April 22, 2020 RNAO COVID-19 update

Dear Colleagues:  Welcome to my Wednesday, April 22, COVID-19 report -- now in the fourth month of COVID-19 in Ontario. For the many resources RNAO offers on COVID-19, visit the COVID-19 Portal. In particular, VIANurse is your go-to page if you need to augment your nursing and personal support worker human resources. You can refer to earlier update reports here, including thematic pieces in my blog. Feel free to share this report or these links with anyone interested – they are public.

The ubiquitous slogan, from TV to social media, is: “We are all in this together!”  However, the reality of the pandemic is strikingly different. The COVID virus insidiously attacks the most vulnerable among us, and it takes an extraordinary amount of intentional focus, effort, resources and humanity to make sure we protect those most exposed to infection and who expect the worst outcomes. We have discussed on various occasions the plight of nursing homes and retirement homes. We have also shared about the needs of and responses to persons experiencing homelessness.

Today, we spotlight the needs of persons requiring mental health and addiction services, one of the most neglected sectors in healthcare. On behalf of RNAO, our tremendous appreciation to Kim Moran (CEO, Children’s Mental Health Ontario), Adrienne Spafford (CEO, Addictions and Mental Health Ontario) and Camille Quenneville (CEO, Canadian Mental Health Association, Ontario) for contributing the article that follows. RNAO calls on government to immediately heed their call!

Shaking the stigma: We need a proactive COVID-19 response for mental health and addiction

Mental health and addictions associations have been sounding the alarm that this sector could follow long term care as the next hot spot during the crisis.  Across the sector, there are more than 20,000 beds with many in congregate living – a key nexus for COVID19.  Due to staff shortages, the impact of an outbreak could lead, sadly, to highly vulnerable children, youth and adults, many with compromised immune systems, left with inadequate care. Some will have no other place to go but hospital. 

One must wonder if there is stigma around mental health and addictions in the Ministry of Health. Dr Thomas Ungar, a noted psychiatrist, has written extensively about the stigma that is present within hospitals. There has been a notable lag and in some cases absence of measures for mental health and addiction.  Guidance documents from the Ministry of Health were only just posted on Monday for community mental health and addictions – more than four weeks after other sectors such as primary care, long-term care, home and community care, community pharmacy and acute care.

Hospitals, long-term care, developmental services, women’s shelters, LHIN staff, all have received emergency orders for the redevelopment of staff from non-essential to essential, and rightly so. However, emergency orders for the redeployment of staff from non-essential to essential services in the mental health and addictions sector have been delayed. So far no orders to protect vulnerable people in congregate living have come, despite almost four weeks of providing evidence and undertaking strong advocacy. 

And, finally the Ministry of Health announced $12M of COVID19 funding with $6.5M to go to community mental health and addictions agencies. This works out to a paltry $380 per bed.  Not enough to support even a days worth of PPE.  Compare this to the $25M announced last week in Alberta – if adjusted to the size of Ontario’s health care system, that would represent a $75M investment, over 10 times that was made in Ontario. Remember too that this government pledged $1.9 B (matched to the federal $1.9 B) to expand community mental health and addictions services as part of their platform… and the provincially matched funding has yet to flow.

Children and youth with very serious mental health issues, often those who have been “formed” as a risk to themselves or others, await support from the government.  While children are unlikely to become very ill from the virus, workers may not feel safe without adequate safeguards in place. We have recent examples of this risk playing out in long-term care and in the developmental services sector. Long standing systemic issues play a significant role in that there are insufficient clinical staff in live-in treatment centres for children and youth, including nurses. Only a few facilities have nurses on staff – a result of chronic underfunding.  The new funds, if they are ever invested, must be targeted to adding clinical staff. The heroic workers now caring for children, have little training or practice in infection control and the use of PPE – and of course, they have little PPE.

In addiction treatment facilities and supportive housing, the issues are the same.  Years of chronic under-funding means that there are few nurses and outdated infrastructure.  Staffing will only be more limited due to the necessary measures taken in the long-term care and retirement home sectors to limit staff to one site.  The clients that we serve are also complex.  People with mental illness and addiction are more likely to die prematurely than the general population: according to research, mental illness can cut 10 to 20 years from a person’s life expectancy. Many clients that providers are serving have compromised immune systems due to HIV/AIDS, Hepatitis C, liver disease, chronic heart disease, obesity and diabetes.  These are statistics and factors that should make system leaders, public health experts and practitioners and decision makers pay attention and get proactive.

Experts are united in their belief that demand will soar for mental health and addictions services post pandemic.  Healthcare workers’ trauma and for some, PTSD, will require long term support from therapists to ensure that they will recover from their experiences. Alcohol use is increasing and the resultant rise in problematic substance use and dependence will call on an already over-stretched system. We still don’t know the impact that COVID-19 has or will continue to have in another crisis facing our sector – that of opioid and other overdoses.  The stresses on families from the economic shutdown and isolation will put negative pressure on families, and children and youth will suffer. Sadly for some, home is not a safe place. And for those Ontarians and families with low income and precarious housing – disproportionately racialized and Indigenous Ontarians – the impacts will be even more profound.

Crisis lines across the province are already seeing surges. The 211 service in Toronto saw a 90% increase in call volume related to mental health over the holiday long weekend. ConnexOntario, the province’s central access for mental health, addictions and problem gambling services has seen a 20% increase in calls related to anxiety. Kids Help Phone has seen text volumes from youth increase 350 per cent.

There were long wait times before the pandemic. CMHO reported 28,000 kids waiting sometimes up to two years for services. The federal government pledged $1.9B and the province committed to matching that for a total of $3.8B over ten years. That investment needs to flow now to ensure that services are there for all Ontarians when they need them.

The government needs to demonstrate its support of Ontarian’s mental wellness by taking action now to ensure essential mental health and addictions services can continue through the pandemic, and to build capacity and expand services so we can be ready for the post-pandemic wave of mental health and addictions challenges.  There is still time to get ahead of this curve, but we need action now.

Your messages: Voices and responses

Each day we welcome new readers to this daily report: thank you deeply for the work you do during this public 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 and other organizations both at home and 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. Many of the articles you see here are posted in my blog, where you can catch up with earlier issues. The COVID-19 Portal is here.

Thank you to Mwali Muray for alerting me that I made a mistake in my last update when paying tribute to the deceased personal support worker. Christine Mandegarian, who was on her 50s, was a personal support worker for 31 years, and not as I wrote. She worked at Sienna Altamont Care Community in Scarborough, and she died last Wednesday, less than 24 hours after testing positive for the virus. Her union says this “tragic death is a difficult reminder of the very real dangers health-care workers face in the selfless delivery of care for Ontario families, as well as the support and protection that they need immediately.” The union confirmed that a second staff member from the same facility is in serious condition after testing positive for COVID-19. They also report that proper personal protective equipment was not used, and infection controls were not put in place at that nursing home.

Together we can do it

Today was day #33 of RNAO’s #TogetherWeCanDoIt campaign, started on March 19. Here are my picks for a noise that is becoming louder and louder in streets, workplaces and social media to #cheer4healthworkers – and it has gone even to Taiwan! Please remember to join-in this community building moment every evening at 7:30pm local time - until we defeat COVID-19! and post tweets from your communities, workplaces and memory places - with your messages, cheers here, pots & pans, songs and other expressions of gratitude -- Because: #TogetherWeCanDoIt.

MOH EOC Situational Report #87 here for Tuesday, April 21

Situation:

Case count as of 8:00 a.m. April 21, 2020
Area	Case count	Change from yesterday	Deaths	Change from yesterday
Worldwide total	2,478,373	+62,185	170,321	+4,212
Europe	1,113,136	+18,786	104,835	+2,079
China	88,423	0	4,632	0
Middle East	224,137	+8,391	7,873	+229
Asia & Oceania	95,083	+1,726	2,656	+43
Africa	22,422	+779	1,134	+28
Latin America and Caribbean	107,861	+4,743	5,287	+247
North America	827,311	+27,760	43,904	+1,586
United States	790,480	+25,715	42,214	+1,476
Canada	36,831	+2,045	1,690	+110

• 551 new cases reported today in Ontario, bringing the cumulative total to 11,735 (this includes 5,806 resolved cases and 622 deaths).
• In Ontario, a total of 174,170 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 5,546 tests under investigation.
• 859 patients are currently hospitalized with COVID-19; 250 are in ICU; and 194 are in ICU on a ventilator.

EOC report #87 for April 21 informs of the following actions taken: 

• The Government of Ontario announced additional funding and services to help seniors and people with disabilities during the COVID-19 outbreak.
• Sentinel surveillance testing will begin immediately in Long-Term Care Homes to ascertain the current status of COVID-19 in these facilities. Please see here. 
• The latest Command Table summary – see here.  

RNAO’s ViaNurse Program

RNAO launched its COVID-19 ViaNurse program on March 13 and it has already registered 283 nurse practitioners (NPs), 1,015 critical care RNs (who have experience and continued competency in the provision of critical care) as well as 7,264 RNs for virtual/clinical care.

RNAO is actively staffing nursing homes and retirement homes requiring NPs, RN and PSWs; so far, 419 organizations have registered. We have also staffed many hospitals and indigenous communities. We urge CNEs, CNOs, and managers – in all sectors and regions of Ontario - to access this talent now to build HR surge capacity. For details and forms, please go here.

Staying in touch          

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 around the world. 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 must redouble our efforts to tackle COVID-19 with the best tools at hand: accurate and transparent information, calmness, determination and swift actions. 

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

RECENT RNAO POLICY CORNER ITEMS:

21 April - We Require Expanded and Accessible COVID-19 Data in Ontario– go here.

20 April - Can Loss of Smell and Taste Help Screen for COVID-19? – go here.

18 April - COVID, Trump and the World Health Organization – go here.

16 April - A Home Based Model To Confront COVID-19 – The Case Of The Balearic Islands – go here.

15 April - COVID-19 and the Challenges in Homecare – go here.

14 April - Reprocessing Of N95 – An Update – go here.

14 April - A New COVID-19 Facility For Persons Experiencing Homelessness In Toronto – go here. 

13 April - Practical Tips for Safe Use of Masks – go here.

10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.

10 April - RNAO Action – Supporting Long-Term Care – go here.

10 April - Update For Nursing Students – NCLEX Exam – go here.

9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.

9 April - Guidance on use of N95 mask – go here.

7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.

7 April - Reprocessing of n95 – safe? – go here.

5 April - We must change the way we do testing and case definition – go here.

5 April - Ringing the alarm bells on critical care beds – go here.

4 April - COVID-19, stay at home and domestic violence – go here.

We have posted earlier ones in my blog here. Please go and take a look.

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.

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.

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.