April 17 2021 COVID-19 report

Dear Colleagues: Welcome to our Saturday, April 17 report during this fourteenth month of COVID-19 in Ontario. You can find earlier update reports here, including thematic pieces in Doris’ COVID-19 Blog. And, for the many resources RNAO offers on COVID-19, please visit the COVID-19 Portal where you will also find RNAO media hits and releases on the pandemic here. Daily Situational Reports from Ontario's MOH EOC can be found here. As always, feel free to share this report and links with anyone interested. Scroll down for information on several webinars in the next few weeks.

In today’s report we briefly discuss the situation in Ontario. Next, we present an article about how the global pandemic could play out in the next year. Third, is an article on how vaccine engagement can help address marginalization and exclusion in disadvantaged neighbourhoods.

Reacting to the latest Ontario government public health measures

Given the devastating situation in intensive care in the province, the dire predictions from the Science Table, and the outcry from nurses, doctors and other health professionals, yesterday the Ontario government announced new measures. Tragically, as often has been the case, the government acted too-little and too-late. Instead of improving the situation, we deepened the pandemic and the suffering. This is catastrophe by design.

Given the collapsing healthcare system, RNAO had earlier called for redefining essential services to only food and medications, closing down all other businesses and protecting workers. It also called for a complete lockdown including curfew. And finally, for vaccinating on-site using all-hands-on-deck, in particular, in hotspot neighborhoods and essential factories that will remain open. Very little of this was implemented in the measures announced yesterday. Here is our press release and here is a tweet (please RT).

Yesterday after the announcements, we tweeted out of desperation: “Shameful, criminal and devastating.” The government’s policies do not match the devastating reality of COVID in Ontario. “Sorry Ontarians, nurses failed to convince Premier Ford” to do the right thing. “Workers left to fend for themselves.”

Nothing of this was a surprise. We have been speaking out for weeks and months, and so many other health professionals have done so. On April 5 RNAO issued a press release denouncing the earlier measures as insufficient. This release followed earlier calls from RNAO cautioning of the impending third wave driven by new variants (see here, here, here and here). RNAO also issued an earlier Action Alert and issued on April 15 another urgent Action Alert. To no avail – this government simply does not want to hear. Please, do continue to sign and ask others to sign, as we can never give up.

Our heart goes to nurses, doctors and other health professionals who must sustain an overwhelmed healthcare system. The prospect of “triaging” in ICU beds is devastating and traumatic. As RNAO member and Pediatric Nursing Interest Group executive RN Chantal Singh says, “I don’t think Premier Ford has any concept of the moral distress, heartache and despair healthcare workers across Ontario are feeling due to the impending onslaught of deaths and difficult decisions no human should ever have to make. He has in fact refused the support we’ve begged for.” She adds that people will pay the price in lives lost, and healthcare workers will remain with lifelong trauma from this preventable scenario. “It’s not about the number of vaccines. It’s about forgetting your pride and your pockets, and putting people -- human lives first”. (Please RT here and here).

After a year of pain, here's how the COVID-19 pandemic could play out in 2021 and beyond

Even during the COVID crisis in Ontario, we should not forget that this is a global calamity. The massive third wave in Ontario is driven by COVID variants of concern that appeared in other parts of the world where the virus ran unchecked. In the most literal sense, we are all in this together. Unfortunately, we don’t behave as if that is the case. This, despite variants running havoc in Ontario (B1.1.7), in other countries such as Brazil (P1), and a large epidemic in parts of India being driven by B.1.617. These mutations are all landing in our country and will continue to do so until we are all vaccinated around the globe.

With the goal of increasing our awareness and actions on COVID-19 global justice, I am posting another article, dated March 10, by Michael Toole, a Professor of International Health at the Burnet Institute in Australia. This article is republished from The Conversation under a Creative Commons license. Read the original article.

One year ago today, the World Health Organization (WHO) declared COVID-19 a pandemic, the first caused by a coronavirus.

As we enter year two of the pandemic, let’s remind ourselves of some sobering statistics. So far, there have been more than 117.4 million confirmed cases of COVID-19 around the world; more than 2.6 million people have died. A total of 221 countries and territories have been affected. Some 12 of the 14 countries and territories reporting no cases are small Pacific or Atlantic islands.

Whether the race to end the pandemic will be a sprint or a marathon remains to be seen, as does the extent of the gap between rich and poor contestants. However, as vaccines roll out across the world, it seems we are collectively just out of the starting blocks.

Here are the challenges we face over the next 12 months if we are to ever begin to reduce COVID-19 to a sporadic or endemic disease.

Vaccines are like walking on the Moon

Developing safe and effective vaccines in such a short time frame was a mission as ambitious, and with as many potential pitfalls, as walking on the Moon.

Miraculously, 12 months since a pandemic was declared, eight vaccines against SARS-CoV-2, the virus that causes COVID-19, have been approved by at least one country. A ninth, Novavax, is very promising. So far, more than 312 million people have been vaccinated with at least one dose.

While most high-income countries will have vaccinated their populations by early 2022, 85 poor countries will have to wait until 2023.

This implies the world won’t be back to normal travel, trade and supply chains until 2024 unless rich countries take actions — such as waiving vaccine patents, diversifying production of vaccines and supporting vaccine delivery — to help poor countries catch up.

The vaccines have been shown to be safe and effective in preventing symptomatic and severe COVID-19. However, we need to continue to study the vaccines after being rolled out (conducting so-called post-implementation studies) in 2021 and beyond. This is to determine how long protection lasts, whether we need booster doses, how well vaccines work in children and the impact of vaccines on viral transmission.

What should make us feel optimistic is that in countries that rolled out the vaccines early, such as the UK and Israel, there are signs the rate of new infections is in decline.

What are the potential barriers to overcome?

One of the most salutary lessons we have learnt in the pandemic’s first year is how dangerous it is to let COVID-19 transmission go unchecked. The result is the emergence of more transmissible variants that escape our immune responses, high rates of excess mortality and a stalled economy.

Until we achieve high levels of population immunity via vaccination, in 2021 we must maintain individual and societal measures, such as masks, physical distancing, and hand hygiene; improve indoor ventilation; and strengthen outbreak responses — testing, contact tracing and isolation.

However, there are already signs of complacency and much misinformation to counter, especially for vaccine uptake. So we must continue to address both these barriers.

The outcomes of even momentary complacency are evident as global numbers of new cases once again increase after a steady two month decline. This recent uptick reflects surges in many European countries, such as Italy, and Latin American countries like Brazil and Cuba. New infections in Papua New Guinea have also risen alarmingly in the past few weeks.

Some fundamental questions also remain unanswered. We don’t know how long either natural or vaccine-induced immunity will last. However, encouraging news from the US reveals 92-98% of COVID-19 survivors had adequate immune protection six to eight months after infection. In 2021, we will continue to learn more about how long natural and vaccine-induced immunity lasts.

New variants may be the greatest threat

The longer the coronavirus circulates widely, the higher the risk of more variants of concern emerging. We are aware of B.1.1.7 (the variant first detected in the UK), B.1.351 (South Africa), and P.1 (Brazil).

But other variants have been identified. These include B.1.427, which is now the dominant, more infectious, strain in California and one identified recently in New York, named B.1.526.

Variants may transmit more readily than the original Wuhan strain of the virus and may lead to more cases. Some variants may also be resistant to vaccines, as has already been demonstrated with the B.1.351 strain. We will continue to learn more about the impact of variants on disease and vaccines in 2021 and beyond.

A year from now

Given so many unknowns, how the world will be in March 2022 would be an educated guess. However, what is increasingly clear is there will be no “mission accomplished” moment. We are at a crossroads with two end games.

In the most likely scenario, rich countries will return to their new normal. Businesses and schools will reopen and internal travel will resume. Travel corridors will be established between countries with low transmission and high vaccine coverage. This might be between Singapore and Taiwan, between Australia and Vietnam, and maybe between all four, and more countries.

In low- and middle-income countries, there may be a reduction in severe cases, freeing them to rehabilitate health services that have suffered in the past 12 months. These include maternal, newborn, and child health services, including reproductive health; tuberculosis, HIV and malaria programs; and nutrition. However, reviving these services will need rich countries to commit generous and sustained aid.

The second scenario, which sadly is unlikely to occur, is unprecedented global cooperation with a focus on science and solidarity to halt transmission everywhere.

This is a fragile moment in modern world history. But, in record time, we have developed effective tools to eventually control this pandemic. The path to a post-COVID-19 future can perhaps now be characterised as a hurdle race but one that presents severe handicaps to the world’s poorest nations. As an international community, we have the capacity to make it a level playing field.

 

Vaccine engagement as a tool to address marginalization and exclusion

RN Amanda Ottley is a registered nurse and RNAO member working in the field of disability management. She is one of the founders of the Save Toronto Carnival community group and in this article, she introduces us to an inspiring grassroots effort. Thank you deeply for your work, Amanda!

I got tired of shouting at the TV during the official COVID-19 briefings every week. “It made my throat hurt.” “I was tired of attending virtual memorials”. “If I had to make one more call to find out how family members are managing in quarantine...”  This is what life looks like for Black and Caribbean people now. This explains how I ended up leading one of the community groups who have received funding under the City’s $5.5 million COVID-19 Vaccine Engagement Teams Grants.  The purpose of the grant is to provide funding to address barriers to acceptance and increase uptake of COVID-19 vaccines in communities most negatively impacted by the virus.

In 2014, we called upon a handful of young professionals to form Save Toronto Carnival (STC).  STC is a grassroots group whose shared purpose was to make Toronto Carnival a safer space for the Black and Caribbean community.  STC quickly grew into a sounding board for the Caribbean community in Ontario. They used social media platforms to create a safe space online where Afro-Caribbean, Indo-Caribbean and Black communities could share their concerns.  STC has three pillars which guide our work: awareness, transparency, and engagement.  STC worked hard over the years to support a safer Carnival.  Each year more positive changes were enacted until STC had accomplished its mandate. 

Fast forward to February 2021, throat sore from screaming at the TV during yet another one of the province’s COVID briefings. The Black and Caribbean community were suffering disproportionately from COVID.  Yet another refusal from the province to protect BIPOC during this pandemic. Hot spots with no vaccination access. Sick days for essential workers that are not a priority. I reached out to the core members of STC. It was time to mobilize. We could make a difference. I felt this was something akin to “Avengers assemble!” It was really, just an email, but it had the weight and passion of a nurse getting ready to save the world.

STC’s core team consists of members of the African and Caribbean community. We have varied professional backgrounds from education, finance, human rights law, nursing, and social media.  We all share a single vision and purpose.  We must do everything we can to protect the Black, Caribbean and African community from the ravages of COVID.

How can it be that in Toronto Black people make up 8.99% of the population but make up 14.32% of the COVID-19 cases? South Asian or Indo-Caribbean people make up 12.7% of the population but make up 25.68% of the COVID-19 cases. Even through the vaccination process we are finding that people living in hotspots are getting vaccinated at lower rates than those who live in less affected areas. Our friends and family members are getting sick and dying, and STC had to answer the call.

That is when the hard work began. There were the late-night grant writing sessions. The efforts to connect with community groups who serve Black, Caribbean and African communities to explore collaboration. Four grant applications later, STC is excited to be included as one of the 150 community groups and agencies who have received funding under the City’s $5.5 million COVID-19 Vaccine Engagement Teams Grants.

While the provincial government has been largely reactive it was initially a welcome change when they spoke of people over 18 years of age in these hotspots now being eligible to receive the vaccine. Now we’re hearing that they’re running out of vaccines and are cancelling these lifesaving appointments which only reinforces the marginalization that our community feels. This latest misstep has crushed the spirits of an already devastated community. We’re hearing from community members in tears because they finally had hope that they could get the vaccine and now that hope is gone. It’s interactions like this that fuel our passion to help our community members and keep them safe.

We have been hearing stories that whole families are contracting COVID-19 because of connections to essential work. It’s enough to make you want to hold your head and bawl. With a government that refuses to implement paid sick leave to protect workers, we will do whatever we can to help those that seem like afterthoughts during this pandemic. Our guide in approaching this work, owes much to the work of Dr. Collins Airhihenbuwa who is an expert in creating solutions to promote health equity in national and global health. He speaks about the importance of “creating spaces and opportunities for those who live in the community to have their voices heard in naming the problem and offering solutions to the problems they face”.

So, to our Black, Caribbean and African family, do not lose hope. We will rise. We will work with our allies like the RNAO and the City of Toronto to create those spaces.

Leading the charge are: Amanda Ottley, RN with a Master of Nursing from University of Toronto. Karli Roopchan, Vice-Chair of the Diversity and Community Engagement Committee for the Town of Ajax. Karli is also a licensed paralegal with the Law Society of Ontario where she has worked primarily in the field of Ontario Human Rights law. Elise Roopchan, second generation Canadian of both Afro and Indo-Caribbean descent. Elise is a third year New Media student studying social media and emerging technology in the RTA program at Ryerson University. Shelly Richardson, IT Consultant living and working in the heart of downtown Toronto.  Shelly is of Afro-Trinidadian descent and has her degree in Information Technology and Statistics from York University.

POLICY UPDATES FOR ALL TO ACT ON & MUST JOIN EVENTS – OPEN TO ALL

Webinar: Let’s Talk about Anti-Black Racism and Discrimination in Nursing

Apr 19, 2021, 6:30pm - 8:00pm

This is a monthly webinar series designed for nurses interested in receiving updates on RNAO’s Black Nurses Task Force and to engage them in meaningful conversations that will inform the work of the Task Force. The Black Nurses Task Force has a mandate to tackle anti-Black racism and discrimination within the nursing profession. Read more here.

The April 19, 2021 webinar will be on:

Topic: Recruiting, retaining and advancing Black nurses

Objectives:

• generate awareness on the underrepresentation of Black nurses in leadership and executive roles in health care;
• describe strategies to incorporate equity, diversity and inclusion in hiring processes;
• explore best practices and effective strategies for recruitment, retention and advancement of Black nurses; and
• identify the meaning of sponsorship and its value in the progression of Black nurses.

Presenters:

• Ingrid Wilson, CHRL, CMS, GridFern Strategic HR
• Josephine Etowa, PhD, RN, RM, FWACN, FAAN, Professor, OHTN Chair in Black Women’s HIV Prevention and Care in Health Sciences, University of Ottawa
• Suzanne Charles Watson, Program Manager, Equity, Diversity and Inclusion, SickKids Research Institute

Register here.

Connecting Culture, Land and Wellness to Indigenous Youth Webinar

Apr 20, 2021, 4:00pm - 6:00pm

This webinar is in partnership with the Registered Nurses’ Association of Ontario (RNAO), Nishnawbe Aski Nation (NAN), Chiefs of Ontario (COO), the Centre for Addiction and Mental Health (CAMH) Shkaabe Makwa, the Canadian Indigenous Nurses Association (CINA) and Ontario First Nation Young Peoples Council (OFNYPC).

The overall purpose of this webinar is to increase health care providers' awareness of the importance of Indigenous language, community, culture and the wise practices and teachings of Elders to support well being amongst Indigenous youth. The objectives of this webinar are to facilitate knowledge exchange between Indigenous youth and health-care providers in regard to:

• the importance of language and what language says about wellbeing;
• how culture helps maintain wellbeing;
• the vision of healthy Indigenous youth; and
• the role of the health-care provider in supporting Indigenous youth

Presenter: Joseph Pitawanakwat (biography)

Moderated by: Quinn Meawasige, Indigenous Youth and Rachel Radyk, RPN, RN Student.

Target audience: Registered nurses, nurse practitioners, registered practical nurses and nursing students across care settings, primary care providers, public health and health promotion professionals, allied health-care providers and policy makers.

Note: Webinar will focus on nurses and health-care providers supporting First Nations communities and organizations; however all are welcome to attend.

NP Virtual Institute on April 21 with LTC Commissioner Frank Marrocco and other notable speakers

April 21, 2021, 9 am - 4:30 p. (ET)

Nurse practitioners from all sectors and settings across the province are welcome to RNAO’s Second-Annual Nurse Practitioner Institute – Nurse practitioners shaping the health system of the future.

The one-day virtual event provides NPs with an opportunity to network, engage and explore topics related to policy, clinical practice, quality improvement and patient safety, leadership and research. Top speakers this year include Matt Anderson, President & CEO, Ontario Health; Frank Marrocco, Associate Chief Justice and LTC Chief Commissioner; Dr. Jennifer Zelmer, President & CEO Canadian Foundation for Healthcare Improvement; Donna Duncan, CEO, OLTC; Shirlee Sharkey, President & CEO SE HeathCare and Greg Tofner, President & CEO from the Ontario Association of Medical Radiation Sciences delivering a clinical session of CT Scans & MRIs, and much more!

Participants will also discuss and debate key lessons and learnings from COVID-19 relevant to their practice and health system performance as well as build leadership and advocacy skills to drive meaningful policy and practice changes.

The NP Institute will close with an update about RNAO’s NP Task Force report Vision for Tomorrow, including the advisory role task force members will take on to ensure progress is made on each of the eight recommendations. 

These awesome speakers and much more are at NO cost for RNAO’s 1,800+ NPs. Register online today. If you are an NP and not yet a member of RNAO, you can join for a short time for ONLY $100 with PLP and all taxes included! And, then join the NP Institute for free! Join here  

To learn more, please see the agenda. Register online today.

 

Mark your calendar: 96th Annual General Meeting (AGM)

Jun 24, 2021, 2:00pm - Jun 26, 2021, 1:00pm

RNAO’s 96th AGM will be held virtually on June 24 - 26, 2021. Details on how to join the live streamed events will be posted in early June.

View the schedule of events and register now!

For a recap on last year's virtual AGM, please visit our AGM portal.

 

Watch the COVID-19 webinar: Wave three: Update, advocacy and what's next?

Ontario is now in the third wave of the COVID-19 pandemic. During this 12 April webinar, Dr. Doris Grinspun, RNAO's CEO, and colleagues provided an update on how the third wave is affecting nurses and Ontarians. Hear how RNAO, together with members and allies, are advocating for immediate actions to save lives, and long-term actions to right wrongs and establish justice for all. Learn about the next steps and how you can help shape the trajectory of this devastating virus and its variants.

Watch a recording of the April 12, 2021, webinar here.

To learn more about the COVID-19 Webinar Series, go here.

The next webinar in the series will be on May 10, 2-4 ET. Details to come.

 

MOH EOC Situational Report

We are posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you can access the Ministry’s guidance at any time.

For a more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here.

Here is a segment from the Situation Report #410 for April 16 (no report on April 17):

Case count as of April 16, 2021 / Nombre de cas le 16 avril 2021
Area / Région	Area / Région	Change from yesterday / Changement par rapport à hier	Deaths / Décès	Change from yesterday / Changement par rapport à hier
Canada*	1,096,716	+ 9564	23,445	+  55
Ontario**	408,383	+ 4,812	7,664	+  25

No updates today.

Staying in touch        

Keeping in touch is now more important than ever. Feeling that you are part of a community and that we have your back will help you get through this challenging time. We are also eager to hear from you how we can best support you. Send to us your questions, comments, and challenges. Feel free to also recommend ideas for future webinars. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten email: pgbatten@rnao.ca. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you all for being there for our communities – everywhere and in all roles! Together, in solidarity, we are stronger and more resilient. These continue to be tough times and we have to reach out to one another in solidarity! Our government, the public and indeed all health professionals – must keep focused. There is hope at the end of this long tunnel. Vaccines are being delivered in large quantities and now we need to fasten the rollout! Hugely important is to continue fighting the spread of the virus to preserve lives. To everyone and most especially our colleagues working in the front lines here at home and in countries around the world hit hard by evil COVID-19 – THANK YOU, and please take care of yourselves and know that RNAO always stands by you!

As we have said before, the silver lining of COVID-19:  Coming together and working as one people – for the good of all!

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

RECENT BLOG ITEMS:

10 April - RNAO and NAN sign Relationship Accord to improve health across NAN Territory – go here.

10 April - RNAO media release on public health measures and vaccination rollout – go here.

10 April - 3 ways to vaccinate the world and make sure everyone benefits, rich and poor – go here.

3 April - Government’s “shutdown” announcement doesn’t go far enough – go here.

3 April - RNAO’s continuing media profile: The March report – go here.

27 Mar - Provincial budget fails to deliver urgent nursing investments to care for Ontarians – go here.

27 Mar - Government's reopening plan threatens the health of Ontarians – go here.

20 Mar - Preliminary results of RNAO‘s Work and Wellbeing Survey – go here.

13 Mar - Getting it right – go here.

13 Mar - RNAO leads dozens of organizations in candlelight vigil – go here.

6 Mar - RNAO’s continuing media profile: The February report – go here.

6 Mar - Communication during a Pandemic: How we can endure the pandemic together – go here.

6 Mar - Webinar: Understanding wellness in Indigenous wisdom traditions for caregivers – go here.

27 Feb - RNAO celebrates Black History Month 2021 – go here.

27 Feb - RNAO’s 21st annual Queen’s Park Day goes virtual – go here.

27 Feb - RNAO’s NP Task Force releases groundbreaking report – Vision for Tomorrow – go here.

20 Feb - Are you struggling with substance use and/or mental illness? – go here.

20 Feb - RNAO hears about COVID-19: A heart-to-heart dialogue for nurses – go here.

20 Feb - With new variants growing, concerns mount about the premature lifting of restrictions – go here.

18 Feb - Anti-Black racism and discrimination in nursing: The power of mentorship in nursing education – go here.

13 Feb - RNAO’s letter to the premier on the vaccine rollout and the current context – go here.

6 Feb - Use community care providers to ramp up vaccinations! – go here.

6 Feb - RNAO’s continuing media profile: The January report – go here.

30 Jan - The PrOTCT plan for nurses: Counseling vaccine hesitant patients & colleagues – go here.

30 Jan - Please sign action alert urging Premier Ford to suffocate COVID-19, NOW! – go here.

23 Jan - Mitigating the spread in Toronto shelter settings – go here.

23 Jan - Home care nurses are #ReadyToVaccinate – go here.

23 Jan - Hurtful comments about law enforcement – go here.

15 Jan - The escalating catastrophe of the COVID-19 second wave in Ontario – go here.

15 Jan - Progress in vaccine distribution: Updates, issues and concerns – go here.

8 Jan - RNAO raises its voice in the media: Media coverage in December 2020 – go here.

8 Jan - A practicum experience at RNAO – go here.

8 Jan - RNCareers: Help during the holidays and help for next phases of this pandemic – go here.

We have posted earlier ones in my blog here. I invite you to look.

Information Resources

Public Health Ontario maintains an excellent resource site on COVID-19 materials. 

Ontario’s health provider website is updated regularly with useful resources.

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.

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.

The World Health Organization plays a central role in addressing the COVID-19 pandemic. See here and here.

You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.