December 11 2020 COVID-19 report

Dear Colleagues: Welcome to our Friday, December 11report– now in the tenth month of COVID-19 in Ontario.Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19.Find earlier update reports here, including thematic pieces in Doris’ COVID-19 Blog. RNAO media hits and releases on the pandemic can be found 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. 

Join us on Monday, December 14 for a fantastic panel on Continuing the conversation: Mobilizing collective action for long-term care reform in Canada. Register here. See details below.

 

RNAO gravely concerned about the second pandemic wave

The government released two days ago the projections in the latest Ontario modeling of the pandemic, and issued today additional measures that bring new regions in the province into lockdown.

RNAO and others remains gravely concerned by the late and insufficient efforts to control the second pandemic wave,which is once again overwhelming long term care (LTC) institutions, in particular nursing homes across the province, adding anguish to residents, staff and the families of both. This “too little, too late approach”continues to disadvantage populations compromised by their social conditions. These are the communities at risk due to precarious employment or unemployment and low income that often also live in tougher housing conditions. These are the same communities that suffered the burden of illness during the first wave of this pandemic. In this second wave the lateness in acting is overwhelming also Ontario hospitals, and this will have renewed repercussions on thousands of Ontarians needing diagnostics and procedures for non-COVID illnesses, who will see delays in access to health-care services.

This grim reality is unacceptable because it was fully preventable given the public health tools available to government. We as individuals also bear responsibility. While many of us strive to act according to the best public health evidence and encourage our families, friends and co-workers to do the same, not all do. And, while I understand people are tired of restrictions and want to get on with life and celebrate holidays – I too want the same –, we simply can’t. Thus, when we see crowded public places, whether these are malls, stores or parks, we must remind people that we are all on this together, for good or for bad. The consequences of our actions will be felt in the form of excess deaths, and in the form of missing loved ones at our future celebration tables.

For nurses and other health professionals working on the front lines, the disconnect between what they are called to do, and what they see the government and some sectors of the public doing, adds to their stress and exhaustion. 

The government’s approach is distorted and belated because it focuses on ICU occupancy as their key indicator for taking action. Basically, the province is taking action when hospitals, and particularly critical care units, are becoming overwhelmed in a particular region. This approach accepts that there will be widespread community transmission and all it wants is to diminish those rates of transmission just below the levels that overwhelm critical care capacity.

This is an approach of planned failure to control the virus that ignores the societal impact, in particular the burden of illness on the most vulnerable. The idea that somehow this approach “saves the economy” is wrong-headed – it simply does not. It also ignores the LTC “collective PTSD” resulting from the traumas of the first wave and the worsening human resources crisis. I ask that no one be surprised as we start to experience shortages of ICU RNs, NPs and CNS – as they can’t continue working at this pace. RNAO begged action during the summer: hire, hire, hire – it never happened and it is still not happening. Shortages of staff during the pandemic, in any sector,result in additional deaths. It also means more illness amongst staff, as they let down their guard when they are rushed and exhausted.

It is sad that the Ontario government is using the vaccination excitement as a political tool to distract the public from the horrors of this second wave. Canada is the country with the largest secured provision of vaccinesper capita in the world, and one of the best prepared vaccination campaigns. Both the federal and provincial governments deserve kudos for this enormous achievement. But while the provincial government wants to see “all political hands on deck” for the vaccination campaign, it seems to be quietly suggesting “all political hands off deck” in addressing this second wave of community transmission.

The sobering reality is thatit will take many months– likely till the summer or fall – to reach levels of inoculation that will allow normalcy to gradually take hold. Vaccination in other parts of the world will advance at much slower speed, so real normalcy is still far away. In the meantime, we must tackle the urgent pandemic crisis at hand. We can take comfort that with the arrival of warmer weather in the spring, at a time when the most at-risk citizens should already be vaccinated, we will start to see tangible improvement in the situation.

Finally, let’s keep together –demanding from ourselves to uphold the public health rules and abstaining from getting together for the holidays. And let’s keep together urging government action towards a more severe and expansive lockdown encompassing all the major urban areas in the province, especially during the holiday period, with the purpose of effectively diminishing the rates of mobility and contact. The short-circuiting of virus transmission requires a number of measures, such as curbing movement between regions at different levels of COVID-19 restriction, and directing big box stores to sell only groceries and basic household goods. Governments should also provide the necessary protection to those who must continue to work in essential services, and adequate supports for vulnerable groups who most suffer the consequences of lockdowns. Without addressing these structural barriers, the lockdown measures cannot be successful. The further strengthening of testing (including rapid testing), contact tracing and isolation (including the provision of isolation places for those with inadequate housing conditions) remain priorities as well. In short, we require a comprehensive, science-based public health framework to control the community spread of the virus that enacts a COVID-Zero strategy.

RNAO issued on December 8, in conjunction with the Ontario Hospital Association, Ontario Medical Association, Registered Practical Nurses Association of Ontario, and Respiratory Therapy Society of Ontario the following media statement:

                                                              

With ICU cases climbing toward potentially devastating levels, health organizations plead for Ontarians to celebrate holiday season safely

As COVID-19 cases reach record highs and the holiday season approaches, the association representing Ontario's hospitals and professional associations representing nurses, physicians and respiratory therapists are issuing an urgent and united plea for immediate action. It's the government's responsibility to put in place strong public health measures we know can prevent and control the spread of the virus. And, now more than ever, every Ontarian has a moral responsibility to strictly adhere to these important measures.

The number of people in intensive care in Ontario hospitals with COVID-19 is rising, with potentially devastating consequences for patients. If hospitals, emergency departments and ICUs are full, it means that surgeries, procedures, diagnostic tests and routine care will have to be delayed, adding to a substantial backlog not just in hot spots, but throughout Ontario. This risk affects all patients, not only those with COVID-19 – the postponement of cardiac or cancer surgeries, for example, puts thousands more in harm's way.

In the face of all this, Ontario's healthcare professionals continue to care for patients with courage, expertise and compassion. They are often called heroes, but they are also human beings under enormous physical, mental and emotional strain. Our organizations stand behind them, and we call on all Ontarians to join us by doing everything they can to curve the spread of the virus, save lives and limit the damage.

We know that fatigue with public health restrictions has set in, and that it is particularly painful to cancel traditional family gatherings – but this sacrifice pales in comparison to the pain of losing a loved one or watching them suffer. While seniors and other vulnerable populations are at greatest risk from COVID-19, we have also seen serious health consequences and deaths among younger people, and we appeal to them to follow public health guidelines and thank those that are doing the right thing.

No one is unaffected by COVID-19, and no one is exempt from doing their part. Whether you have a grandparent living in a long-term care home, a colleague with a heart condition, or a friend who is a nurse, physician, or respiratory therapist, we all know someone who needs and deserves our protection.

In the spirit of love, family and generosity that characterizes the holiday season, we ask all Ontarians to celebrate safely and responsibly. Celebrating at a distance is the best way to support healthcare professionals, and it is a small price to pay compared to the grief of those who could face far greater losses if we fail to do our part.

Anthony Dale
President and CEO, Ontario Hospital Association

Dr. Doris Grinspun
CEO, Registered Nurses' Association of Ontario

Dr. Samantha Hill
President, Ontario Medical Association

Dianne Martin
CEO, Registered Practical Nurses Association of Ontario

Paula Smith
President-Elect, Respiratory Therapy Society of Ontario

Here are the top five things all Ontarians can do to protect themselves and others:

• Wash your hands often.
• Wear a mask or face covering at all times, unless you are at home with housemates or outdoors at a guaranteed two metres' distance from others.
• Stay away from crowded places.
• Celebrate or gather only with members of your household. Don't invite others into your home.
• Prepare for contact tracing if you get COVID-19. Download the COVID Alert app and/or keep track of where you go and when.

 

 

A critical resource for pandemic times: Learn about the Nurses’ Health Program

COVID-19 has made it a more challenging time for people with addiction and mental health disorders. It’s also been an enormously stressful, exhausting and sometimes traumatizing experience, particularly for nurses at the frontlines dealing with COVID or working anywhere under the extraordinary circumstances created by the pandemic.

For that reason, I am taking the opportunity to remind our nursing readers – NPs, RNs and RPNs – of the Nurses’ Health Program that can be a crucially important resource for those who may need it.

Are you struggling with mental health and/or substance use disorders? Do you know a colleague who is seeking help? Please forward them this information.

The Nurses’ Health Program (NHP) is a voluntary bilingual program for Ontario nurses. It is designed to encourage nurses to seek treatment for substance use and/or mental health disorders that may affect their ability to practice nursing safely. It is a recognized best-in-class approach that focuses on early identification and referral for treatment. The program is modelled on similar ones used by other regulated health professions across the province.

NHP provides an opportunity for Ontario nurses with substance use and/or mental health disorders to receive support to recover and practice safely. It is designed so that eligible participants can continue practicing while following a treatment and monitoring plan.

The program monitors the nurses’ recovery so that they may be supported to practice safely or return to practice, which promotes professional accountability and protects the public.

The Nurses’ Health Program embraces the philosophy that nurses who have substance use and/or mental health disorders should have an opportunity for education, treatment and recovery. We know nurses benefit from specialized treatments that recognize their unique needs as health care professionals.

Our focus reflects the balance between supporting nurses in recovery and protecting the public. We believe that with the right support nurses can continue or return to safe nursing practice benefiting both the nurse and the public.

When you join the program, you benefit from:

• access to professional advice and health care services, including treatment providers
• an initial assessment and case management paid for by NHP
• a program tailored to your unique needs to support your recovery
• confidence that your name will not be disclosed to the public if you follow the obligations of the program

The Nurses’ Health Program is supported by:

• College of Nurses of Ontario (CNO)
• Ontario Nurses’ Association (ONA)
• Registered Nurses’ Association of Ontario (RNAO)
• Registered Practical Nurses Association of Ontario (RPNAO)

NHP was developed when the four nursing organizations agreed this approach provides an effective channel for nurses with substance use and/or mental health disorders to receive support to recover and practice nursing safely.

To be eligible for the program you must be:

• registered with the College of Nurses of Ontario (CNO) in the general or extended class
• experiencing issues with substance use and/or mental health disorders that impact your ability to practice safely

You can contact the program here or call toll-free 1-833-888-7135.

 

 

Upcoming webinar: Continuing the conversation - Mobilizing collective action for long-term care reform in Canada

Monday, December 14, 6:45 – 8:00 pm

Due to the overwhelming response and active engagement during our Nov. 9 webinar, we are hosting another cross-country meeting on Dec. 14.

All are invited to attend including anyone across Canada who cares about seniors and wants to join forces to inspire our provincial, territorial and the federal governments to establish national standards for long-term care and to take additional action to support people staying in their homes longer. 

Moderatedby Globe and Mail columnistAndré Picard, the author of Neglected No More: The Urgent Need to Improve the Lives of Canada's Elders in the Wake of a Pandemic.

Panelists (in order of presentation):

Nathan Stall, staff geriatrician at Sinai Health System, will update on COVID-19 outbreaks in LTC in Canada, with particular attention to Alberta, British Columbia, Ontario and Nova Scotia. Dr. Stall will also share emerging research regarding COVID-19 and its impact on residents and staff in LTC.

Carole Estabrooks, nursing professor, University of Alberta, expert on knowledge translation in LTC, will challenge us to reject quick fixes and ask about our collective vision for LTC in Canada. Dr. Estabrooks brings a wealth of knowledge from the research program of TREC (Translating Research in Elder Care) and its impact during COVID-19 and beyond.

Morgan Hoffarth, RNAO President and Director of Care at Mount Hope Centre for Long Term Care, will discuss current challenges and opportunities faced by front line providers and managers in LTC homes. She brings real life experience from a leader who was inspired to join an LTC home during COVID-19.

Wendy Francis, Family Councils Collaborative Alliance (FCCA), will share the vital role of family councils during COVID-19. The FCCA brings a collective voice to inform the challenges of families during the first and second waves of COVID-19, as well as learning for a post COVID-19 era.

Doris Grinspun, RNAO CEO, will inspire a call to action. Our feisty CEO and sophisticated analyst and strategist will remind us this is our “last kick at the can.” We should honour the lives already lost – due in part to government failure, ageism and discrimination – and the anguish of their families, by securing a brighter future for all who call LTC their home. Dr. Grinspun will offer thoughts for targeted action.

REGISTER NOW

 

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 latest Situation Report #320 for 11 December:

 

Case count as of December 11, 2020 / Nombre de cas le 11 decembre 2020
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
Worldwide total / Total mondial*	69 281 963	+ 663 552	1 582 374	+ 12 226
Canada*	442 069	+ 6 739	13 109	+  126
Ontario**	136 631	+ 1 848	3 916	+  45

Update:

 

• Ontario Begins Rollout of COVID-19 Vaccine. The Ontario government has developed a three-phase implementation plan to receive, store and administer COVID-19 vaccines to Ontarians as soon as they are received. Phase One will begin on Tuesday, December 15, 2020 with a pilot project in Toronto and Ottawa which will include the vaccination of over 2,500 health care workers with the Health Canada approved Pfizer-BioNTech vaccine.

• Ontario Moving Regions to New Levels with Stronger Public Health Measures. The Ontario government, in consultation with the Chief Medical Officer of Health, local medical officers of health, and other health experts, is moving seven public health regions to new levels with stronger public health measures, including Windsor-Essex County Health Unit and York Region Public Health moving into Grey-Lockdown. These steps are being taken to stop the spread of COVID-19 in order to keep schools open in the regions where in-class learning is permitted, safeguard health system capacity, and protect the province's most vulnerable populations. The regional levels and specific public health measures are set out in the Keeping Ontario Safe and Open Framework.

 

Staying in touch       

Please continue to keep in touch and share questions, comments and challenges. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten <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 will continue to be tough times for the next few months for 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!

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, O.ONT
Chief Executive Officer, RNAO

 

RECENT BLOG ITEMS:

4 Dec - Continuing the conversation: Mobilizing collective action for LTC reform – go here.

4 Dec - Nurses urge dedicated funding for infection prevention and control in LTC – go here.

27 Nov - RNAO, once again, plays major role in the media during November – go here.

27 Nov - COVID-19 in long-term care: A nurse’s witness statement – go here.

20 Nov - Government’s measures too late and insufficient; calling for a COVID-Zero strategy – go here.

13 Nov - Mobilizing collective action for long-term care reform in Canada – go here.

13 Nov - RNAO’s media conference to address the crisis in long-term care– go here.

6 Nov - Fall 2020 provincial budget once again leaves vulnerable populations to fend for themselves – go here.

6 Nov - Elections in the US: A path to healing and respect for science – go here.

30 Oct - 2S-LGBTQ+ Seniors: Our Existence is Our Resistance! – go here.

23 Oct - Responding to the second wave of COVID-19: RNAO continues to speak out – go here.

16 Oct - RNAO advocates for national long-term care standards in Canada – go here.

16 Oct - Reta’s Story  (a contribution of Judy Smith, Reta’s daughter-in-law) – go here.

9 Oct - RNAO relieved that Premier Ford engages late, but essential, action – go here.

9 Oct - Patient-centred-care – the dream and the reality – go here.

2 Oct - RNAO urges stricter measures to combat rapidly rising number of COVID-19 infections – go here.

25 Sept - Nurses say throne speech advances A Just Recovery for All – go here.

18 Sept - Is Your Hospital Using Blood Wisely? – go here.

18 Sept - RNAO calls to Delay Action on CNO Council Decision to Expand RPN Scope – go here.

11 Sept - International Overdose Awareness Day: Statement from RNAO – go here.

11 Sept - RNAO joins global movement: A Just Recovery for All – go here.

28 August - RNAO letter to Prime Minister Justin Trudeau regarding Speech from the Throne – go here.

21 August - Black August and an update on RNAO’s Anti-Black Nursing Task Force – go here.

21 August - Winter Surge Planning: How one Ontario Health Team is Preparing – go here.

14 August - Insights from Cuba: Primary care as the focus of COVID-19 prevention – go here.

7 August - School reopening: Ontario government can still do the right thing on class sizes – go here.

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

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 HopkinsCSSE.