March 19, 2020

March 19, 2020 COVID-19 report

•

Tags:

Hello dearest members,

To keep you well informed, here is RNAO’s daily communication for Thursday, March 19 – our second month of the COVID-19 outbreak in Canada – a global 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, 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 urges all health professionals – in the strongest possible terms – to defer any non-essential travel during the pandemic. We need you at work and we need you healthy! Today, a clear directive of this went to all sectors leader and I attach it here. I ask that if you experience interpretation challenges at your workplace, you inform me right 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." We should also exponentially increase public education of how to practice social distancing. I want to emphasize that education is not only the government’s responsibility, but ours – individually and collectively.

Today, we launched the #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! It was launched, as planned, at 7:30 p.m. today, and it will continue every evening at the same time until we defeat COVIC-19! Please join in whichever way you can – our colleagues and us all need the collective energy 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. At 7:30 pm local time, each evening, 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, ring your bike’s bell, and yes – you can honk. Watch the short video (courtesy of a CP24 interview yesterday 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!

Sometimes, the celebration serves also to suffocate the pain, at least for a bit, as was for me today upon learning we lost more Canadians to the battle with COVID-19, and we also lost a Spaniard nurse from one of RNAO’s BPSOs, a formidable woman and outstanding professional! Please take a minute to think about her and to retweet our condolences.

MOH EOC Situational Report #54 here – EOC reports that the number of confirmed cases in Canada, today, is 770 (up from 614 persons yesterday, 433 persons on Tuesday, 336 persons on Monday and 247 persons on Sunday), and 10 deaths including a person in Ontario. EOC reports 22 new cases which as per EOC brings our province to 257 cases (of which 5 are resolved cases). EOC reports that in Ontario, at this time, we have 3,972 persons under investigation with lab results pending. Several important guidance documents, directives, and memorandums are attached to today’s Situation Report:

CMOH Memo Hospital Visitors COVID-19 (2020-03-19) here
CMOH Directive 2 - RHPA professionals (2020-03-19) here
COVID19_Food Premises_Final (20200319) here
CMOH Memo Health Worker Illness and Return to Work 2020-03-19 here
Improving COVID Surveillance within ACES here
CMOH Memo COVID-19 surveillance 2020-03-19 here
MOH-OH Memo - Virtual Visits - March 18 2020 (002) here

Coronavirus COVID-19 Global Cases by Johns Hopkins -- CSSE reports 872 total cases in Canada as of March 17, at 12: 35 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).

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. 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 59 from WHO updates that worldwide there are 209,839 confirmed cases (16,556 new) and 8,778 deaths (828 new). The vast majority of the cases are local transmission. There are 35,713 confirmed cases (4,207 new) in Italy, 17,361 confirmed cases (1,192 new) in Iran, and 8,413 confirmed cases in South Korea (93 new). Other countries to note are Spain (with 13,716), France (with 9,043), Germany (with 8,198), Switzerland (with 3,010), UK (with 2,630) and Netherlands (2,051). China has 81,174 cases (with only 58 new, an exceptional achievement). The number of confirmed cases worldwide has exceeded 200 000. It took over three months to reach the first 100 00 confirmed cases, and only 12 days to reach the next 100 000.

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 7,087 cases in the United States, CSSE reports 14,250.

RNAO Policy Corner: The need to test, trace contacts, and isolate cases

We are going through a very challenging period. Governments in Canada have reacted responsibly and have acted seriously and in coordination to effect social distancing while preparing health-care services for the enormous demands that COVID-19 may be presenting. There is a flurry of activity to prevent infection among vulnerable individuals such as retirement and nursing homes. Hospitals are preparing to receive large numbers of very sick persons requiring intensive care.

At the same time, social distancing is having a profound social and economic impact. Social distancing means for many social isolation, loss of jobs and livelihoods, small businesses closing down, compromised mental health, family violence, children losing education, loss of financial reserves, evictions and homelessness, and many, many other concerns. Governments are moving, and need to move much more aggressively, to lessen some of these negative impacts, particularly the economic ones, so families, particularly those in precarious and low-wage employment, self-employment, vulnerable situations such as Indigenous communities, or the gig economy, can survive while maintaining their dignity, health, housing and ability to care for their children and provide for their families.

Concurrently with lessening the tough effect of social distancing, MUST aggressively do all we can to shorten this period of social distancing. The situation will become dire, at many levels, if this period of social isolation prolongs itself beyond just a few weeks. In the view of RNAO, there is one major tool we are not using sufficiently, at this time, to flatten the virus curve and shorten the period of social isolation: testing and contact tracing.

In the words of World Health Organisation head Tedros Adhanom Ghebreyesus, there has not been an urgent enough escalation in testing, isolation and contact tracing, which should be the "backbone" of the global response. He said it is not possible to "fight a fire blindfolded", and social distancing measures and handwashing will not alone extinguish the epidemic. He says he has “a simple message for all countries: test, test, test.” If we don’t test, then we don’t know who has the virus, and thus one cannot isolate and trace it.

We have been slow to learn this lesson in Canada, perhaps influenced by the terrible example south of the border, a lack of leadership that is driving the United States, according to some observers, to a catastrophic situation such as the one experienced by Italy, but on a much larger scale. That’s why it is good the border has been closed to non-essential travel.

In Canada, the situation with testing is better, but we should not be complacent. Ontario and British Columbia, the provinces with the highest numbers of cases, have had to set new limits on who will be tested due to a demand for testing materials. In BC, testing is limited to people showing symptoms of the COVID-19 disease who are either hospitalized, work in the health-care system, are residents of long-term care facilities, or are part of an investigation into a cluster or outbreak. A similar situation happens in Ontario. That leaves many potential community cases of COVID-19 undetected, untraced and not isolated. These community cases are the most dangerous ones in terms of propping the epidemic curve up, the opposite of flattening it.

The logic for this approach is faulty. A provincial health authority in BC says: "We have recently adapted the testing strategy in BC. People with mild symptoms who can recover on their own at home don't need testing because the medical care and advice is the same regardless of whether they test positive or not." This approach completely ignores the need to trace contacts of persons who are COVID-19 positive. In fact, this approach assures there will be community spread, since the effort to trace contacts and isolate them has been abandoned.

We should learn the lesson from South Korea. Amid dire global trends, South Korea has emerged as a sign of hope and a model to emulate. The country of 50 million appears to have greatly slowed its epidemic; it is reporting less than 100 cases each day now, down from 900 at its peak at the end of February. It has done so without locking down entire cities or taking some of the other authoritarian measures that helped China bring its epidemic under control. Behind its success so far has been the most expansive and well-organized testing program in the world, combined with extensive efforts to isolate infected people and trace and quarantine their contacts. South Korea has tested more than 270,000 people, which amounts to more than 5200 tests per million inhabitants—more than any other country except tiny Bahrain. In contrast, the United States has so far carried out 74 tests per 1 million inhabitants.

Canada has so far done about 1,400 tests per 1 million, much better than the US, but still only one third of the testing levels reached in South Korea, and very little of the contact tracing and case isolation done extensively in that country. South Korea’s experience shows that “diagnostic capacity at scale is key to epidemic control,” says Raina MacIntyre, an emerging infectious disease scholar at the University of New South Wales, Sydney. “Contact tracing is also very influential in epidemic control, as is case isolation,” she says. This was part of a systematic and coordinated societal effort in South Korea that included a number of crucial elements, according to the WHO. It educated, empowered and engaged communities; it developed an innovative testing strategy and expanded lab capacity; it rationed the use of masks; it did exhaustive contact tracing and testing in selected areas; and it isolated suspected cases in designated facilities rather than hospitals or at home. As a result, cases have been declining for weeks.

RNAO’s policy recommendation: Canada needs to ramp up, within days, its capacity to test. At the same time, the increased testing capacity should be accompanied by aggressive contact tracing and case isolation. Our current approach, relying too much only on social distancing to flatten the curve, will prolong the period of social distancing and the enormous social and economic dislocation. If we want to shorten this period, and diminish the social and economic impact, we must strengthen the weak elements in the current COVID-19 strategy: test extensively, trace aggressively, and make sure contacts are isolated.

RNAO’s ACTIONS:

Our thanks again 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

Canada needs to ramp up, within days, its capacity to test. At the same time, the increased testing capacity should be accompanied by aggressive contact tracing and case isolation. See our analysis above.

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 this week 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 this week 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 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.

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