December 14 2021 COVID-19 report
Dear Colleagues: Welcome to my Tuesday, December 14 blog during this twenty second 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. Feel free to share this report and links with anyone interested. Scroll down for policy updates and action alerts, as well as several RNAO webinars this week!
This week we share: (1) Ontario’s nursing crisis – next steps in #RepealBill124 campaign; (2) Repeal Bill 124 – RNAO asks for pledge of support from MPPs; (3) Omicron variant becoming dominant in Canada and driving new wave; and (4) what we know about the science of Omicron.
Ontario’s Nursing Crisis: Next steps in #RepealBill124 campaign to gain Premier Ford’s support
Join today, Tuesday December 14, at 2:30 pm, RNAO’s emergency press conference: https://us02web.zoom.us/j/89398617217 -- Passcode: 627700
TORONTO, Dec. 13, 2021 – The Registered Nurses’ Association of Ontario (RNAO) says the province’s nursing crisis is spiraling out of control. Yet the Ontario government insists on keeping Bill 124, which nurses say is a slap in the face. RNAO will hold a media conference on Tuesday, Dec. 14 at 2:30 p.m. ET to call on the premier to take immediate action, and discuss crucial next steps to address Bill 124 and Ontario’s nursing crisis.
Nurses have been pushed to their limits after 22 months of the COVID-19 pandemic. They have been working flat out on the frontlines, caring for Ontarians, risking their own lives and the lives of their families while cancelling vacation and days off. They are exhausted and burnt out just as the Omicron variant threatens to make the situation even worse.
Yet, Premier Doug Ford’s Bill 124 caps salary increases at one per cent, far lower than the rate of inflation, meaning it is actually a decrease in compensation. Nurses resent Bill 124 and are leaving their jobs. Many have gone to work in agencies at double the pay rate, others are moving to other jurisdictions in Canada or the U.S., and some have left the profession altogether.
On Nov. 14, RNAO spoke at a rally organized by a grassroots group of nurses known as Nursewithsign416 (@Nursewithsign on Twitter). During the address, RNAO CEO Dr. Doris Grinspun implored Premier Ford to repeal Bill 124 within 30 days. Despite calls to his office and a pointed letter on Nov. 29, “we have heard nothing from him and no action has been taken. He has ignored RNAO and nurses’ demands to repeal this bill,” says Grinspun. “Premier Ford and his caucus are out of step with other elected representatives in Ontario who fully support nurses.” Last week, RNAO sent a letter to all MPPs, inviting them to #StandWithNurses and call for the #RepealBill124.
“Given the premier’s silence, we are left with no choice but to take our campaign to Ontarians to highlight for them how detrimental this bill is to their health,” says RNAO President Morgan Hoffarth. Tuesday, Dec. 14 marks the end of RNAO’s 30-day countdown to get Premier Ford to act.
What: Media conference to implore Premier Ford to #RepealBill124, and share its impact on the nursing crisis.
When: Tuesday, Dec. 14 at 2:30 p.m. ET
• Dr. Doris Grinspun, RNAO CEO*
• Dr. Claudette Holloway, RNAO president-elect
• Nancy Halupa, RN and co-founder of the advocacy group NurseWithSign416
Where: Join via Zoom: https://us02web.zoom.us/j/89398617217 -- Passcode: 627700
Repeal Bill 124 – RNAO asks for pledge of support from Members of the Provincial Parliament
Ontario is in a nursing human resource crisis that has been made worse by Bill 124 and the COVID-19 pandemic. Nurses are leaving their workplaces and at times the province or the profession altogether. This has a direct impact on patient safety and the effectiveness of Ontario’s health system.
RNAO issued a call on December 7 to all Ontario MPPs: #StandWithNurses by demanding Bill 124 be repealed. A letter sent the same day asked MPPs to sign a pledge stating: "I (full name), MPP for (name of riding), call for the repeal of Bill 124 to support nurses in Ontario."
As of now, ALL MPPs from the three opposition parties have signed the pledge. None from the PC Party and none of the independent MPPs have signed. You can see the signatories here.
Omicron variant caseload expected to 'rapidly escalate' in the coming days, Tam says
Canadians need to get booster shots, limit contacts to prevent uncontrollable spike in cases, top doctor says. This is a 13 December 2021 article by John Paul Tasker, CBC News. The original article can be found here.
Canada's chief public health officer said today there is evidence of community spread of the highly transmissible omicron variant and new COVID-19 cases are expected to "rapidly escalate" in the coming days.
Dr. Theresa Tam said there is "great spread potential" with omicron and the situation in Canada is a "few days or maybe a week" behind the U.K. — where British Prime Minister Boris Johnson today said that the country is dealing with a "tidal wave" of new infections, with the caseload doubling every two or three days as the variant takes hold.
"We know how to work together to flatten that curve and we need to do that pretty rapidly, starting now," Tam said. "As with other waves of the pandemic, rapid action and reducing contact [are] key to preventing that very sharp peak."
In Ontario, COVID-19 cases have doubled in two weeks' time, with 1,328 new cases reported today. Some communities — notably Kingston, Ont. — have seen conditions rapidly deteriorate with hundreds of new cases posted over the weekend, pushing case counts to the highest level seen since the onset of the pandemic in March 2020.
'We are seeing community transmission'
The Ontario COVID-19 science advisory table said today the omicron variant will replace the currently dominant delta variant as the main strain in the province by Christmas — something Tam said she expects to see happen elsewhere in the country by year's end. Early data suggest omicron is three times more transmissible than delta.
"What we're seeing in Ontario, I expect to be seen in other areas of the country," Tam told a press conference. "We are seeing community transmission, possibly in its early stages, but this can rapidly escalate in the days to come."
While Canada could soon be facing the largest wave of COVID-19 cases ever recorded during this health crisis, one big unknown is just how virulent the omicron variant is compared to past variants like alpha or delta.
The U.K. has reported a stunning 54,661 coronavirus infections in the past 24 hours, but only 10 people with the omicron variant have so far been hospitalized in England.
While researchers scramble to determine the severity of this variant, Tam said provinces must urgently roll out booster shots to protect older and vulnerable Canadians.
She said there's evidence of "waning immunity" from COVID-19 infections and vaccines — and quickly administering a third shot to as many people as possible can help blunt the spread.
Tam also said it will take time for the booster shots to kick in — so Canadians should closely follow public health guidelines and "layer on protections" such as medical-grade masks until more people are covered with a third shot.
"We've achieved high vaccination coverage compared to other countries and here we are again asking people to roll up their sleeves for those booster shots — especially for the higher risk populations. That's what we need to focus on," Tam said.
"But you need both vaccines and reduced contact rates right to dampen the effect of this virus," she said.
Tam said that last recommendation — staying away from other people — will help protect Canada's hospitals from being inundated with patients.
"I think we've learned over time, if we don't act fast then you begin to lose the ability to manage things," she said.
Tam's omicron warnings come on the same day she released her annual report. In that document, Tam says the public health system is "stretched dangerously thin" after two years of the COVID-19 crisis and a parallel opioid epidemic.
To address some of the system's shortcomings, Tam said governments have to earmark more money for public health to bring an end to what she calls the "boom and bust" cycle — a funding pattern where money flows during a time of crisis only to be clawed back when the situation stabilizes. Tam said money should be dedicated to recruiting and retaining health care workers, who have faced challenging working conditions during this pandemic.
Tam's annual report also lays bare just how damaging the COVID-19 crisis has been for other areas of public health. The pandemic has wreaked havoc on the lives of Canadians suffering from mental illness, opioid addiction and other substance abuse problems.
Tam's report says there were 7,150 more deaths than expected in people under the age of 65 between March 2020 and May 2021. COVID-19-related deaths accounted for 1,600 of those deaths, while the worsening opioid overdose crisis also likely caused a significant number of these excess deaths, Tam said.
Social isolation, a more toxic drug supply and physical distancing measures at safe-consumption sites, among other factors, have made the opioid crisis more deadly, the report found. The number of opioid-related deaths in 2020 (6,214) far exceeded the number of deaths in 2018 (4,389), the previous peak of the crisis.
Canada is also grappling with mental health concerns, with 42 per cent of people reporting their perceived mental health is "somewhat worse" or "much worse" than it was before the pandemic, according to the Canada Community Health Survey.
Although individuals aged 12 to 17 years were among the age groups least likely to report feelings of worsening mental health, the share of this demographic reporting perceptions of poorer mental health has doubled since September 2020.
Kids Help Phone, an e-mental health service offering free confidential support to young Canadians, reported that the number of calls, texts and clicks on their online resources more than doubled in 2020 over 2019.
And because many jurisdictions have postponed elective and other surgeries, Tam's report suggests there will be a "future surge of cancer cases" once surgeries resume after COVID-19-related interruptions.
What we know about Omicron two weeks after it became a variant of concern
Two weeks after the World Health Organization designated Omicron a variant of concern, it has dominated headlines, sparking renewed fears about the spread of COVID-19 and forcing countries to strengthen their vaccination campaigns with booster shots.
Over the last several weeks, health officials across the globe have been paying close attention to Omicron cases to answer important questions like how transmissible it is, how good it is at evading immunity from vaccines or past illness, and whether it causes more severe illness.
Their work has painted a more complete picture of how the variant spreads and how concerned we need to be.
No signs of increased severity
On Friday, scientists in South Africa, where the variant was first detected, said they have seen no sign that Omicron is causing more severe illness, despite increased rates of hospitalizations.
Hospital data shows that COVID-19 admissions are rising sharply in more than half of the country's nine provinces, but deaths are not rising as dramatically and indicators such as the median length of hospital stay are reassuring.
"Preliminary data does suggest that while there is increasing rate of hospitalization ... it looks like it is purely because of the numbers rather than as a result of any severity of the variant itself, this Omicron," the country’s health minister, Joe Phaahla, said Friday.
ICU occupancy in South African patients with confirmed Omicron cases sits at just 6.3 per cent, much lower than previous Delta wave, with fewer patients requiring supplemental oxygen to help them breathe.
To date, all reported cases of Omicron in Canada have been asymptomatic or mild.
Experts say it is possible that Omicron has mutated to become less severe – but it’s too early to make that assumption, especially without concrete data to show how many people that are sick with Omicron are vaccinated or have had previous COVID-19 infections.
“Here's the thing for everybody to keep in mind. Most of the cases that we're hearing about happening are in people that have had COVID before who have had vaccines,” Sarah Otto, virologist at the University of British Columbia, told CTV National News.
“What is really unknown at the moment is how severe cases will be among people that have never had any exposure whatsoever. And I think here in Canada, we have still have a large proportion of the population that is not vaccinated, not just children, but then another 10 to 15 per cent of adults that are also not vaccinated and at risk of severe cases.”
Omicron is spreading fast
New cases are rising steadily in South Africa, the epicentre of this variant’s outbreak.
In the past few days, a nationwide outbreak linked to Omicron has been infecting around 20,000 people a day, with 19,018 new COVID-19 cases on Thursday, according to data from the country’s National Institute of Communicable Disease.
However, infections have yet to reach the peak of more than 26,000 daily cases during a third wave fuelled by the Delta variant.
In the U.K. – where officials expect Omicron to become the dominant strain in the next two to four weeks – preliminary studies of household contacts found a higher risk of transmission from Omicron when compared to Delta.
While the Delta variant remains the dominant strain in Canada and around the world, the spread of Omicron is increasing globally. And in Canada, there are early signs of community spread.
While most of the confirmed Omicron cases in Canada have been traced back to international travel and close contacts, cases with no known links to travel are starting to be reported, Chief Public Health Officer Dr. Theresa Tam noted during a press conference on Friday.
Some Canadian provinces are already seeing a jump in daily case counts, which could be aggravated further by the spread of Omicron, Tam said.
The current rise in new cases is primarily driven by Ontario and Quebec, with both provinces experiencing numbers not seen since spring. Should transmission rates increase by 15 per cent, or if Omicron takes hold under current levels of transmission, then Canada could see cases skyrocket to record levels above 10,000 cases before January, modelling charts show.
“We must approach the coming weeks with an abundance of caution and at the same time, we must be prepared to act quickly to control the spread at the first sign of rapidly accelerating cases,” said Deputy Chief Public Health Officer Dr. Howard Njoo.
Genetic mutations linked to the common cold
A stand out factor about the Omicron variant is the sheer number of mutations to the virus’s spike protein, which allows it to bind to human cells and gain entry to the body.
But a new study suggests that Omicron likely acquired at least one of its mutations by picking up a snippet of genetic material from another virus – possibly one that causes the common cold.
This specific genetic sequence does not appear in any earlier versions of SARS-CoV-2, the virus that causes COVID-19, but is common in many other viruses including those that cause the common cold, and also in the human genome, according to researchers.
Lead study author Venky Soundararajan of Cambridge, Mass.-based data analytics firm nference, suggests this may mean Omicron is attempting to make itself look “more human” to trick the immune system.
What about vaccine immunity?
In an update this week, WHO said existing vaccines should still protect people who contract the Omicron variant from severe illness, but noted that preliminary lab tests from South Africa suggest the variant can partially evade the Pfizer jab.
On Wednesday, Pfizer released preliminary data suggesting that two doses may not be protective enough to prevent an Omicron infection, but a booster increased by 25-fold people's levels of virus-fighting antibodies against the Omicron variant.
However, those findings are preliminary and haven't yet undergone scientific review.
Several countries have already announced booster shot initiatives in light of the Omicron variant.
Ontario announced Friday that anyone over the age of 18 will be eligible to book a booster shot in January. Several other provinces, including Alberta and B.C., have expanded their booster shot program. However, Canadian officials have said the efficiency of booster shots remains to be seen.
“The extent of the protection against Omicron from the primary series and booster dose remains to be seen, and we're going to learn a lot about this in the days to come,” Tam said during a news conference last week.
“But nevertheless, it is still prudent to maximize the possibility of protection from vaccine by, first of all, offering the vaccine to anyone who hasn't had the primary series, but then offering the boosters.”
The National Advisory Committee on Immunization strongly recommends that adults aged 50 and older receive a COVID-19 booster shot. The committee also made a discretionary recommendation on booster shots for Canadians 18 to 49 years of age, saying they “may” be offered a third dose based on individual risks and where they live – recommendations that would have been made with or without the presence of the Omicron variant.
While there is a good chance current vaccines may not be as effective against the Omicron variant, experts say they are still likely to offer some level of protection given their role in helping the body develop antibodies and T-cells to fight off the virus.
“It's very unlikely that it's going to completely make our current vaccines obsolete,” Dr. Susy Hota, medical director for infection prevention and control at the Toronto-based University Health Network, previously told CTVNews.ca.
“They may be reduced in effectiveness, but there's still a very broad immune response that these vaccines elicit. “If we can increase the overall protection, it just puts us in a better place with all the variants that we're dealing with.”
- With files from Jennifer Ferreira, The Canadian Press, The Associated Press and Reuters
POLICY UPDATES FOR ALL TO ACT ON & MUST JOIN EVENTS – OPEN TO ALL
COVID-19 Webinar Series: Key issues of 2021 and collective action for 2022
Dec 13, 2021, 2:00pm - 4:00pm
Now that 2021 is coming to a close and we approach the two-year mark of the pandemic let’s summarize this challenging year, and our moving forward together.
Join RNAO CEO, Dr. Doris Grinspun, nurses and other health-care colleagues to discuss the big issues:
- Delta, Omicron and their impact in Ontario and elsewhere
- vaccine justice
- nursing health human resource crisis
- overall HR crisis
- sluggish government actions to protect the public
Join the discussion and join in the action to get us through this pandemic and beyond, while protecting Ontarians and rebuilding our profession
Presenter: Doris Grinspun, RNAO CEO
Jan. 10, 2022, 2 - 4 p.m. ET
Details coming soon.
Virtual Clinical BPG Institute
Dec 14, 2021, 1:00pm - 3:30pm
Sign up today for RNAO's virtual Clinical BPG Institute!
The 19th Annual Clinical BPG Institute will be offered via Zoom video-conferencing in fall 2021.
The virtual BPG Clinical Institute has been designed for nurses and other health-care professionals interested in developing the knowledge and skills necessary to successfully introduce and sustain practice change in their organization through the implementation of best practice guidelines. The institute will feature strategies and approaches from the new Leading Change Toolkit™ and focus on creating evidence-based practice cultures within the workplace. The program is offered as a series of five webinars facilitated on a weekly basis. Don't miss out on this powerful opportunity to bring positive change and innovation to your workplace!
For further details, go here.
Building a Team of Champions to Create and Sustain Change
Dec 16, 2021, 11:00am - 11:45am
This presentation will highlight how our team has been able to recruit and engage champions in our organization to lead change initiatives. It will also give practical tips for fostering champions' engagement and sustaining their engagement overtime. We hope that we would inspire other organizations to engage and utilize the skills of their champions to lead change in their organization.
During this presentation, participants will learn:
- tips to help recruit and engage champions
- the importance of developing champion roles
- creating an interdisciplinary team of champions
- the benefits of having champions in your organization
- how we have structured our home to include champions that support best practice guideline implementation
- strategies to help sustain champion engagement
Emily Cotter RN, BScN, assistant director of care, Nithview Community, Tri-County Mennonite Homes
NP LTC Council Webinar
Dec 16, 2021, 1:00pm - 2:00pm
Please join us for our upcoming nurse practitioner (NP) long-term care (LTC) council webinar to be held on Dec. 16, 2021. This is our regular monthly NP LTC Council that has been an important forum for NPs working in LTC to discuss clinical, operational, and policy-related issues in LTC, build networks, exchange knowledge, and inform RNAO’s advocacy work related to NPs and the LTC sector.
Join your NP colleagues working in LTC for a discussion about medications in long-term-care, including reconciliation and over-prescribing. Our presenter is Jonathan Lu BScPhm, RPh CGP (registered pharmacist and certified geriatric pharmacist). Jonathan is also the chief quality and clinical services officer at Silver Fox Pharmacy. He will discuss medication reconciliation, best practices and practical tips around prescribing in LTC and geriatrics.
Jonathan Lu, BScPhm RPh CGP
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 detailed Ontario epidemiological summary from Public Health Ontario, you can go here.
According to the latest Situation Report #574 for December 13, the case count was as follows: 633,683 total, +1536 change from yesterday; 10,079 deaths, +1 change from yesterday.
Staying in touch
Keeping in touch and being part of a community helps us get through challenging times. Keep telling us 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 <firstname.lastname@example.org> and copy to < email@example.com>. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!
Thank you for continuing to be there for your community, everywhere and in all roles! Together, in solidarity, we are stronger. Thanks for encouraging your colleagues, their loved ones and your communities to be fully vaccinated – including booster shots. Keep reminding them that COVID-19 is aerosol and that proper ventilation and N95 masking is not just preferred but necessary.
Let’s also be thoughtful and remember Dr. Tedros when he said that “#VaccineEquity is not an act of charity; it’s the best and fastest way to control the pandemic globally, and to reboot the global economy.” Canada has purchased more vaccines than what it needs, while the poorest countries in the world have almost nothing. Like with other challenges we face – systemic discrimination and climate change – we are not safe until everyone is safe. Vaccines for all – literally for all, across the world – must guide policy in the upcoming months. Let’s learn from the 22-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 that political leaders protect patients, students, and workers – and secure #Vaccines4All.
Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, FCAN, O.ONT
Chief Executive Officer, RNAO
RECENT BLOG ITEMS:
7 Dec - RNAO’s continuing media profile: The November 2021 report – go here.
7 Dec - South African envoy calls on Canada to support waiver on COVID-19 vaccines – go here.
7 Dec - RNAO welcomes expansion of boosters and says Omicron is the #VaccineInjusticeVariant – go here.
28 Nov - The NHS staffing crisis is killing people – and this winter it will be even worse – go here.
28 Nov - A note to Premier Ford: Repeal Bill 124! – go here.
21 Nov - I’m an infectious disease doctor. Yes, I’m vaccinating our 5-year-old against COVID-19. Here is why you should too – go here.
21 Nov - Rich countries only shared 14% of COVID-19 vaccine doses promised to poorer nations – go here.
21 Nov - Nurses gather in Toronto to rally: Recap of #RepealBill124 rally and next steps – go here.
14 Nov - Nurses celebrate National Nurse Practitioner Week and call for scope expansion to improve access to the health system – go here.
14 Nov - Congratulations to all NPs during National Nurse Practitioner Week – go here.
14 Nov - Ontario nurses discuss the crisis in the profession during RNAO’s Fall Tour – go here.
14 Nov - Ontario’s RN understaffing crisis: Impact and solution – go here.
6 Nov - RNAO’s continuing media profile: The October 2021 report – go here.
6 Nov - Ontario’s economic statement signals government’s concerns with nursing human resources – go here.
6 Nov - RNAO deeply disappointed with Premier Ford’s decision on mandatory vaccination – go here.
30 Oct - Hospitals ‘bleeding out’ as nursing shortage intensifies – go here.
30 Oct - The Lancet calls for emergency action to tackle climate change, restore biodiversity, and protect health – go here.
24 Oct - Big tech has a vaccine misinformation problem – go here.
24 Oct - RNAO is deeply disappointed with government’s reopening plan – go here.
24 Oct- Misinformation is an urgent threat that prolongs the pandemic and puts people at risk – go here.
17 Oct - Health organizations around the world: Urgent climate action required – go here.
17 Oct - Climate change the new public health emergency – go here.
17 Oct - A crucial moment for global public health: The Glasgow climate conference – go here.
10 Oct - RNAO launches new, evidence-based online implementation toolkit – go here.
10 Oct - Media release: Mandate vaccinations and establish safe zones – go here.
10 Oct - A renewed call: Prime minister, stop the court battle with First Nations children! – go here.
10 Oct - The inherent racism of anti-vaxx movements – go here.
3 Oct - RNAO’s continuing media profile: The September 2021 report – go here.
3 Oct - RNAO commends move to mandate vaccination for long-term care staff; urges for more – go here.
3 Oct - Action Alert – Stop fighting First Nation children in court: Concrete action on Truth & Reconciliation – go here.
We have posted earlier ones in my blog here. I invite you to look.