January 18 2022 COVID-19 report


Dear Colleagues: Welcome to my Tuesday, January 18 blog during this twenty fourth 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 several upcoming RNAO webinars in January.

A HUGE THANKS to the thousands of healthcare workers who drove and sometimes walked for hours to get to work yesterday on the biggest snowstorm in decades, and the many who stayed for shifts up to 30 hours straight when other workers became stranded in the snow! Without you, there is NO healthcare system. 

This week we share: 1) RNAO’s submission to the Toronto Board of Health on return to school; and 2) how France's contact tracing tool and health pass became the most popular app in the country.

RNAO’s submission to the Toronto Board of Health on return to school 

RNAO’s CEO Doris Grinspun made a deputation to the Toronto Board of Health on Jan. 17. The following is a slightly edited version of the submission found here.

RNAO represents 48,500 registered nurses (RN), nurse practitioners (NP) and nursing students in Ontario. Since 1925, RNAO has been a leader in healthy public policy and promoted excellence in all areas of nursing practice, including child and adolescent health. RNAO is internationally known for informing and supporting clinical practices through our Best Practice Guidelines (BPG) Program. Our BPGs are considered the gold standard for the clinical work of nursing and interprofessional teams and are used extensively in healthcare and academic centres in Ontario, Canada and abroad. 

RNAO recognizes the importance of our public education system for all children’s learning, physical, social and emotional development. In principle, there is no question – school is where kids and youth ought to be. However, the provincial government’s response to school safety has mirrored its response to the pandemic generally. Public health measures have been too little, too late – undermining our capacity to ameliorate the damage caused by the virus, and jeopardizing recovery.  

The ethics of public health focus on making choices that minimize harm for the public, and the precautionary principle must take precedence. This principle tells us that our kids – and grandkids – should not be back in the classroom yet. On behalf of RNAO and the great majority of nurses, I offer you the following:    

Ontario’s healthcare system is on the brink of collapse, and we cannot risk further Omicron spread and hospitalizations

In the midst of a profound nursing human resource crisis, hospitalization rates are at their highest in the pandemic to date. On Jan. 16, the province reported 3,595 hospitalizations, up from 508 as recently as January 4th. The provincial government’s public health measures, implemented on Jan. 5 – closing schools while keeping many non-essential services open, despite the plea of RNAO and others – placed hospitals, their emergency rooms and ICUs, and hospital staff, on the path to collapse.  

We know that kids transmit Omicron as much or more than adults 

While most children do not get seriously ill with Omicron, they are all capable of transmitting the virus and bringing it to their homes. In fact, children are more likely to transmit the virus than adults because of less disciplined masking. Some kids go home to well-ventilated homes with healthy family members; others go home to overcrowded housing and/or families with heightened risk factors including grandparents, siblings or parents with cancer or diabetes. The most affected families will be once again low-income and multigenerational. As such, reopening school before it is safe to do so places families and communities at risk that can ultimately add further strain on our already over-stretched healthcare system.  

We know that vaccination rates for kids are too low 

The most recent Ontario data tells us that only 49.7% of children ages 5 to 11 have received at least one COVID vaccine dose, and only 6.6% are fully vaccinated. Unvaccinated children will be particularly susceptible to contracting the virus and spreading it to each other and their families, especially in environments with poor ventilation, inadequate air filtering, and unclear protocols. Unvaccinated children are also at higher risk of becoming symptomatic and feeling ill. 

We know that kids are at risk of hospitalization from the Omicron variant  

While much has been made about the Omicron variant being milder, it does pose a risk for children.  Over the course of the pandemic, 758 people under the age of 19 have been hospitalized.  

Nine children have died in Ontario from COVID – two in the past couple of weeks – proving that Omicron is hitting kids harder than publicly discussed. In New York City, there was a five-fold increase in hospitalizations among children over the last three weeks of December 2021.

We don’t know case rates among kids or the general public 

PCR testing has been unavailable to the general public since Dec. 31, 2021. Consequently, we have nothing reliable, other than lagging hospitalization rates, to inform the decision to return kids to the classroom. In these circumstances, the precautionary principle must rule.  

Influenza has been kept in check, but data from the US warrants caution for Canadians and our healthcare system   

Influenza activity across Canada remains low for this time of year, with no evidence of community circulation of influenza. To date this season (August 29, 2021 to January 8, 2022), seven pediatric influenza-associated hospitalizations and less than five intensive care unit (ICU) admissions were reported by the IMPACT network. While the numbers remain low, we must remember that Ontario has only 93 pediatric ICU beds.  

We also need to learn from the situation in other countries. In the United States there has been a slight decline in influenza cases the past week, but it remains much higher than last year and is expected to continue for several weeks. The CDC also reports that cumulative hospitalization rates in the FluSurv-NET system is higher than the rate for the entire 2020-2021 season, but lower than the rate seen at this time during the four seasons preceding the COVID-19 pandemic.  

Alex Munter, president of CHEO, tweeted in September2021: “#Ontario has 93 pediatric ICU beds. Some days only 2-3 beds are empty - in the entire province and with no Covid cases. Children's hospitals can surge up, but it means cancelling surgeries, closing clinics and longer Emergency waits as specialized staff are redeployed to the ICU.” RNAO urges added caution for the next 10 days given the pick of Omicron and the potential increase in influenza cases in children.


RNAO wants Ontario’s students to be able to return to school as soon as we have the evidence to support a safe return for children and education workers. RNAO opposes a return to school at the peak of the Omicron wave. We recognize the importance of in-person learning to the well-being of kids and youth. But, returning them today, given all circumstances and available data, is irresponsible.  

TousAntiCovid - how France's contact tracing tool and health pass became the most popular app in the country

France has been more successful than Canada in implementing a COVID-19 app. We extend our appreciation to Maia Foulis for bringing us this article that highlights the French experience with the app. 

French app TousAntiCovid (which loosely translates to "all against Covid") was launched by the French government in June 2020.

Initially called StopCovid, the app was created as a means of contact tracing. Individuals using the app could use it to declare a positive test, anonymously alerting those who may have been in contact with them to isolate (and, later on, get a Covid test).

But in those first few months, adoption rates were embarrassingly low.

Between June 2020 and October 2020, the StopCovid app had only been downloaded 2.7 million times. Even Prime Minister Jean Castex said that he hadn't downloaded it!

With so few people using it, its initial use as a grassroots contact tracing tool was, well, useless.

Adoption rates picked up between October 2020 and January 2021. Why? Because there was a strict lockdown - and then a curfew - introduced.

Unlike in Ontario, to circulate during lockdown French people were required to fill in a specific piece of paper (or multiple bits of paper) and carry their ID to be able to circulate. Police could stop and check your papers, and give out fines to those breaking the rules.

The app was updated around this time, and users could generate said papers and store them easily on their phones. It's also around January 2021 when the app started sharing Covid stats (not updated over the weekend - this is France after all).

In June 2021, France widely adopted location QR codes. This allowed for better contact tracing on the app.

Similar to Ontario, places like bars, restaurants or museums have a QR code at the entrance that visitors or clients are invited to scan before entering. This adds an additional layer to contact tracing.

So how exactly does contact tracing work with TousAntiCovid? When you download the app, you have to enable Bluetooth for it to work. You can switch it on within the app.

When two people with the app are in within a certain distance (1,5 metres) and for a certain amount of time (at least 15 mins), the app detects the closeness via Bluetooth, explains CNET. This "meeting" is then saved to the phone. If one of these people tests positive and declares it on the app within 15 days of "meeting", the other person is automatically alerted in the app.

According to Cédric O, Secretary of State (junior minister) for the Digital Economy, positive tests within the app are verified by a third party health provider.

Millions more French people downloaded the app, but downloads ultimately exploded in July 2021 when the French government decided to introduce a restrictive health pass.

To combat low vaccine rates in France, French President Emmanuel Macron announced on July 12., 2021, that individuals would be required to show a "passe sanitaire" (health pass) to access public events like concerts, gatherings, etc. In August, the health pass was extended to cafés, restaurants, bars, and long-distance trains (TGV). In recent months, the pass has been further extended to cover even more locations.

Though not without criticism (there have been regular demonstrations against the pass since August 2021), this was a game changer for vaccine rates in France.

(When you get vaccinated in France, a QR code is generated. Your doctor - or whoever it is giving you your vaccine dose - will do some computer magic and you receive your QR code a few hours later. When I got my third dose, my doctor actually generated it on the spot so I could directly scan the QR code with the app.)

It was also a game changer for the adoption of the TousAntiCovid app. Six months later, pretty much any person with a smartphone has it (for those without, you can simply print your QR code and show that to enter any location needing one).

It's been a huge success. A few weeks ago, the French government announced that TousAntiCovid was the most downloaded free app in France. Around 50 million people have it on their phones (for info, the population of France is around 67 million).

When I moved back to France a few months ago, I finally downloaded the app. As a French person, I can tell you that - at least in my experience - we've never been great with the tech stuff. We love our paperwork and we're slow to modernize. But I was pleasantly surprised by how easy to use and streamlined the actual thing was! With the app you can:

  • Access your QR codes
  • Be reminded when to get a booster jab done (and where to find a centre based on postcode)
  • See if you are close contact case (and if you are, where you can find a testing centre)
  • Scan a bar, restaurant, museum, etc. QR code
  • Declare a positive Covid test
  • Access any relevant paperwork needed to circulate in France
  • See any recent Covid news stories
  • See key Covid data for France, and your region (including case numbers, vaccine rates, deaths, circulation rates, etc.)

Not only do I have access to all the stuff I need to get around, I am also empowered with information on Covid that is easily accessible all in one place.

I do understand that some of my fellow French people may have privacy concerns, and the app apparently still has some issues with QR codes from other countries, but in the midst of this Omicron surge, the practicality of the app shouldn't be dismissed.

In Canada, with provinces taking the lead on Covid response, a nationwide one-stop-shop may be harder to implement. A Canada-wide contact tracing app does exist, but adoption rates have been low. And separate vaccine passes exist in each province. Canadians may not want to cumulate these apps.

In France, TousAntiCovid may become even more important in the future.

Like in Ontario, PCR tests are increasingly hard to come by (and usually only provided if prescribed by a doctor). This means that there is an increasing reliance on rapid antigen tests done in pharmacies or at home.

But unlike with an "official" test, how can the government and public health bodies track these positive cases?

You should do it through an online portal, which to be honest hasn't been clearly advertised in recently updated health guidelines.

As well as this, to alert fellow citizens, more and more French people are also declaring their positive tests on TousAntiCovid. Why? Because it's easy. The app is already on their phones, and they use it almost every day. It's become part and parcel of our daily lives. Almost two years later, it may finally become the contact tracing app it was initially conceived to be.


Best Practice Champions Virtual Workshop - Session 1

Jan 19, 2022, 9:00am - 12:00pm

The Best Practice Champions Network team has established a new, two-part Best Practice Champions Virtual Workshop to replace the in-person champions workshops. This free, online educational opportunity consists of a brief pre-recorded introductory video, and two live virtual sessions to be completed in sequential order.

The Best Practice Champions Virtual Workshop series will be offered monthly, with Session 1 and Session 2 taking place once a month. This will provide you with ample opportunity to select the live session that best suits your work schedule. This online educational opportunity can be completed individually or as a group.

For further details and registration, go here.

Wisdom in Wound Care Webinar Series

Jan 19, 2022, 12:00pm - 12:45pm

The Wisdom in Wound Care Webinar Series offers 11 monthly, 45-minute webinars hosted by RNAO and facilitated by wound care experts in Ontario. The webinar series will cover best practices in relation to acute and chronic wound prevention, assessment and treatment. 

The mission of the webinar series is to reduce the physiological, psychological and the fiscal burden of wounds throughout Ontario by building clinical expertise using best practices related to wound care. 

By the end of the webinar series, attendees will be able to explain:

  • the appropriate best practices as they pertain to varying wound care issues; and
  • how they can influence optimal person-centered outcomes.

Recordings of previous sessions are available to watch.

For details and registration, please go here.

RNAO’s Clinical Pathways for LTC

Jan 21, 2022, 9:00am - 10:00am

RNAO’s Clinical Pathways for long-term care (LTC) is a webinar designed for registered nurses and registered practical nurses in the sector to learn about how these digital clinical decision support tools will optimize resident care and help homes meet key requirements of the proposed Fixing Long-Term Care Act 2021.

For more details and registration link, please go here.

Best Practice Champions Virtual Workshop - Session 2

Jan 26, 2022, 9:00am - 12:00pm

The Best Practice Champions Network team has established a new, two-part Best Practice Champions Virtual Workshop to replace the in-person champions workshops. This free, online educational opportunity consists of a brief pre-recorded introductory video, and two live virtual sessions to be completed in sequential order.

The Best Practice Champions Virtual Workshop series will be offered monthly, with session 1 and session 2 taking place once a month. This will provide you with ample opportunity to select the live session that best suits your work schedule. This online educational opportunity can be completed individually or as a group.

For more details, please go 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 detailed Ontario epidemiological summary from Public Health Ontario, you can go here.

According to the latest Situation Report #596 for January 17, the case count was as follows: 956,607 total, +8,521 change from yesterday; 10,628 deaths, 23 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 <dgrinspun@rnao.ca> and copy to < ceo-ea@rnao.ca>. 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


12 Jan - A message as we begin 2022 amid a fifth wave – go here.

12 Jan - A health system on the verge of total collapse – An open letter to Premier Doug Ford – go here.

12 Jan - RNAO’s continuing media profile: The December 2021 report – go here.

12 Jan - Canada isn’t responding with foresight when it comes to COVID-19 – go here.

21 Dec - RNAO addresses nursing crisis, Omicrom-led wave and preventing health-system collapse – go here.

14 Dec - What we know about Omicron two weeks after it became a variant of concern – go here.

14 Dec - Omicron variant caseload expected to 'rapidly escalate' in the coming days, Tam says – go here.

14 Dec - Repeal Bill 124 – RNAO asks for pledge of support from Members of the Provincial Parliament – go here.

14 Dec - Ontario’s nursing crisis: Next steps in #RepealBill124 campaign – go here.

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 - Omicron edition: Uncertainty, uncertainty, uncertainty – 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.

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