August 28 2021 COVID-19 report


Dear Colleagues: Welcome to our Saturday, August 28 report during this nineteenth 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 policy updates and action alerts, as well as RNAO’s upcoming webinars.

Dear readers, we are following with horror the evolving tragic events in both Haiti and Afghanistan. Please extend your support to those helping on the ground. One committed organization working for decades in Haiti is Partners in Health. Canadian Medical Assistance Teams (CMAT) responded immediately to the earthquake. In Afghanistan, UNICEF is addressing the children’s humanitarian crisis and the World Food Program is providing food for millions under threat of famine.

Participate in the federal election: Call on the leaders of all political parties to demand that their plans for Canada include a healthy and just recovery for all Canadians. Elections matter, especially when it comes to the health of Canadians. But health isn’t just about health care. Our economic, social and environmental circumstances affect our health. These are important issues at stake in the election. It is vital to address the longstanding inequities laid bare by the COVID-19 pandemic. Everybody has a right to housing, clean water and safe and dignified health care. The calls to action of the Truth and Reconciliation Commission must be implemented. Climate change must be addressed with urgency. Here is our policy platform. Sign our Action Alert.

In this update we share: (1) advancing mandatory vaccination for health-care and education in Ontario; vaccine certificates coming; (2) addressing the global pandemic by sharing the mRNA vaccine technology with manufacturers in low- and middle-income countries.

Mandatory vaccination in process; vaccine certificates coming to Ontario

RNAO has led the call for mandatory vaccination of workers in health-care and education and has pushed for enacting vaccine certificates in the province. Mandatory vaccination is already under way in key sectors, but much work remains. We are calling on the Ontario government to make an announcement on vaccine certificates on Monday.

RNAO action

Let’s recap a bit of the background. RNAO has been at the forefront of the effort to fight the pandemic in Ontario and specifically, to mitigate the impacts of the fourth wave driven by the treacherous Delta variant. Canada has been for several months in the privileged position of having enough vaccine doses for all its eligible population, but the vaccine uptake has stalled at levels that will not bring about herd immunity with the highly transmissible variant.

RNAO launched on July 15 a #FullyVaccinated social media campaign to encourage everyone to receive both doses of the COVID-19 vaccine, and was the first major organization in Canada calling for mandatory vaccination for all health-care workers in contact with patients. In our July 21 open letter to the premier we surveyed the evidence on mandatory vaccination and called for measures to address inequities, such as vaccination clinics in accessible places, and paid time off to get vaccinated and recover from the shot. The Ontario Medical Association and then the Canadian Nurses and Medical Associations alongside many other organizations joined the call for mandatory vaccination of health-care workers. We were thrilled to know a coalition had emerged.

In a second, 28 July, open letter to the premier, RNAO called for mandatory vaccination of teachers as part of a comprehensive set of measures required to reopen schools safely in September. On August 3 the government announced mandatory indoor masking for students in grades one through 12 and improving ventilation systems, two of the measures RNAO had advocated for. However, it did not include mandatory vaccination for educators or mandatory indoor masking for children in daycare and kindergarten – measures that RNAO has consistently recommended.   

The government announced on August 13 that it is starting to move on mandatory vaccination for workers in hospitals, long-term care (LTC) and homecare, will give booster shots to the vulnerable, and will halt further reopening given the impending fourth wave. In response, RNAO urged the government to do more: expand mandatory vaccination to include all health-care workers in all sectors and settings; mandatory vaccination for all teachers and educators in all education settings – from daycare to post-secondary – and implementing indoor masking for those in daycare, kindergarten and schools, from the age of two and up.

On August 17 the government announced more measures on vaccination policies for health-care, education and other congregate settings. In a media release, RNAO emphasized the measures announced don’t achieve the goal of mandatory vaccination since they allow anyone who wishes to substitute vaccination with rapid testing (once a week, which RNAO deems insufficient) and an educational session. RNAO is seeking stronger provincial vaccination mandates in both health-care and education. We are also insisting on vaccine certificates for all eligible Ontarians.

RNAO urges the government to implement a vaccine passport / certificate / safe pass that is mandatory for access to risky indoor non-essential services – such as indoor entertainment, sports events, restaurants, bars and gyms – as well as long-distance travel. A vaccine certificate will keep the workforce safe, energize dormant sectors of the economy and protect businesses that implement these measures. RNAO had joined on August 5 the organizations demanding vaccine passports following a motion unanimously passed by the RNAO Board of Directors calling to enact such a system in a way that addresses concerns about inequity, privacy and safety.

RNAO issued an Action Alert calling on premier Ford to implement the 3 Mandatory Asks of Nurses: 1) #MandatoryVaccination for health-care workers (unless medical exemption); 2)     #MandatoryVaccination for teachers and educational staff (unless medical exemption); and 3)     #MandatoryVaccinePassports for everyone (unless medical exemption). In addition, we are asking for indoor masking for children two years old and up.

The context for vaccine certificates    

The push for vaccine certificates in Ontario is widespread and the question is why the government has taken so long to announce it. Business associations, mayors, medical officers of health, universities and political leaders have joined the call. After denying that the province was working on a vaccine certificate program, they acknowledge it is now under consideration. The announcement cannot come soon enough.

An article in CBC News surveys the advances in vaccine certificates across Canada. In the campaign trail, prime minister Justin Trudeau announced a billion-dollar fund to help provinces create their own vaccine passports. The plan is for Ottawa to pay for the development and the rollout of that program. The federal government has long promised its own vaccine passport-style program for international travel but that too is taking much too long. At a press conference before the election, the government said work is underway on a smartphone app and it could be available sometime this fall. Other countries have had it in place for months. Ottawa has explained the delay by pointing to the provinces, which control vaccination records.

Some provinces, notably B.C. and Quebec, already have created smartphone-based vaccine passports that people can use to prove their COVID-19 immunization status in commercial or public spaces — everything from bars and restaurants to bowling alleys and sports venues — where provincial law will soon require proof of a shot before entry. Manitoba is also expected to make its passport system mandatory for some nonessential businesses in the coming weeks.

The CBC reports that in two of the country's largest provinces — Alberta and Ontario —provincial leaders have refused to implement such a system. Ontario Premier Doug Ford has said earlier a vaccine passport would lead to a "split society" and claimed the paper receipts people receive at vaccine clinics are sufficient proof of status. In Alberta — where COVID-19 case numbers are high and vaccination numbers comparatively low — government officials have been insisting that a proof-of-vaccination program is a non-starter.

The European Union, with 27 member states, implemented their system much earlier. The EU Digital COVID Certificate Regulation entered into application on July 1. EU citizens and residents are now able to have their Digital COVID Certificates issued and verified across the EU. The Digital COVID Certificate is a digital proof that a person has either been vaccinated against COVID-19, received a negative test result or recovered from COVID-19.

In Ontario, immediate action is required. In the absence of a province-wide vaccine certificate, large private businesses and universities have stepped into the void by creating their own vaccine verification programs. This hodge-podge of measures disadvantages small businesses who do not have the same resources. Small businesses experience troubling animosity and bullying when they ask patrons if they are vaccinated. A provincial mandate is necessary to bring legitimacy, consistency and legal protection. RNAO is very hopeful the premier will make an announcement this Monday on Ontario’s implementation of vaccine certificates.

In an August 5 media release RNAO delineated the requirements for a good vaccine certificate program, that would address equity, safety and privacy considerations.

Take action to implement the 3 Mandatory Asks of Nurses: mandatory vaccination for health-care workers; mandatory vaccination for teachers and educators; and implement a vaccine passport mandatory for access to non-essential services. Sign our Action Alert. 


MSF: Following full FDA approval, Pfizer-BioNTech must share COVID-19 vaccine technology to boost global supply

Earlier this week the Food and Drug Administration gave full approval to the Pfizer-BioNTech vaccine in the US. The following is a media release from Doctors Without Borders/Médecins Sans Frontières (MSF) addressing the COVID-19 crisis in Africa and the devastating lack of vaccines. The original media release is here.

Sharing mRNA vaccine technology and know-how with additional manufacturers in low- and middle-income countries, including in Africa, could help increase global production and supply

NEW YORK/GENEVA, AUGUST 23, 2021—Following today’s full approval of the Pfizer-BioNTech mRNA COVID-19 vaccine by the US Food and Drug Administration, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) called on US-based Pfizer and German-based BioNTech to immediately share the vaccine technology and knowledge with manufacturers on the African continent that could help boost the global supply. MSF is also calling on the US government to demand these companies follow through. As COVID-19 vaccines remain scarce and people continue to die from COVID-19 at alarming rates across Africa, additional manufacturers stand ready to help boost the global supply, but cannot do so because Pfizer-BioNTech will not share the information and expertise needed for them to make more doses.

Pfizer-BioNTech received significant public funding to accelerate the development of these vaccines and is one of only two corporations producing mRNA COVID-19 vaccines, along with US-based Moderna. Pfizer-BioNtech should share this information through the World Health Organization’s (WHO) mRNA vaccine technology transfer hub hosted in South Africa. With only 1.7 percent of Africa’s population fully vaccinated against COVID-19, increasing and diversifying production and supply of mRNA vaccines through additional manufacturers, beginning with those based in countries on the African continent, offers an opportunity to urgently and sustainably address vaccine inequity.

“Supporting sustainable, independent vaccine manufacturing capacity in an African country would only require technology transfer from Pfizer-BioNTech and Moderna, but it would be a gamechanger for equitable access to vaccines for people in low- and middle-income countries,” said Dr. Carrie Teicher, director of programs at MSF-USA. “The US government must immediately urge Pfizer-BioNTech and Moderna to share COVID-19 mRNA vaccine technology and know-how. It really is a no-brainer—sharing mRNA technologies will increase the global production and supply of COVID-19 vaccines, saving lives in this pandemic and in the future.”

In an analysis by Imperial College of London commissioned by MSF, the estimated total cost needed for starting up mRNA vaccine manufacturing in an existing manufacturing site and producing 100 million doses is approximately $127 million for Pfizer-BioNTech’s vaccine and $270 million for Moderna’s vaccine. Considering the estimated $2.5 billion of public money that has gone into the development of mRNA vaccines—and the forecasted 2021 sales revenues of $26 billion and $19 billion for Pfizer-BioNTech and Moderna, respectively—these companies have a public obligation to facilitate increasing vaccine production and supply wherever possible.

“Setting up mRNA vaccine manufacturing capacity in Africa is absolutely possible,” said Lara Dovifat, campaign manager for MSF’s Access Campaign. “Our analysis shows that at least seven manufacturers in African countries currently meet the prerequisites to produce mRNA vaccines, if all necessary technology and training were openly shared. In fact, since July 2020, we’ve observed Pfizer-BioNTech and Moderna facilitate mRNA vaccine production with manufacturers in Switzerland, Spain, and Germany—all within eight months—so it is clearly feasible for other manufacturers to swiftly produce mRNA vaccines. The only reason these vaccines aren’t being produced more widely is because Pfizer-BioNTech and Moderna are refusing to share mRNA vaccine technology and information with manufacturers, including those in Egypt, Morocco, South Africa, and Tunisia that could have the capacity to produce up to 100 million doses annually within a 10-month timeframe.”

Currently, only 1 percent of Pfizer-BioNTech vaccine doses have been delivered to low-income countries (0.1 percent), and low- and middle-income countries (0.9 percent), based on MSF calculations using August 22 data from AirFinity. Given that countries in Africa historically import 99 percent of the vaccines they administer, such vaccine dependence is clearly not sustainable for a continent of 1.2 billion people.

“As we’re seeing in the places we work, being almost entirely dependent on erratic vaccine imports and donations has so far proven woefully insufficient for vaccine access on the African continent,” said Dr. Khosi Mavuso, medical representative for MSF-South Africa. “As new variants emerge and people continue to die from COVID-19 at alarming rates across Africa, the vaccine shortages we’re seeing are incredibly concerning. This suffering could be alleviated if pharmaceutical companies shared the mRNA technology and know-how needed to produce more COVID-19 vaccines now, through the WHO technology transfer hub so that local vaccine production can begin as soon as possible. It is a failure for global public health that governments and mRNA vaccine producers are not doing everything they can to scale up production of COVID-19 vaccines when there are potential manufacturers on the African continent.”

These mRNA vaccines are a revolutionary and lifesaving new medical tool that are an advantageous choice for use and manufacturing in low- and middle-income countries as they are relatively simpler, faster, and cheaper to produce than traditional vaccines. It is relatively easy to scale up production of mRNA vaccines, and they are highly adaptable to new variants of the virus that causes COVID-19. In addition, mRNA technology can be adapted to target other pathogens, meaning the same platform can be “switched” to produce different vaccines or even therapeutics for other diseases of concern, including those that may cause future pandemics.

In addition to demanding that Pfizer-BioNTech and Moderna share this technology, MSF urges all governments to support the WHO COVID-19 mRNA Vaccine technology transfer hub with financial and political support. Additionally, MSF calls on the US government and others with sufficient COVID-19 vaccine doses to immediately redistribute excess doses to the COVAX Facility. MSF also urges all countries to support the "TRIPS waiver" proposal at the World Trade Organization to waive intellectual-property monopolies on all COVID-19 vaccines, tests, treatments, and other health tools during the pandemic, and to use all legal and policy tools to facilitate uninterrupted production and diversity in the supply of COVID-19 medical tools.


Take action on global vaccine access: Sign an Action Alert calling on Prime Minister Trudeau to ensure global vaccine access. Let’s also make sure we urge Prime Minister Trudeau to match President Biden’s commitments to Covax.




RNAO Action Alerts

Take action on Bill 124 and sign the Action Alert. Add your voice to the 5,195 others calling on Premier Ford to exempt health-care workers from Bill 124. We join the call to #RepealBill124. This is urgent given the deterioration of nursing human resources as colleagues leave the profession or move to the United States. President Biden is eager to welcome our awesome RNs.

Call on elected leaders to step up and end the opioid crisis: Sign an Action Alert calling on politicians at all orders of government to work together to save lives and bring this crisis to an end.

Enshrine a nursing home basic care guarantee in legislation, premier, set the path forward! Sign an Action Alert! Call on the premier to enshrine in legislation RNAO’s Nursing Home Basic Care Guarantee.


Webinar: COVID-19 Webinar Series

September 13, 2021, 2:00pm - 4:00pm

When: Every second Monday of the month (except for August)

RNAO's CEO Dr. Doris Grinspun will be hosting COVID-19 webinars for health providers.

Topics include:

  • updates on COVID-19 and the health system: latest news and pressing issues
  • guest speakers (as applicable)
  • questions and answers
  • calls to action

Health providers from Ontario, Canada, and anywhere in the world are welcome to join at no cost.

We are here with you in solidarity. Together, we will continue to tackle COVID-19 with the best tools at hand, including accurate information, calmness, determination and swift actions!

Upcoming webinar:

September 13, 2021, 2 - 4 p.m. ET register here.

Details and registration link coming soon.

Watch and read about earlier webinars here.


Let’s Talk About Anti-Black Racism and Discrimination in Nursing

Sep 20, 2021, 2:30pm - 4:00pm

This is a webinar series designed for members of the public 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.

Upcoming webinar

Sept. 20, 2021, 2:30-4:00 pm - Details and registration link coming soon.

Watch and read about earlier webinars here.


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 last Situation Report #502 for August 27:

Case count as of August 27, 2021 / Nombre de cas le 27 août 2021

Area / Région

Case count / Nombre de cas

Change from yesterday / Changement par rapport à hier

Deaths / Décès

Change from yesterday / Changement par rapport à hier


562 756

+  781

9 489

+  17**


A number of COVID-19 screening tools and documents have been updated including:


Staying in touch          

Keeping in touch remains important as we face the pandemic and other challenges in Ontario, in Canada and elsewhere – in particular, in Africa and Latin America – two of the continents most affected by COVID-19 and its variants – delta and lambda. Feeling that we are part of a community and that we have each other’s backs helps us get through these challenges, becoming better people in the process. We are eager to hear how we, at RNAO, can best support you. Send us your questions, comments, and challenges. Recommend ideas for articles and webinars. Write to me at and copy my executive assistant, Peta-Gay (PG) Batten at RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you for being there for your community – everywhere and in all roles! Together, in solidarity, we are strong and resilient. In Canada we see hope at the end of this long pandemic tunnel. Please keep encouraging your colleagues, their loved ones and your communities to be fully vaccinated. We must not forget, however, about our privilege. Canada has purchased more vaccines than what it needs, while 9 out 10 countries have almost nothing. Like in other challenges we face, such as racism, Islamophobia, and other forms of discrimination, we are not safe until everyone is safe. Vaccines for all – literally for all, across the world – must guide policy in the upcoming 12 months. Let’s learn from the 17-month pandemic and take real action to build a better world.

To everyone – THANK YOU! Please take care of yourself and know that RNAO always stands by you!

Here’s one constant throughout the pandemic. The silver lining of COVID-19 has been to come together and work as one people for the good of all. Let’s join efforts to demand political leaders bring about #Vaccines4All!

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



21 Aug - Nurses call on voters to vote for a healthy recovery for all – go here.

21 Aug – RNAO calls for a stronger vaccine mandate and action on vaccine certificates – go here.

21 Aug - WHO condemns rush by wealthy nations to give Covid vaccine booster – go here.

21 Aug - Calling on Canada to back WHO Moratorium on Booster Shots and Donate Vaccines – go here.

15 Aug - Why is Delta such a worry? – go here.

15 Aug - This is what we know about the Delta variant and kids – go here.

15 Aug - RNAO welcomes mandated vaccination for health care workers – go here.

8 Aug - COVID-19 vaccine boosters: is a third dose really needed? – go here.

8 Aug - RNAO calls to implement vaccine passports to help reopen Canada – go here.

8 Aug – School reopening plan: additional measures needed to stave off worst effects of fourth wave – go here.

1 Aug - RNAO’s continuing media profile: The July 2021 report – go here.

1 Aug - Preparing for the fourth wave – go here.

25 July - Action Alert: Mandate COVID-19 vaccination for all health-care workers, premier! – go here.

25 July - Are we preparing for a safe school reopening? – RNAO asks once again – go here.

17 July - Mandatory vaccination for health-care workers – Exploring issues, challenges and supports – go here.

17 July - #FullyVaccinated campaign and mandatory vaccination for health-care workers – go here.

10 July - A Detailed Study of Patients with Long-Haul COVID – go here.

10 July - Prolonged brain dysfunction in COVID-19 survivors – go here.

3 July - RNAO’s continuing media profile: The June report – go here.

3 July - RNAO celebrates virtual 96th Annual General Meeting – go here.

26 June - Global herd immunity out of reach because of inequitable vaccine distribution – go here.

26 June - Canada is virtue signalling while waffling on global access to COVID-19 vaccines – go here.

20 June - Building your Twitter presence: Here are tips from RNAO – go here.

20 June - Let’s flatten the infodemic curve – go here.

12 June - RNAO statement on the terrorist attack in London, Ontario – go here.

12 June - Reducing the time interval for second dose after first AstraZeneca dose – go here.

12 June - AstraZeneca second dose: Should I get the same vaccine or Mrna? – go here.

5 June - RNAO’s continuing media profile: The May report – go here.

5 June - RNAO supports Premier Ford's announcement on schools as risk is too high – go here.

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