June 26 2020 COVID-19 report

Dear Colleagues: Welcome to our Friday, June 26 report – now in the fifth month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. You can refer to earlier update reports here, including thematic pieces in my 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. Feel free to share this report or these links with anyone interested – they are public.

Doris’ blog goes weekly

Colleagues and friends – It has been a long haul and this blog and all of us at RNAO have walked with you every step of the way! I started the COVID-19 updates on January 27, two days after the first Ontario case was announced. For a period of three months, until May 1, we kept an almost daily schedule for the updates. During the month of May we kept a schedule of three times a week, and in June we have moved to a schedule of once a week. We will continue with the weekly update, including a summary of the week and other topics of interest (i.e., LTC Commission, government consultation for wave #2 of COVID-19). Should you have ideas you want discussed or want to offer to submit a piece for my blog – send me a note at <dgrinspun@rnao> with copy to Peta-Gay (PG) Batten <pgbatten@rnao.ca>.

The Daily Situational Reports we get from Ontario's MOH EOC are being posted daily in RNAO’s website. That way, you can access the Ministry’s guidance without having to wait for my COVID-19 report. The link is here and you can check it every day.

We don’t know how long and with what intensity COVID-19 will come back, but what it is certain is that we are still not free from it and will not be until there is an effective and widely used vaccine and/or treatment.

As many have said, this is a marathon, not a sprint, so we must keep our strength and our responsible action through a long and difficult period. Although we are already preparing for wave #2 of COVID-19, we must also take time to regain energies and there is nothing like good weather to do so! 

As always, feel free to continue writing to me and my staff and we will continue to do the best we can to respond.

Masks for all – the policy imperative in Canada

RNAO has been for several weeks calling on public health authorities in Ontario and in Canada to immediately implement mandatory masking in certain settings. Specifically, we follow the Masks4Canada letter from healthcare professionals asking that mandatory masking (or face covering) policies be established for “ACT”:

• All indoor spaces outside the home (such as schools, shops and businesses)
• Crowds (anywhere that is difficult to distance from others)
• Transit (public transportation).

Anyone with a relevant medical condition or disability should be exempt from this policy, and the same should go for young children under the age of two. We recommend distribution of free masks to populations that may be vulnerable and/or at higher risk, in order to reduce inequity.

Furthermore, these measures should be implemented through an educational approach and not a policing one. We recommend avoiding fines, arrests, or criminal penalties to enforce the policy. Instead, we encourage politicians to role model and encourage mask use, same for our medical officers of health and all of us as leaders in health care. We are also asking government to engage in campaigns to help the public understand how to wear a mask properly, and the importance of masks for health and economic recovery.

The evidence on the effectiveness of masks to reduce the spread of COVID-19 grows daily and by now is irrefutable. In RNAO’s view, any further delay in the implementation of mask policies constitutes poor public health policy that will cost lives and have serious economic impacts.

For an accessible summary of the evidence and arguments, check this article, this website, another website, and a Facebook page.

RNAO calls on public health officials to ACT today: some already did – please RT!

If you want to hear an expert on why we should push for Masks for All, join us this coming Monday, July 1, 6:45-8:00 pm with Dr. Jennifer Kwan, one of the organizers of #Masks4Canada. The webinar is open to all, including reporters. Please register here.

 

Nursing Home Basic Care Guarantee

RNAO action alert – RNAO demands government implement a Nursing Home Basic Care Guarantee - please read the following action alert and sign it.

We must demand that government take action to address the severe understaffing and inadequate numbers of registered staff in long-term care. The deadline is July 31, 2020 when Minister Fullerton must table in the legislature her report on the adequacy of regulated staff. There have been 35 reports in the past 21 years! Let this be the government that delivers action, not more study!  

Seventy‐nine thousand (79,000) of the province's older adults call Ontario's 626 long‐term care (LTC) facilities home and trust them to meet their physical, social, spiritual and cognitive needs on a daily basis. Tragically, COVID-19 has wreaked havoc through these homes, exposing long-standing shortcomings in the LTC system including severe understaffing and inadequate numbers of registered staff given the increasing acuity, the intensity of nursing care required, and complexity of residents.

On June 9, 2020 RNAO released the Nursing Home Basic Care Guarantee in response to the Long-Term Care Staffing Study Advisory, struck to address Recommendation 85 of the Gillese Inquiry into the criminal acts of a staff member that resulted in the murder of eight residents. Justice Eileen Gillese gave the government a deadline of July 31, 2020 to develop a staffing plan for long‐term care and table it in the legislature.   

RNAO’s submission provides detailed, evidence-based analysis supporting the basic care guarantee and staffing formula. It calls for implementing and funding recommendations from past inquiries and commissions, rather than engaging in more study and deliberation. RNAO says such action must begin right away, with Minister Fullerton’s tabling of her staffing plan by July 31, 2020.

RNAO calls on the government to adopt, fund and implement a nursing home basic care guarantee, and its related staffing formula, so residents of nursing homes can be assured safe care and quality of life, their families can sleep at peace, and staff will no longer need to struggle to meet the minimum care needs of their residents. It means that no home – whether for-profit or not-for-profit – will provide care below the guarantee. The staffing formula is based on evidence that builds on earlier reports and studies and addresses resident needs.

The Nursing Home Basic Care Guarantee minimum staffing formula provides no less than four (4) hours of direct nursing and personal care per resident, per day. The formula also calls to ensure the proper skill mix by allocating a minimum of:

• 0.8 hours (48 minutes) of RN care per resident, per day, 
• 1 hour (60 minutes) of RPN care per resident, per day and 
• 2.2 hours (132 minutes) of PSW care per resident per day. 

Each home should have one nurse practitioner (NP) for every 120 residents and a full time registered nurse specializing in infection prevention and control.

RNAO says the recommended four hours of care, based on past studies of care need, is very conservative. In 2017, the government committed to providing these four hours of direct care. Shockingly, only 2.71 hours of direct care are currently provided to each resident on a daily basis. This means LTC residents in Ontario receive one third less nursing and care hours than the very conservative estimate government committed to, but hasn’t implemented since 2017.

Equally alarming is that current legislation in Ontario does not specify skill mix ratios for RNs, RPNs and PSWs. It only assigns one RN on-site per shift, which is grossly deficient. We estimate the current skill mix at 0.30 hours of RN care per resident, per day, 0.49 hours of RPN care and 1.92 hours of PSW care.

All three groups are below the recommended levels of nursing and care hours. For RNs, the shortfall is 63 per cent from the recommended level. For RPNs, there is a shortfall of 51 per cent. And for PSWs, the shortfall is 13 per cent. Added to these deficiencies is the reality that only a small number of nursing homes have NPs. Most homes must do without an NP.

The increase in staffing to meet the guarantee must be accompanied by immediate changes in human resources policies permitting staff to work in only one LTC facility; providing wage parity with hospitals; and ensuring that full-time employment with benefits is offered to staff who want full time work to enable continuity of care for residents, improve staff retention, and remove the need to work in multiple locations.  

Action alert: Premier Ford has vowed to fix the LTC system. We urge you to demand the government implement with funding, the Nursing Home Basic Care Guarantee based on the minimum staffing formula. Let Minister Fullerton, Premier Ford, and the Staffing Study Advisory know that this is a necessary step to protecting Ontario’s older adults who call LTC their home. Ontario’s seniors deserve nothing less.

Please, add your voice today - sign the action alert here.

Also, please share this tweet with a retweet:

Connection: Updates, voices and opportunities to engage

We have continued to hold weekly webinars on Mondays, 6:45-8:00 pm together with external guests. Attendance is always anywhere between 200 and 350! The COVID-19 Webinars: Together We Can Do It! are free and open to all. The information for the upcoming webinar, as well as the archive for earlier ones, can be found here.

The upcoming webinar is this Monday, July 1, 6:45-8:00 pm, and we are delighted to host Dr. Jennifer Kwan, a family physician and one of the organizers of #Masks4Canada. She will speak about what we need to do to have a successful re-opening of the economy, and the role that COVID-19 surveillance and masking have in achieving that. To register go here.

If you have not had a chance to watch previous webinars, here are the last two:

• On June 22 we discussed the Impacts of COVID-19 on Indigenous Communities with three guest speakers: Ontario Regional Chief RoseAnne Archibald; Mae Katt, Nurse Practitioner with Temagami First Nation; and Marilee A. Nowgesic, CEO of the Canadian Indigenous Nurses Association. You can watch it here.
• On June 15 the topic was: Let's Talk About Racism. Our guest speakers were Allison Dalby, Hoodo Ibrahim, Nora Van Dalen, and Shirley Davis & Anthony Morgan. You can watch it here.

Together we can do it

Today is day #99 of RNAO’s #TogetherWeCanDoIt campaign. RNAO began this campaign on March 19 to cheer up health care workers and others in essential services. The campaign keeps expanding far and wide and shows to the world that  #TogetherWeCanDoIT.

Thanks “dependable cheerer”  HornonTheCob with their beautiful music. Susan McNeil,  Irmajean Bajnok and her inspirational messages, and Valerie Gelinas who posts every evening upbeat messages.  I also spotted our colleague Christina Medeiros in a solo play and with her father – THANKS to both for sharing your joy and to Kumudhini Thavaraj for being a cheering colleague!  Once again, to the Stephen’s family who each day post cheering tweets watch this one! Remember to join in this community building moment every evening at 7:30pm local time - until we defeat COVID-19! Make sure to post tweets using #TogetherWeCanDoIt.

MOH EOC Situational Report

As announced above, we will be posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you will be able access the Ministry’s guidance without having to wait for my COVID-19 report. Again, the link is here and you can check it every day.

Since this report will come out once weekly, that will provide a more timely access to Ministry guidance.

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 #152 for 25 June:

 

Case count as of 8:00 a.m. June 25, 2020 / Nombre de cas à 8h le 25 juin 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	9 557 562	+174 337	485 609	+5 188
Canada	102 242	+279	8 484	+30
Ontario	34 205	+189	2 641	+10

 

Actions taken:

• The Quick Reference Public Health Guidance on Testing and Clearing Cases has been updated and is here. The updated guidance provides more information on management and clearance of asymptomatic cases and on work self-isolation in non-health care settings. It will be available shortly in French and English on the Ministry’s website.
• The guidance document for Management of Cases and Contacts of COVID-19 in Ontario has also been updated and is here. It will be available shortly in French and English on the Ministry’s website.
• The Ontario government announced it is allowing Windsor-Essex to move into Stage 2 of reopening on Thursday, June 25, 2020 at 12:01 a.m., with the exception of the Municipality of Leamington and the Town of Kingsville. These areas are being held back due to the higher transmission rates in the local agriculture and agri-food sector. This decision was made in consultation with the Chief Medical Officer of Health and the local Medical Officer of Health of Windsor-Essex County Health Unit.

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>. Due to the volume of comments and questions, we are responding as fast as we can. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you deeply colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and around the world. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!

Together, we must redouble our efforts to tackle COVID-19 with the best tools at hand: full, accurate and transparent information, calmness, determination and swift actions. 

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

 

RECENT BLOG ITEMS:

18 June - Annual General Meeting – an exhilarating week! – go here.

12 June - Petition on masks for Canada – go here.

12 June - LTC: RNAO releases list of 35 reports and recommendations dating back 20 years – go here.

6 June   - Statement – RNAO stands together with our Black sisters and brothers – go here.

3 June   - Adapting harm reduction during a pandemic – go here.

29 May - Foot care nurses – go here.

29 May - Update on pandemic pay; pandemic pay in consumption and treatment sites – go here.

28 May - RNAO Calls for Immediate Action in Response to the Canadian Armed Forces’ LTC report – go here.

26 May - Update on VIANurse – go here.

26 May - Ending homelessness: Will you join us to build a COVID-19 recovery for all? – go here.

24 May - Technology as a solution: Opportunities and pitfalls of COVID contact-tracing apps – go here.

21 May - Debunking PPE myths with Dr. Jeff Powis: Which masks should health care workers wear during COVID-19? – go here.

20 May - RNAO response to announcement of an independent commission into Ontario's long-term care system – go here.

19 May - With the pandemic curve flattening, VIANurse program will focus its effort on outbreaks – go here.

14 May - Nursing Week update – go here.

14 May - Pandemic puts health system to the test: Nurses have answers for shortfalls – go here.

14 May - Disappointment for not being included in pandemic pay – go here.

13 May - RNAO saddened by the loss RN Brian Beattie to COVID-19 – go here.

13 May - End racism and prejudice – go here.

12 May – Enhancing Community Care for Ontarians (ECCO 3.0) – go here

11 May - Nurses share their successes and challenges during National Nursing Week – go here.

10 May - A story of hope, ingenuity, support and genuine care for an LTC resident – go here.

7 May    - Counting the missing deaths: Tracking the toll of the coronavirus outbreak – go here.

5 May    - Life on the front lines of the pandemic: Profile of RNAO member NP Daria Gefrerer – go here.

5 May    - Addressing differential access to virtual care due to technology inequities – go here.

3 May    - Being person-and-family-centred during COVID-19 – go here.

1 May    - Migrant agricultural workers and the COVID-19 crisis – go here.

30 April - COVID-19 pandemic in provincial institutions and correctional centres – go here.

28 April - Supporting First Nation Communities during COVID-19 – go here.

27 April - Responses to COVID-19 for persons experiencing homelessness in Toronto: An update – go here.

25 April - Lessons learned through a COVID-19 nursing home outbreak – go here.

25 April - Letter from a retired RN to Premier Ford: The problems with LTC were evident long before COVID – go here.

23 April - Working with seniors in long-term care requires specialized knowledge – go here.

22 April - Shaking the stigma: We need a proactive COVID-19 response for mental health and addiction – go here.

21 April - We Require Expanded and Accessible COVID-19 Data in Ontario – go here.

20 April - Can Loss of Smell and Taste Help Screen for COVID-19? – go here.

18 April - COVID, Trump and the World Health Organization – go here.

16 April - A Home Based Model To Confront COVID-19 – The Case Of The Balearic Islands – go here.

15 April - COVID-19 and the Challenges in Homecare – go here.

14 April - Reprocessing Of N95 – An Update – go here.

14 April - A New COVID-19 Facility For Persons Experiencing Homelessness In Toronto – go here. 

13 April - Practical Tips for Safe Use of Masks – go here.

10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.

10 April - RNAO Action – Supporting Long-Term Care – go here.

10 April - Update For Nursing Students – NCLEX Exam – go here.

9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.

9 April - Guidance on use of N95 mask – go here.

7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.

7 April - Reprocessing of n95 – safe? – go here.

5 April - We must change the way we do testing and case definition – go here.

5 April - Ringing the alarm bells on critical care beds – go here.

4 April - COVID-19, stay at home and domestic violence – go here.

We have posted earlier ones in my blog here. Please go and take a look.

RNAO’S policy recommendations for addressing the COVID-19 crisis: We presented 17 recommendations for government, last revised on April 2. Read them here.

 

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 here.

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 Hopkins CSSE.