January 23 2021 COVID-19 report

Dear Colleagues: Welcome to our Saturday, January 23 report during this twelfth month of COVID-19 in Ontario.It’s difficult to even think that we have been a full year at this! Nonetheless, we must keep going until we are COVID-free...

 

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 pandemichere. As always, feel free to share this report and links with anyone interested. Daily Situational Reports from Ontario's MOH EOC can be found here.

 

Mitigating the spread in Toronto shelter settings

RNAO’ commitment to vulnerable populations precedes this pandemic and will continue forward, as we tackle together the social inequities exposed and deepened by the virus. In doing so, we will be inspired by examples of tremendous strength. One of those is the work of Inner City Health Associates (ICHA). We share with pride and gratitude the progress presented next by our colleagues Leigh and Andrew.Leigh Chapman, RN, PhD is Director, Clinical Services, and Andrew Bond, MD, CCFP, FCFP, MHA(c),is Medical Director of ICHA.

Inner City Health Associates (ICHA) was a group of more than 100 physicians working in over 50 shelters and drop-ins across Toronto until March 2020. Since the onset of the COVID-19 pandemic in Toronto, registered nurses (RNs), registered practical nurses (RPNs) and nurse practitioners (NPs) have joined ICHA in an effort to mitigate the spread of COVID-19 in Toronto shelter settings.

The COVID Recovery Site is a collaboration between the City of Toronto Shelter Support Housing Administration, Parkdale Queen West Community Health Centre, The Neighbourhood Group, University Health Network, and Inner City Health Associates. At the Recovery Site, Inner City Health Associates clinicians provide acute episodic care for individuals and families who are unable to isolate without supports due to homelessness (including those living in shelters, those who are unsheltered, and some people in precarious or congregate housing).

Many of ICHA’s clients have complex health needs including untreated chronic and complex multi-system diseases, an elevated risk of acute health emergencies, and serious and persistent mental illness and substance use. The COVID Recovery Site provides 24/7 medical supports, delivered by a team of nurses, harm reduction workers, peers, client support workers, and physicians.

To date, over 2000 clients have been supported to isolate at the COVID Recovery site. Given the high community prevalence of COVID, urgent need for the site persists. In addition to the COVID Recovery Site, ICHA RNs, RPNs and NPs provide transitional primary care and specialist (i.e. psychiatry, addictions) care to those who do not otherwise have access to care who are living in physical distancing hotel-based shelters as well as those living in encampments.

Many of ICHA’s clients have complex health needs including untreated chronic and complex multi-system diseases, an elevated risk of acute health emergencies, and serious and persistent mental illness and substance use. Nurses use their knowledge, skill and judgment to assess and care for clients who may present with complex health issues in addition to COVID-19 such as unmanaged chronic conditions, infectious diseases, skin conditions and wounds, mental illness and substance use issues. Services provided by the nursing team use a holistic, client-centred model of care with an emphasis on trauma-informed primary care, harm reduction and conflict de-escalation.

At this time, with the rising community prevalence of COVID-19, we are at a critical juncture in our pandemic response. We are working hard to meet the surge in cases of COVID-19 and ensure we have the capacity to care for those in need of isolation supports. We continue to actively recruit RNs, RPNs and NPs to address urgent health human resource challenges to be able to effectively respond to the crisis before us.

We have pivoted our primary care services to support several hotel-based shelter programs that are on suspect or confirmed outbreak. Our small team of encampment nurses work to address urgent cold-related injuries as they support people by meeting them “where they are at” to provide low-barrier clinical supports and care. We urgently await the COVID-19 vaccine and have a team of over 100 nurses strong ready to deliver the vaccine to the population of people experiencing homelessness.

The COVID-19 crisis has laid bare many of the structural inequities in society that persisted long before the pandemic. We hope it is a moment of reckoning for society at large about the need to provide housing for all and invest robustly in homeless healthcare. Nurses are keen to engage in this work on a sustained basis, but need continued post-pandemic funding to be able to do so.

 

Home care nurses are #ReadyToVaccinate

RNAO remains deeply involved in the vaccination process and advancing the role of community providers in this unprecedented effort. RNAO is urging that public health and primary care be the healthcare sectors leading the rollout and execution of the COVID-19 vaccination, a practice applied in other countries from the outset and one we are just beginning now in Ontario. As you read in our press release last week, RNAO also asserts that home care has a vital role to play in the vaccination rollout. We are grateful for the following contribution from Shirlee Sharkey, CEO ofSE Health. RNAO wholeheartedly supports the approach presented by Shirlee.

At a virtual townhall last Tuesday evening, record numbers of frontline staff logged on to hear more about the COVID-19 vaccination plan and when home care providers and their clients will get their turn. Scrolling through their questions and comments, the level of enthusiasm and anxiety surrounding access to the vaccine was palpable – and completely understandable! At a time when community transmission is raging, our nurses, personal support workers and therapists are in regular and close contact with COVID-19 patients as well as the frail elderly and other vulnerable populations on a daily basis. It was both difficult and disheartening for me to explain that – while frontline healthcare workers and adult recipients of chronic home care are both duly identified as priority populations for Phase 1 of the Ontario’s government’s vaccination plan – there is currently no specific distribution plan for the home care sector.

It’s a tough pill to swallow, but an easy problem to fix.

Every year, thousands of nurses, physicians and pharmacists provide routine vaccinations through public health and established networks. In the past three months alone, SE Health nurses have provided the flu shot to approximately 2,500 clients in their own homes as well as 4,000 essential frontline workers including health care, education and municipal staff. If you’re one of the estimated 1.4 million people in Ontario who got the flu shot this season at a drug store, chances are the pharmacist wielding the needle received injection training from SE Health nurses. Since 2013, we have partnered with the Ontario Pharmacist Association to deliver this education to more than 5,400 pharmacists across the province.

The point is, home care nurses have the competencies and skills to provide vaccinations and we already have a distribution network set-up. There is no need to reinvent the wheel. If we were given access to the vaccine today, our nurses would be vaccinating seniors in their homes tomorrow.

SE Health recently teamed up with RNAO and other home care providers to urge the Ontario government to make use of existing community care providers and their infrastructure to accelerate the rate of vaccination across the province. As personal support worker Betty Wheeler-Clark put it, “One of the ways I can keep my clients safe is to get the COVID-19 vaccine. When I got the shot, I was really excited!”

Betty was fortunate enough to work in a retirement home setting that invited community staff to participate in their home’s onsite vaccination program; however, there are literally hundreds of thousands of vulnerable home care clients and frontline workers who are still waiting in line.

The COVID-19 vaccine represents our best hope for moving to a better place in the pandemic. We need to take advantage of every opportunity possible, starting with our community-based infrastructure and the practiced and perfected distribution systems for vaccination that already exist.

 

Hurtful comments about law enforcement

We receive every week messages regarding my blog, most of them being positive, thankful and heartwarming. This week was no different, except for a message that I share with permission, making me reflect on the many sides to an issue, and how sensitive we must always be. Please read, see my response, and reflect.

Doris,

I am writing to express my disappointment and concern at your negative police comments in your COVID-19 Report for January 15th. I am an Ontario RN who happens to be married to a police officer. The wording you chose such as “an excuse to torment” minorities “once again” seem to imply that police are looking and waiting for an excuse to hurt minorities. You also call on nurses to “be watching” law enforcement for this behaviour. I am hoping that I am misinterpreting how you intended this message. If so, I encourage you to clarify what you do mean.

The stay-at-home order issued by Mr. Ford does not actually give law enforcement any more power. It is all appearances meant to scare people into compliance. This is the very last thing that police officers want. They have been trying (though not recognized for doing so) to mend paths to marginalized people. This order sets any progress made in this area way back. People trust police and cooperate with police even less. This is not the choice of law enforcement.

I have noticed a very anti-police rhetoric in multiple of your COVID reports. I have been very upset by this. Nurses and police work in partnership. Here in [region], we have Crisis Outreach and Support (Coast) and the Mobile Crisis Rapid Response Team where officers work side by side with nurses to help people in crisis. I worked in the ER for almost 4 years here in [region]. I depended on police. They came to our rescue many times. Your words have created conflict in this much needed partnership. It compromises patient care.

I encourage you to speak with police officers and understand what this pandemic has been like for them. Every shift is filled with trauma. What they see in a single shift would cause the average person to need therapy for the rest of their lives. Every day, while facing the worst that this world has to offer, they do it while people scream at them, call them pigs, and call them racists. The news vilifies them. They are told every day, that they are not heroes. They are told that they are terrible people. Even the advertisements thanking first responders now are so careful not to show pictures of police. No one is clanging pots and pans in their honour. This is a group of people that nurses should be advocating for instead they are the one group of front-line workers that you seem to want us to work against. They need support not divisive words. Instead of casting blame, why not advocate for them to have the resources they need. Advocate for an expansion of the teams such as COAST. Advocate for mandatory sessions with psychologists for officers involved in any sort of traumatic call. Advocate for objective and fair investigations of police related incidents free from media bias.

It seems very easy to talk about policing and systemic racism. Everything they do is public. They show up when people are in crisis with almost no resources. When I worked in the ER and had to call a code white, we had teams of people, including doctors and crisis nurses who would show up in a matter of seconds with sedation and bring control. Plus, no one had any cameras to show the public the 5-10 people who would be piled on top of that person, holding them down while injecting drugs into them against their will. It is so easy to judge. What is available to officers in the community at a moments notice? Of course, the system needs to change, but that doesn’t happen over night. In the meantime, officers have to continue to do the job that no one else is equipped to do right now.

What about systemic racism in the health care system and among nurses? Why are minorities suffering and dying of COVID 19 at shockingly higher rates than non-minorities? Systemic racism exists in every institution. Just like nurses, officers work in the world they were handed. Minorities are over-represented in the economically disadvantaged sectors of society. Crime, just like sickness, go hand in hand with poverty.  Such anti-police messaging just makes it harder for the divide between police and minorities to be bridged. It increases the distrust and the ability of police to help in a meaningful way. It increases the likelihood of escalation.

I have depended on RNAO through this pandemic. I have no nursing colleagues as I work in primary care. RNAO has been where I have gone to feel connected to others in my profession. I have depended on their advocacy for nurses and for their scientifically-based information during this infodemic.  Now I feel more isolated, alone and afraid than ever before. I am hoping that your words were not meant how they came across. I encourage you to make that clear to the many readers of your report.

Sincerely,

[name], RN

My response: I sincerely appreciate the heartfelt message from [name]. I wrote to her immediately and thanked her deeply for reaching out to me and for her open and courageous communication. Dear [name], you have helped me reflect and learn on this challenging issue.

The way I framed my remarks on this matter in my earlier blog item were insensitive to the many police and law enforcement members, as well as police leadership, who are doing a sincere effort to reach out to racialized and marginalized communities and overcome the devastating history we are all aware of. Reflecting on your email, I fully agree that my remarks could make harder the critical collaboration that happens every day in multiple settings between health providers and law enforcement officers. That is a collaboration we should support, not undermine.

The fact that there is still a lot of work to do to address systemic racism and much police transformation to advance, should not deter us for a second from acknowledging the essential work involved in policing, many times without the necessary training, resources and organizational preparedness that would facilitate and improve that work (particularly in the area of mental health crisis). Please know that I recognize and thank the work done by members of the police, such asyourhusband, who are trying to do the best they can under extremely challenging circumstances.

Dear [name], I think many readers will learn from your email, and I am grateful that you agreed for me to publish its content. RNAO has been active in raising discussion about racism and discrimination in healthcare, for example in our series on Let’s Talk about Anti-Black Racism and Discrimination in Nursing. I hear your encouragement for us to speak with police officers and discuss the work of law enforcement. We will seek opportunities to do so.

 

Please receive my regards and don't feel isolated. RNAO is committed to be there for you, and I am doubly committed given your personal email.

 

ANNOUNCEMENTS AND UPDATES

Once again, we would like to thank our many colleagues who have reached out to us expressing a desire to help during the pandemic, including providing vaccination support. This is a kind reminder that you can link with employers throughRNCareers.ca, RNAO’s official career site since 2005. There is a section for jobseekers and one for employers. For more details, go here.

 

Upcoming webinar: NP LTC Council webinar series–Thursday, Jan 28 from 12:00-1:00 pm

RNAO’s support for nurse practitioners (NPs) is stronger than ever. With 46,000 members, including over 1,800 NPs, RNAO’s policy advocacy, programs and services offer a myriad of opportunities and benefits. This includes RNAO’s work with NPs working in long-term care throughout the COVID-19 pandemic and beyond. RNAO facilitates webinars to discuss clinical, operational, and policy related issues to LTC so colleagues can exchange best practices, support one another, and receive regular updates from NP LTC Council Co-Chairs, RNAO CEO, Dr. Doris Grinspun and Kaitlan Laviolette, Attending NP at Holland Christian Homes.

The upcoming webinar for NPs is this coming Thursday, January 28 from 12:00-1:00 pm. All NPs working in LTC are invited to participate and contribute your knowledge and expertise.

You can register here. For more information, please contact Catherine Jewel at cjewell@rnao.ca.

 

Upcoming webinar: Vaccine hesitancy and effective vaccine communication 

Feb. 8, 2021, 2 - 4 pmET

The COVID-19 vaccine will change the course of this pandemic. As millions of people are getting immunized, how can we as health-care workers become champions for this vaccine, and feel empowered to communicate about it with our patients, colleagues, family and friends?

Join Dr. Cora Constantinescu, pediatric infectious disease specialist, for a session on COVID-19 vaccine hesitancy and effective communication.

At the end of the session, the participants will be able to:

• appreciate the extent of vaccine hesitancy around the COVID-19 vaccine and some of the reasons for this phenomenon,
• understand how Canada measures up globally and at home; and
• apply a communication framework to hold a vaccine hesitancy conversation around COVID-19 vaccine.

You can register here.

RNAO holds its Health System Transformation and COVID-19 Webinar webinar series every month to support health providers from Ontario, Canada and anywhere around the world. They are free and open to any health provider. For information on the series and on earlier webinars, go here.

The January 11 webinar was on COVID-19 vaccine distribution: Progress to date with Dr. Dirk Huyer, Chief Coroner, member, Lead Clinical Guidance and Surveillance Work-Stream, COVID-19 Vaccine Distribution Task Force. About 850 health providers participated online. You can watch the webinar here and see the slides here. Dr. Huyer’s written summary and RNAO’s perspective on vaccines can be found here.

 

For our non-nurse friends: Become a “Friend of RNAO”

Many non-nurse colleagues have inquired about belonging to RNAO. Yes, you can also be part of RNAO and a positive change agent. We have had for over a decade a membership category for you: Friend of RNAO (an annual contribution of $92.99 inclusive of all taxes). And, as always, if you are an RN or an NP residing outside Ontario, you too can join RNAO as an “Out of province associate” for the same annual contribution of $92,99 (inclusive of all taxes). When you sign up online, under Membership, choose the corresponding category in the dropdown box. In both these categories, you will get all our policy documents, action alerts for advocacy, RNAO’s monthly e-newsletterIn the Loop and our award winning quarterly JournalRNJ–to be on top of the important issues in nursing, health and healthcare. You will also receive timely updates on our advocacy events, media releases, Best Practice Guideline (BPGs), educational webinars and more. You can also access RNAO’s affinity partners’ group rate discounts in home & auto insurance, mortgage savings… and more. Sign up online at MyRNAO.ca or call 1-800-268-7199.

 

 

Register for February 25, Queen’s Park Day – open to all RNAO members

Registration is open for Queen's Park Day on Thursday, February 25, 3:30 to 7:30 pm. The virtual event will feature remarks by Premier Doug Ford, Minister of Health Christine Elliott, Minister of Long-Term Care Merrilee Fullerton, Official opposition and NDP leader Andrea Horwath, Liberal Party leader Steven Del Duca, and Green Party leader Mike Schreiner.

The agenda will also feature the release of Vision for Tomorrow: The Nurse Practitioner Task Force Report. You can register for the event 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 Situation Report #351 for January 22 (no report on January 23):

 

Case count as of January 22, 2021 / Nombre de cas le 22 janvier 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
Canada*	731 450	+ 5 955	18 622	+  160
Ontario**	250 226	+ 2 662	5 701	+  87

 Update

 

• Case & Contact Management COVID-19 Surge Support Model guidance has been posted to the Ministry’s website

 

Staying in touch        

Please continue to keep in touch and share questions, comments, and challenges. Feel free to also recommend ideas for future webinars. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten email: 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 continue to be tough timesand we have to keep strong and focused! While the vaccine is hugely important, the immediate target is fighting the spread of the virus to preserve lives. To 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 – THANK YOU, and please know we stand by you!

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:

15 Jan - The escalating catastrophe of the COVID-19 second wave in Ontario – go here.

15 Jan - Progress in vaccine distribution: Updates, issues and concerns – go here.

8 Jan - RNAO raises its voice in the media: Media coverage in December 2020 – go here.

8 Jan - A practicum experience at RNAO – go here.

8 Jan - RNCareers: Help during the holidays and help for next phases of this pandemic – go here.

29 Dec - Public health nurses in schools – go here.

29 Dec - Government failing Ontarians as virus runs rampant and endangers lives – go here.

29 Dec - We need your help in addressing urgent staffing needs in health facilities – go here.

29 Dec - Best wishes for the holiday – go here.

18 Dec - Providing compassionate nursing care in an age of artificial intelligence – go here.

18 Dec - RNAO continues to express grave concern regarding the second wave – go here.

18 Dec - Long-term care staffing plan lacks urgency and legislated action – go here.

11 Dec - RNAO gravely concerned about the second pandemic wave – go here.

11 Dec - Health organizations plead for Ontarians to celebrate holiday season safely – go here.

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.

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.