senior’s residential care organizations, can be searched by city and organization. Students can apply from the page and the DOC or HR person of the home will receive the student’s application and take it from there. A number of organizations, including several undergoing an outbreak, have already been served by accessing RNAO’s ViaNurse. 

NOTE TO ORGANIZATIONS SEEKING TO EMPLOY RNS, NPS AND PSWS

RNAO can help organizations increase their nursing human resource capacity to tackle COVID-19. To request RNs and NPs for your organization, fill out this form.  RNs and NPs in the city where your organization is located will be connected with you.

To request nursing students in second, third or fourth year for personal support worker (PSW) positions, fill out this form and your organization will appear in a registry where students will select hiring organizations through this registry. (Your home will appear on the registry within 24 hours.) Nursing students will be able search the registry by city and name of the homes. 

Worth repeating: COVID-19 and persons experiencing homelessness

RNAO's Director of Policy, Matthew Kellway, has been seconded to serve as Director, Public Affairs for Inner City Health Associates (ICHA). Matt will be working closely with Dr. Andrew Bond, ICHA's Medical Director, Dr Leigh Chapman, ICHA's Director of Nursing and former RNAO Communications Director, Sine MacKinnon. ICHA, who provides health care to many of Toronto's shelters and drop-in centres, has been funded by the province to urgently bring to life an innovative, nurse-led program, to provide care to Toronto's homeless population through this Covid-19 pandemic. Absent urgent intervention, Toronto's shelter system threatens to be the epicentre of this pandemic in the city given the vulnerability of the population and the impossibility of social distancing in existing shelter facilities. I am so proud that ICHA is staffing it's program with RNAO members using RNAO's VIANurse program and I have the utmost confidence in ICHA's commitment to keep its nursing staff as safe as possible as it fulfills its critical mission.

COLLEGE OF NURSES

The College of Nurses of Ontario (CNO) is working quickly to help support Ontario’s health care system during this unprecedented and rapidly changing situation. To enhance Ontario’s nursing resources, it is expediting registration for non-practicing nurses, including those who have retired or have an expired registration implementing an emergency class for nurses who work or have worked in other jurisdictions in Canada or the U.S. For more details see here.

URGENT STEPS FOR GOVERNMENT TO TAKE: RNAO’s VOICE

1. Continue to prepare for a New York City scenario. Yes, our approach must be to continue to prepare for 'worst-case' scenarios such as in Italy or New York. Good for Premier Doug Ford to acknowledge today that “The hard truth is, right now, today, there is very little separating what we will face here in Ontario from the devastation we’ve seen in Italy and Spain,” said our Premier. Incubation periods and the delays in obtaining test results means today’s data reflects the reality of a couple of weeks ago. This means we do not have a good grasp of where we are in the curve. We are only testing a relatively small number of symptomatic individuals and likely missing a much larger number of persons without or with mild symptoms – thus test data is likely quite incomplete. This means there is lots of uncertainty as to the actual shape of the curve. It is RNAO’s view that policymakers and governments MUST continue to plan according to the worst-case scenarios. Unfortunately, we are seeing this scenario unfold in the United States. In Ontario and Canada, we do hope that social distancing will flatten the curve, but for the moment, we are seeing large numbers of new daily cases. We hope to avert worst-case scenarios, but we cannot afford not to plan for such a case, that might risk the tragic death of thousands of people.
2. Communication: We are entering a very challenging period for all. During this period, it is crucial that governments at all levels engage in honest an transparent communication with the public. Don't try to gloss over issues, don't minimize them, be transparent when decisions are driven by lack of resources (such as shortages of PPE), acknowledge we may be entering into more difficult scenarios, with many deaths and, very likely, an overwhelmed health system. During this period we need to acknowledge the challenge and that we all, each one in our own way, are trying to do the best we can - and that we are all in this together. Not only governments and those filling essential services have a role – also the public has a crucial role in bringing down the curve, through "staying at home" and keeping "physical distance."
3. Nursing homes: RNAO has been expressing to government and to the media -- for several weeks -- our extreme concern about nursing homes and their vulnerability to outbreaks, given the vulnerability of their residents and the staff. We were pleased with important steps in government’s recent announcement. The Ministry is currently focusing on providing central supplies to Long-Term Care Homes that already have outbreaks. However, this is the wrong approach. A government directive MUST go out that all the staff should wear PPE – RNAO suggests providing at least one each day, upon entrance to the building, until there is more availability. The purpose ought to be to prevent outbreaks, not come to fix them after they have happened, residents died, and staff got ill. Staffing shortages should be addressed, taking advantage of available resources. On this point, RNAO has launched ViaNurse -- free of charge, including 5,000 BScN students ready to serve as PSWs. Finally, it is important that when one finds a single case of COVID-19 in a nursing home, then every person in the facility, both residents and staff, should be tested. Medical directors and attending NPs in nursing homes should ask for a test immediately that they see a symptomatic resident or staff.   
4. Home Care: Many of the home care agencies have only a few days of PPE supplies left. Staff are quitting as they demand PPE and clients don't let them go into their homes without PPE. Patients that require home care are persons with cancer, wounds, and more - they need home care. This situation must be fixed.
5. Expand testing, contact tracing and self isolation: Now is not the time to slow down on testing. Ontario MUST continue to increase its testing capacity and maintain rigorous contact tracing and self-isolation. Even when we manage to flatten the curve, as China, South Korea and Singapore and other countries have so far done, the virus will remain out there and ready to raise its head again. Only a rigorous, comprehensive system of testing, tracing and isolation, which is the case in those countries, will allow us to go back to some normalcy after the peak of the epidemic, until such time as new therapies or vaccines are ready to be used. Since contact tracing and isolation is a laborious process, if we need health personnel to strengthen public health units, RNAO can assist through the ViaNurse program. 
6. Shutting down of all non-essential movement in the streets.  Let’s educate that the more stringent the shutdown, the shorter the period we will live through it. The more gradual, less effective, and less enforced are the physical distancing measures, the longer the shutdown will prolong and more people will die. We need to double down on making the shutdown effective. Government took a few days ago an important step by prohibiting gatherings of more than 5 people. The loopholes to the shutdown, allowing non-essential businesses to pass as essential (example, condo building), and the lack of enforcement of quarantine – all these have a price in shutdown time and lives. Clearly, there is still a sector of the public that believes they are invincible or does not understand the situation. Governments must enact actions to either educate them, or enforce the measures.   
7. Telehealth: Virtual care plays a central role in physical distancing and helping fight the pandemic. Telehealth can help keep people in their homes and avoid them going to clinics and ERs. RNAO has reiterated the call to strengthen Telehealth to better fulfill that role at this crucial time. About a week ago we were receiving reports of wait times of 10 hours or more. Let us know if you have more recent experience using the service. In RNAO’s view, the Ministry should monitor wait times and assign resources so that they are within acceptable parameters.
8. Extensive use of surgical masks. Given the wide community spread as well as the solid evidence about asymptomatic transmission of COVID-19, RNAO has been, for the past two weeks, actively recommending to health officials that all health workers should be using surgical masks while facing patients/clients/residents.
9. Procurement of all Personal Protective Equipment (PPE). RNAO has been vocally urging the federal and provincial governments – and will continue to do so - to aggressively secure a supply chain for all the required PPE to protect our colleagues and their patients. Health organizations – across all sectors -- are reporting shortages of PPE. This situation is unacceptable and governments must address it urgently, including preparing for a huge increase in the demand for PPE as we move towards the peak of the pandemic. Government took an important step by providing an update on PPE stewardship, procurement and distribution. While this is welcome first step, RNAO urges to change the planning parameters of the Ministry to assume worst-case scenarios (such as Spain, France or New York City). The planning document specifies additional procurement of 12 million surgical masks from suppliers and the federal government. In comparison, the government of France announced the purchase of 1 billion surgical masks, given that their weekly consumption is 40 million masks. If we translate those numbers to the population of Ontario, it means a purchase of 217 million masks for a weekly consumption (during a worst-case scenario such as France) of 9 million per week. These numbers suggest that the current procurement of the Ontario government will last, during a France-type situation, roughly for a week and a half. In the view of RNAO, Ontario is still not well prepared for what likely is coming ahead, a pandemic that will last for several weeks, if not months. We call for URGENT and massively increased, procurement of PPE. We were pleased to hear the federal government is investing $2 billion to support diagnostic testing and to purchase ventilators and PPE. We were similarly pleased with the Ontario government announcement of a $50 million fund to help businesses manufacture essential medical supplies and equipment, including gowns, coveralls, masks, face shields and testing equipment. We desperately need to know from both levels of government what are the timelines for delivery. Health care workers and patients lives are on the line.
10. Hospitals: Hospitals are working to ramp up their ability to receive an avalanche of COVID-19 patients, while trying to serve the needs of non-COVID patients. Government should provide the regulatory and financial resources so they can do so. Several are already building makeshift structures, redeploying personnel, and taking the measures to expand capacity. In New York State they have added tens of thousands of beds, including through a military hospital ship. Are we ready for to scale up capacity in this way? Let's plan for the very worse so we are ready to execute, and celebrate if we don't.
11. Expansion of ICU beds and ventilators. The information provided that the government has been successful in entering into contracts for up to 10,000 ventilators is great news. However, there is no specification about delivery dates, and how reliable those dates are, as Ontario Health has earlier reported that “it will take months” for orders to start coming in. We have, perhaps, a couple of weeks until hospitals start to become overwhelmed. In a different jurisdiction, the governor of New York State is asking for 30,000 ventilators, as the worst-case scenarios become a reality across the United States. If the equipment and specialized personnel are not available, people needlessly die. That has been the horrifying reality in Italy, which has had one of the highest death rates – about 5% --from COVID-19. For RNAO, no one’s life should be lost because the proper equipment was not available. This past week RNAO issued a public statement on ventilators and PPEs and we also discussed these matters extensively in the media (here). We urge the government to substantively increase the procurement of ventilators. We heard yesterday good news that the federal government is investing $2 billion to support diagnostic testing and to purchase ventilators and PPE. Similar good news from the Ontario government announcing it has placed an order with O-Two Medical Technologies who, with the support of Ontario's manufacturing sector, will produce 10,000 ventilator units. We did not hear from either government about timelines for delivery
12. Support for vulnerable populations and workers. Governments should implement urgent measures to alleviate the enormous burden placed by fighting the virus. COVID-19, and the measures required to address the emergency, have profound social equity impacts, especially on vulnerable and disadvantaged populations. This includes Ontarians experiencing homelessness and shelters and testing positive for COVID-19 (please RT urgently) and others living in crowded shelters (please RT urgently), as well as Indigenous communities and northern and isolated communities. Both the federal and provincial governments have announced important measures to protect workers from losing their jobs as businesses suspend operations or they have to stay home to take care of children. RNAO is urging for much more to be done to assist low-wage earners and those in precarious employment, who may transmit disease simply because they have no option. RNAO’s response to the recent Ontario economic statement can be found here.
13. Massive public education and enrollment. Please become a champion for #StayAtHome and #SocialDistance, by educating your families, friends, colleagues and members of your community. RNAO and our members are heavily engaged in mainstream and social media to keep the public fully informed, engaged and enrolled into #socialdistance action. We ask that you follow us at @RNAO and @DorisGrinspun and retweet + Facebook as much as you possibly can. Send your friends and members of the public to the government website and here
14. Solidarity during a difficult time. It is very important to call on citizens to organize informal networks of support, largely virtual, for people who live alone, who may be elderly, or vulnerable, or who do not have the money to buy essentials, or who are struggling through this period in so many ways. With mental health and other conditions exacerbated by isolation, we call on all of us and the public at-large to display solidarity and humanity like never before – message: #togetherwecandoit.

Please continue to keep in touch and share questions and/or challenges of any kind, and especially shortages of PPE. Send these to me at dgrinspun@rnao.ca. We are responding daily and are continuously solving your challenges. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

THANK YOU DEEPLY colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and in other regions – especially New York, Italy, Spain, France, Iran and Germany – now hit the hardest. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!

Together, we are and will continue to tackle COVID-19 with the best tools at hand: accurate information, calmness, determination and swift actions! 

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer, RNAO