March 14, 2020 COVID-19 report

Hello RNAO members,

This is RNAO’s daily communication for Saturday, March 14 – our second month of the COVID-19 outbreak in Canada – now a pandemic. To see previous updates visit RNAO updates and resources on COVID-19 for members and other health professionals. Feel free to share any and all updates with other health professionals at home or abroad.

MOH EOC Situational Report #49 here – An initial COVID-19 Self Assessment Tool has been posted to the Ontario Government site. Individuals who suspect they have COVID-19 can consult this tool to determine whether and how to seek further care. An automated click-through version of the tool is under development. The latest case definition shared yesterday clarifies that testing should continue to be conducted for individuals who are symptomatic and have travelled or have had close contact with someone who has travelled or a confirmed case. Asymptomatic individuals should not be tested. The ministry will continue to monitor and consider modifications to the testing criteria.

EOC reports that the number of confirmed cases in Canada, today, is 218 cases, and one death. This includes 22 new cases in Ontario, which brings our province to 101 cases (of which 5 are resolved cases). EOC reports that in Ontario, at this time, we have 939 persons under investigation with lab results pending (as compared to 580 persons yesterday).

Media reports a total of: 252 confirmed cases and one presumptive, in Canada. Ontario: 103 confirmed (5 cases resolved), British Columbia: 73 confirmed, including one death (6 cases resolved); Alberta: 39 confirmed; Quebec 24 confirmed; New Brunswick: 2 confirmed; Manitoba: 4 confirmed; Saskatchewan: 2 confirmed; Prince Edward Island: 1 confirmed; Newfoundland and Labrador: 1 presumptive; Canadians quarantined at CFB Trenton: 4 confirmed. These figures are also the same as those reported by Coronavirus COVID-19 Global Cases by Johns Hopkins -- CSSE -- as of March 14, at 10: 53 pm.   

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers; I encourage you to visit it.  Public Health Ontario posted yesterday a technical brief Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 (in English and French).

Another essential resource is Health Canada's website on COVID-19. It 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. This is, again, a vital resource for those following the COVID-19 outbreak in Canada.

The Public Health Agency of Canada has developed two new guidance documents for health system partners. The first, regarding community-based measures to mitigate the spread in Canada, and the second on informed decision-making related to mass gatherings.

Situation Report 54 from WHO updates that worldwide there are 142,539 confirmed cases (9,769 new) and 5,393 deaths (438 new) in 135 countries (13 new). The vast majority of the cases are local transmission. There are 17,660 confirmed cases (2,547 new) in Italy, 11,364 cases in Iran (1,289 new) and 8,086 confirmed cases in South Korea (107 new). Other countries to note are Spain (with 4,231), France (with 3,640), Germany (with 3,062), Switzerland (with 1,125), Japan (with 675), Netherlands (614), Sweden (620) and UK (594).

You can also find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. These numbers appear in some cases to be more updated than those of WHO. For example, while WHO reports 1,264 confirmed cases in the United States, CSSE reports 2,174.

In his daily media update, WHO Director-General acknowledged that even though COVID-19 has captured the world’s attention, there are still many other health issues people continue to face every single day. Babies are still being born. Essential surgery is continuing. People still need emergency care after road traffic crashes. People still need treatment for cancer, diabetes, HIV, malaria and many other diseases. And for all of these, we need health workers. In his words, “[t]oday I want to send a personal and sincere thank you to every health worker around the world – especially nurses and midwives, who we are celebrating this year through the International Year of the Nurse and the Midwife. You do a heroic job. We know that this crisis is putting a huge burden on you and your families. We know you are stretched to the limit. You have our admiration, our respect, and our commitment to doing everything we can to keep you safe and enable you to do your job.”

RNAO’s ACTIONS:

RNAO is unwavering in our commitment to support Ontarians, all health professionals and in particular nurses and nursing students, and our health system during the COVID-19 pandemic. An initiative we engaged yesterday, 12 March, was to invite Ontario nurses to volunteer for providing virtual clinical care or non-clinical services in their communities, when needed given the extraordinary demands created by the COVID-19 pandemic. The nurses will receive appropriate training and protocols so they can support quality care and outcomes. These nurses are being deployed to work in telehealth activities, and clinical leads are being provided as a resource for real time consultation and support. In 48 hours over 1,700 RNs and NPs have responded to the call. We also welcome non-practicing class, or nurses who are no longer a member of CNO (e.g., retired, resigned) as we need all hands on-deck. Thanks to your response we are already connecting a good number of nurses with employers.

Call to RNs & NPs: If you are interested in getting involved, please CLICK HERE to complete our survey. We would appreciate your response as soon as possible, given the rapidly evolving situation and urgent need to augment Telehealth Ontario, no later than Monday, March 16, 2020.

Note for employers in Public Health Units: If you are experiencing a staff shortage to answer phone calls following protocols, please let us know. Write to dgrinspun@rnao.ca and Daniel Lau dlau@rnao.ca and we will connect you within hours with RNs and NPs in your locality. On this note, KUDOS to Chief Nurse Officer, Ottawa Public Health, Esther Moghadam and her team who contacted us for support. Together, in less than 48 hours, we are relieving some of the tremendous pressure they are experiencing. Esther messaged us this evening as follows: “50 nurses responded. Reached out to the 33 who provided resumes. Spoke with 30. Hiring 27. Of these, 12 will be trained tomorrow (Sunday), others Monday. Amazing. Thank you so much!” Colleagues, we are a team: Together we will get through this pandemic – We are here for you!

URGENT STEPS FOR GOVERNMENT TO TAKE: RNAO’s VOICE

1. Strict social distancing. RNAO has been supporting the efforts to educate the public about the role of social distancing in slowing down community transmission in Ontario.  Even if the number of people infected by the virus continues to climb, a slowdown in the progression can do a life-and-death difference for the healthcare system. As the tragic situation in Italy demonstrates, an overwhelmed healthcare system can have devastating implications for many people, particularly those vulnerable and sick. Italy has so far the highest rate of death with COVID-19 outside of China; it appears this is related to the incapacity of health services to respond to an explosive number of cases in a short period of time. Social distancing can slow down dramatically the spread of the virus and thus allow healthcare institutions to better respond by reducing the number of people requiring care at a particular time. An article in the Toronto Star reports on research about the effectiveness of social distancing during the 1918 Spanish flu in the United States. The city of St. Louis shut down public gatherings quickly when the flu hit. In contrast, the city of Philadelphia held a parade and saw death rates spike. The researchers found that US cities that acted quickly to shut down schools, churches, and ban social gatherings had peak death rates about 50 per cent lower than cities that didn’t and had “less-steep epidemic curves.”
2. Massive public education and enrollment. RNAO is actively engaged in public education through mainstream media to slow down community spread – which buys us time for the health system to respond. To assist on this effort, RNAO is retweeting government messages and we ask you do the same. We are also engaged in our own social media education, as well as public education through our website and though the media (please take a minute to watch and retweet).
3. RNAO believes we should have ready-to-go plans for postponement of elective surgeries and opening new emergency, step-down and ICU beds in our hospitals. There is a distinct possibility that the capacity of hospitals will be tested with possibly large number of patients arriving in emergency departments with severe respiratory infection. RNAO is calling to speed-up plans for postponement of elected surgeries, the redeployment of medical personnel and the opening of new emergency and ICU beds ready to receive those patients. If we have ready-to-go plans now – RNs, NPs and physicians would be temporarily re-deployed and receive training to treat the specific conditions presented by COVID-19 and the common procedures and protocols required for such patients – even if that’s not their specialty. These plans and essential training and preparation cannot wait until we have hundreds of critically sick patients arriving at Emergency. They must happen now so we can trigger execution if and when required. Better safe than sorry – that should be the call.  

Canada cannot and should not be caught in a tragedy such as the one unfolding in Italy. We have had plenty of time to plan and we are now working on “borrowed time.” An article in The Lancet published yesterday provides evidence for the “now grave concern regarding the Italian national health system's capacity to effectively respond to the needs of patients who are infected and require intensive care for SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be 30 000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed by mid-April, 2020.”

Colleagues, we urge you to continue to educate yourself and others on how to diminish the risk of transmission. You can see the WHO recommendations for prevention here.   

Given that community spread already exists, here is an excellent guidance document for homes and residential communities, from the USA Center for Disease Control (CDC). 

At this time, RNAO is urging to replace face-to-face meetings with virtual meetings. RNAO has already moved to do so.  

Please continue to keep in touch and share questions and/or challenges of any kind, and especially shortages of PPE. Send these to me at dgrinspun@rnao.ca. We are responding daily and are solving your challenges. You can also use the health provider hotline and website regarding questions about the outbreak, protocols, preparedness, and more. The toll free number is 1-866-212-2272, and the health provider website, updated regularly with useful resources, can be accessed here. An important reminder that the health provider website and the toll free number are for you – as a health professional – and not for members of the general public.

Ontario’s ministry’s public website on the COVID-19 exists 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. RNAO has updated its information page for the public. Please share it widely.

Together, we are and will continue to tackle COVID-19 with the best tools at hand: accurate information, calmness, determination and swift actions. 

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