March 4, 2020 COVID-19 report

Good Wednesday RNAO members,

A reminder of RNAO’s updated daily communications for this second month of the COVID-19 outbreak in Canada. You are receiving summary updates on Tuesday, Thursday, Saturday and Sunday – inclusive of Ontario’s Ministry of Health’s Emergency Operations Centre (EOC) Situational Report, and World Health Organization (WHO) Situational Report. In addition, you are receiving on Monday, Wednesday and Friday, longer updates such as the one you are receiving today, inclusive of an RNAO policy corner and more detail. 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.

Brief Update on Repatriated Canadians: Canadians from the Diamond Princess cruise ship, who arrived on Feb. 21 from Japan, are in Cornwall and have 1 day left of their quarantine period. To date, there are no COVID-19 positive cases among the repatriated Canadians from Wuhan who were quarantined at CFB Trenton or who are currently in quarantine at the NAV Centre.

MOH EOC Situational Report #39 here, inclusive of: 1) Chart showing the Risk Levels and Precautions for COVID-19 with links to resources on how to Self Isolate and Guidance for Close Contacts in English and French; 2) Updated patient signage for healthcare settings in English and French; 3) Visitors signage for healthcare settings in English and French. The number of confirmed cases in Canada reported by EOC today is 33, with 20 persons in Ontario, 12 in British Columbia, and one in Quebec. In Ontario, at this time, there are 102 persons under investigation with lab results pending.

We just learned from the news that BC announced a 13th COVID-19 patient which unfortunately is in critical condition. This brings Canada to a new total of 34 cases. 

Minister of Health Christine Elliott announced earlier this week the enhanced measures to safeguard the public from COVID-19. The enhanced response structure brings together a wide range of partners to review, strengthen and implement provincial and regional plans and ensure their responsiveness to the specifics of COVID-19. Local public health units, hospitals, emergency health services, nurses and primary care providers, among others, have been critical in managing the early phases of this new coronavirus. The new structure is tapping into a broader network of clinical expertise, experience and capacity across the health sector to ensure extensive plans are in place to quickly and effectively respond to any and every possible scenario. The new response structure is comprised of a number of tables with specific mandates each one (for details, see here). RNAO is heavily involved in the Collaboration Table which provides advice to the Command Table. At our meeting tomorrow we expect to have details on next steps, as well as discuss proposals we are bringing to the table. We endeavor to keep you fully informed as plans evolve. Media engagement is important to both maintain factual information, and enroll the public in calm preparation for the event that community spread takes place. See our participation in today’s CBC The National.

Public Health Ontario maintains an excellent resource site on materials on COVID-19. Very useful are the materials on What We Know So Far About… Coronavirus Disease 2019 (COVID-19). These documents are intended to provide an overview of knowledge on the subject, done through ongoing scanning of the published literature, scientific reports, as well as media articles. Current topics include: zoonotic origins, infection in children, risks to health care workers, fecal-oral transmission, bloodborne transmission, incubation period, as well as asymptomatic infection and transmission. More generally, the Public Health site is an essential resource for Ontario health providers; I encourage you to visit it. 

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.

Please note that the Public Health Agency of Canada has released guidance for schools (k-12) and childcare programs (COVID-19), see here.

Situation Report 44 from WHO updates that worldwide there are 93,090 confirmed cases (2,223 new) and 3,198 deaths (86 new) in 76 countries (4 new). 95% of the new cases are outside China. There are 5,328 confirmed cases in South Korea (516 new). Other countries to note are Italy (with 2,502 confirmed cases, 466 new), Iran (with 2,366 cases, 835 new), Japan (with 284), France (with 212), Germany (with 196), Spain (with 151) and Singapore (with 110). In all these countries the main form of transmission is local. The total number of confirmed cases aboard the Diamond Princess cruise ship is 706. Four new countries (Argentina, Chile, Poland and Ukraine) have reported cases of COVID-19 in the past 24 hours.

You can also find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.

RNAO policy corner

WHO has warned that severe and mounting disruption to the global supply of personal protective equipment (PPE) – caused by rising demand, panic buying, hoarding and misuse – is putting lives at risk. Healthcare workers rely on PPE to protect themselves and their patients from being infected and infecting others. But shortages are leaving nurses, doctors and other frontline workers dangerously ill-equipped, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons. Without secure supply chains, the risk to healthcare workers around the world is real. Since the start of the COVID-19 outbreak, prices have surged. Surgical masks have seen a sixfold increase, N95 respirators have trebled and gowns have doubled. Supplies can take months to deliver and market manipulation is widespread, with stocks frequently sold to the highest bidder.

WHO says industry and governments must act quickly to boost supply, ease export restrictions and put measures in place to stop speculation and hoarding. Health care workers must be protected. RNAO agrees! In our view, this is an unacceptable situation. The Government of Canada should immediately take action with other governments and international organizations to regulate key product and supply chains, stop speculation and selling to highest bidder, make sure products reach those most in need, and that prices remain reasonable. Supply chains are controlled by a few large corporations; it is not the time to amass massive profits at the cost of death and disease, and governments are responsible if they allow this to continue. Governments around the world don’t hesitate to take speedy action to assure supply chains when they face a military war situation. Well, we are at war with a COVID-19 virus – and such action is essential now. We also need clear evidence-based directions on which PEE is to be used and when, depending on the type of patient, procedures done, and the context.

Real-time training is critical for effective preparedness and response. WHO has several COVID-19 online resources for health professionals, decision-makers and the public in multiple languages. Please see the COVID-19 courses on OpenWHO here.

Infection prevention and control (IPC) is a major factor in preventive and mitigation measures for COVID-19. To ensure evidence-based quality guidance and prompt response to global demand for personal protective equipment (PPE), WHO has convened the IPC expert global network of specialists from around the world since the beginning of the outbreak. In consultation with this global IPC expert network, WHO has released three key IPC interim guidance materials. One of these is the Rational use of personal protective equipment (PPE) for COVID-19. This document summarizes WHO recommendations for the appropriate use of personal protective equipment (PPE) in health care and community settings, including the handling of cargo. In addition, OpenWHO launched the online course Infection Prevention and Control (IPC) for COVID-19 on 25 February which is being widely used.

Please review the proper donning and doffing of PPE; guidelines can be found here.

The time now must be divided into 1) continuing to prevent or at least delay the spread, and 2) preparing all sectors for a possible large-scale spread so we are confident we can effectively respond. Thus, we urge you to continue to educate yourself and others on how to diminish the risk of transmission. I reproduce here, again for those who didn’t see them before, the WHO recommendations for prevention in full:

First, as we keep saying, clean your hands regularly with an alcohol-based hand rub, or wash them with soap and water. Touching your face after touching contaminated surfaces or sick people is one of the ways the virus can be transmitted. By cleaning your hands, you can reduce your risk.

Second, clean surfaces regularly with disinfectant – for example kitchen benches and work desks.

Third, educate yourself about COVID-19. Make sure your information comes from reliable sources – your local or national public health agency, the WHO website, or your local health professional. Everyone should know the symptoms – for most people, it starts with a fever and a dry cough, not a runny nose. Most people will have mild disease and get better without needing any special care.

Fourth, avoid traveling if you have a fever or cough, and if you become sick while on a flight, inform the crew immediately. Once you get home, make contact with a health professional and tell them about where you have been.

Fifth, if you cough or sneeze, do it into your sleeve, or use a tissue. Dispose of the tissue immediately into a closed rubbish bin, and then clean your hands.

Sixth, if you are over 60 years old, or if you have an underlying condition like cardiovascular disease, a respiratory condition or diabetes, you have a higher risk of developing severe disease. You may wish to take extra precautions to avoid crowded areas, or places where you might interact with people who are sick. 

Seventh, for everyone, if you feel unwell, stay at home and call your doctor or local health professional. He or she will ask some questions about your symptoms, where you have been and who you have had contact with.

This will help to make sure you get the right advice, are directed to the right health facility, and will prevent you from infecting others.

Eighth, if you are sick, stay at home, and eat and sleep separately from your family, use different utensils and cutlery to eat.

Ninth, if you develop shortness of breath, call your doctor and seek care immediately.

And tenth, it’s normal and understandable to feel anxious, especially if you live in a country or community that has been affected. Find out what you can do in your community. Discuss how to stay safe with your workplace, school or place of worship.

Thanks for continuing to keep us informed of questions and/or challenges of any kind, and especially shortages of PPE. We are receiving your emails and are responding to all. Keep sending those directly to me at dgrinspun@rnao.ca. As always, we also encourage you to access 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. We also have information for the public on our website at www.rnao.ca which we update daily. The WHO has provided an excellent link for you to share with members of the public here.

RNAO’s COVID-19 Mantra: Let’s remain informed, calm and resolved – through collaboration we will tackle the COVID-19 challenge together! 

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