March 18, 2020 COVID-19 report

Hello Nurses and all Health Professional Heroes!  

To keep you well informed, here is RNAO’s daily communication for Wednesday, March 18 – 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 these updates with other health professionals at home or abroad.

Yesterday, the province has acted in the right direction. Premier Doug Ford has declared a state of emergency in Ontario, immediately ordering select closures of gatherings above 50 people. The measure announced closes indoor recreation centres, public libraries, private schools, parades, places of worship, licensed day-care centres, cinemas, theatres, concerts and the like until the end of March. Ford announced $304 million in “surge funding” to bolster the health-care system with an additional 75 critical-care beds, 500 post-acute care beds, and another 25 COVID-19 assessment centres at hospitals to keep potential patients out of emergency departments. There will be more resources for monitoring and testing as well as more personal protective equipment like masks, gloves, surgical gowns for healthcare providers as well as more ventilators. Nursing homes will share in the funding to augment infection control measures and cleaning and support in screening staff and visitors for the new coronavirus to help protect the vulnerable residents, who are at high risk for complications like potentially fatal pneumonia. The surge funding includes money for 1,000 nurses and 1,000 personal support workers to help look after COVID-19 patients. See here the various Orders in Council announcements: OC-518, OC-519, OC-520.

Today, Health Minister Christine Elliott announced in no uncertain terms that any health professional who travels abroad MUST upon return to self-isolate for 14 days. RNAO is thanking the minister for a decisive action that puts an end to variation in practices by health organizations and serves to protect health professionals and patients alike. RNAO wants to urge – in the strongest possible terms – nurses, doctors, and all other health professionals – to defer any non-essential travel during the pandemic. We need you at work and we need you healthy!

RNAO raised, as mentioned, concerns about healthcare workers who returned immediately to work upon return from travel abroad, if they were asymptomatic. The assumption of those advocating they go back to work was that only symptomatic individuals shed the COVID-19 virus, thus other healthcare workers and their patients are protected as long as symptomatic persons stay away. New research suggests persons can be infectious even before symptoms appear, or when they have very mild symptoms like those of the common cold. Although these are preliminary studies, they emphasize the role of social distancing even among people who appear “healthy”, since one cannot rule out that a healthy looking person may actually be shedding virus. Several studies support this conclusion, although how important asymptomatic transmission is in the spread of the virus remains unclear. A lead researcher concludes: "Don't forget about hand washing, but at the same time we've got to get people to understand that if you don't want to get infected, you can't be in crowds." He adds: "Social distancing is the most effective tool we have right now." In RNAO’s view, this is sound advice. Until we have full understanding of the behavior of the virus, we should assume that asymptomatic individuals can spread the illness, and act accordingly, particularly in sensitive settings such as a health service unit. And we should re-double of our education of the public: practice social distancing.

Colleagues, now more than ever we MUST move forward boldly and practice - as well as demand from others - social distancing, to protect our health professionals and other essential services so they can protect patients and communities.

For this, RNAO is launching a #TogetherWeCanDoIt campaign. NOW, more than ever -- we MUST inject positive energy to lift-up our colleagues working in the front-lines, as well as keep all of us going with long hours and long worries! This is why, beginning Thursday, March 19, 2020 at 7:30 p.m. (EST) and every evening thereafter – we ask you to cheer on the millions of health providers, social service and other essential front-line workers in Ontario, Canada, and around the world tackling #COVID-19. Step out onto your porch, balcony or open a window and make some noise in honour of our heroes who are working on our behalf. You can bang some pots and pans, you can sing a song, you can applaud, and yes – you can honk.   

Remember 7:30 p.m. (EST) sharp – everyday – until the fight against COVID-19 is over! – Watch the short video (courtesy of a CP24 interview this eve) RETWEET and GET READY TO PARTICIPATE. Use the hashtag #TogetherWeCanDoIt and tag @RNAO when sharing how you and your community are cheering on our front-line providers!

MOH EOC Situational Report #53 here – EOC reports that the number of confirmed cases in Canada, today, is 614 (up from 433 yesterday, 336 cases Monday and 247 cases on Sunday), and eight deaths including an Ontario man from Simcoe Muskoka. In Ontario, EOC reports 22 new cases which as per EOC brings our province to 211 cases (of which 5 are resolved cases). EOC reports that in Ontario, at this time, we have 3380 persons under investigation with lab results pending. Several important guidance documents, directives, and memorandums are attached to today’s Situation Report:

• Guidance documents for Food Premises and Personal Service Settings (here) and (here)
• Memo regarding the Provincial Transfer Authorization Centre (PTAC)  (here) 
• Canadian Blood Services advisory to hospitals (here) (here) and (here)
• A Cyber advisory has been shared with the health system (here) and (here)
• A summary of today’s Command Table meeting (here)

Media Reports Today, Wednesday, March 18: Total: 705 (647 confirmed, 9 deaths, 10 resolved, 39 presumptive); British Columbia: 231 confirmed (including 7 deaths, 5 resolved); Ontario: 214 confirmed (including 1 deaths, 5 resolved); Alberta: 97 confirmed; Quebec: 94 confirmed (including 1 deaths); Manitoba: 13 confirmed, 4 presumptive; Saskatchewan: 2 confirmed, 14 presumptive; Nova Scotia: 3 confirmed, 9 presumptive; New Brunswick: 2 confirmed, 9 presumptive; Canadians quarantined at CFB Trenton: 9 confirmed; Newfoundland and Labrador: No confirmed cases, 3 presumptive; Prince Edward Island: 1 confirmed; The Territories: No confirmed cases.

Coronavirus COVID-19 Global Cases by Johns Hopkins -- CSSE reports 665 total cases in Canada as of March 17, at 11: 13 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.  Make sure to check the Public Health Ontario technical brief on the 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 58 from WHO updates that worldwide there are 191,127 confirmed cases (15,123 new) and 7,807 deaths (786 new). The vast majority of the cases are local transmission. There are 31,506 confirmed cases (3,526 new) in Italy, 16,169 confirmed cases (1,178 new) in Iran, and 8,320 confirmed cases in South Korea (84 new). Other countries to note are Spain (with 11,178), France (with 7,652), Germany (with 7,156), Switzerland (with 2,650), UK (with 1,954) and Netherlands (1,705). China has 81,116 cases (with 39 new).

You can also find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. These numbers appear to be more updated than those of WHO. For example, while WHO indicates there are 3,536 cases in the United States, CSSE reports 7,769.

WORTH REPEATING: WHO Director-General said yesterday that, with the rapid escalation of cases outside China, there has also been a rapid escalation in social distancing measures, like closing schools and cancelling sporting events and other gatherings. But he is concerned we have not seen an urgent enough escalation in testing, isolation and contact tracing – which is the backbone of the response. Social distancing measures can help to reduce transmission and enable health systems to cope; handwashing and coughing into your elbow can reduce the risk for yourself and others.  But on their own, they are not enough to extinguish this pandemic. It’s the combination that makes the difference. He keeps repeating that all countries must take a comprehensive approach. The most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, he says, you must test and isolate. “You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.  We have a simple message for all countries: test, test, test. Test every suspected case. If they test positive, isolate them and find out who they have been in close contact with up to 2 days before they developed symptoms, and test those people too.” [NOTE: WHO recommends testing contacts of confirmed cases only if they show symptoms of COVID-19]

RNAO’s ACTIONS:

Endless THANKS to the 3,950 RNs and NPs who responded to the RNAO survey with your availability to provide virtual clinical care or non-clinical services in your communities, when required given the extraordinary demands we face. We have already deployed 59 to Ottawa Public Health and a good number to other places. RNAO is in the process of working with various other areas of need and will connect with you depending on the locations required. We also understand that TeleHealth will necessitate additional staff. We know that you are ready and eager to help and thank you hugely for it!   

Note to employers in Public Health Units and other call centres: If you are experiencing a staff shortage to answer phone calls following protocols, please let us know. Write to Daniel Lau dlau@rnao.ca and we will connect you within hours with RNs and NPs in your locality. We are here for you!

URGENT STEPS FOR GOVERNMENT TO TAKE: RNAO’s VOICE

Strict social distancing. Please become a #SocialDistance Champion by educating your families, friends, colleagues and members of your community. #SocialdistancingNOW works to slow 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. Please also help neighbours who leave alone, exchange phone numbers with others, and help make sure that social distance doesn’t translate into social isolation.

Massive public education and enrollment. RNAO and our members are heavily engaged in mainstream and social media to keep the public fully informed, engaged and enrolled into #socialdistance action. We ask that you follow us at @RNAO and @DorisGrinspun and retweet + facebook as much as you possibly can. WHO issued two new technical guidance documents: Critical preparedness, readiness and response actions for COVID-19 and Risk Communication and Community Engagement (RCCE) Action Plan Guidance.

Support for Vulnerable Populations and Workers. Protecting Ontarians experiencing homelessness and those living in crowded shelters are issues we are actively pursuing with government officials, and we are pressing for an urgent plan. We also know that government is meeting with Indigenous leaders to discuss their preparations for COVID-19, and we are eager to hear the outcome of those discussions. While we were pleased with the initial measures announced earlier by Ontario’s Premier Doug Ford to protect workers from losing their jobs as businesses suspend operations or they have to stay home to take care of children, RNAO was also urging for much more to be done to assist low-wage earners and those in precarious employment, who may transmit disease simply because they have no option. Thus, we are pleased with the important announcements made today by the federal government. Workers and businesses hurt by the COVID-19 pandemic may be eligible for part of the $82 billion aid package announced today by Prime Minister Justin Trudeau, which includes $27 billion in direct support for those struggling to find work or care for family members. The package, now before Parliament, stands to adjust the rules on who qualifies for employment insurance (EI), and includes two emergency benefits for those who don't.

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 continuously solving your challenges. WE ARE HERE FOR YOU! 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.

Worth repeating: WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, makes a heartfelt plea for solidarity. He says: “This is the defining global health crisis of our time. The days, weeks and months ahead will be a test of our resolve, a test of our trust in science, and a test of solidarity. Crises like this tend to bring out the best and worst in humanity. Like me, I’m sure you have been touched by the videos of people applauding health workers from their balconies, or the stories of people offering to do grocery shopping for older people in their community. This amazing spirit of human solidarity must become even more infectious than the virus itself. Although we may have to be physically apart from each other for a while, we can come together in ways we never have before. We’re all in this together. And we can only succeed together. So the rule of the game is: together.”

Let’s remember our colleagues in the front lines in Ontario, Canada and in other countries. These are tough and stressful times, and also the time to be together and support one another. This is why I ask that you please take a second to retweet a YouTube I tweeted on your behalf to our BPSO colleagues in Spain, Chile, Colombia and Peru.

Colleagues, 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