March 5, 2020 COVID-19 report

Good Thursday 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 received yesterday, 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 and are in Cornwall, are being released on Friday of their quarantine period. We wish them a safe return home as they adjust to their normal lives. 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 #40 here, inclusive of various signage posts in Farsi: 1) caregivers 2) self-monitoring, and 3) self-isolation. The number of confirmed cases in Canada reported by EOC today is 33. Also, EOC reports that in Ontario, at this time, there are 78 persons under investigation with lab results pending.

Since we received the EOC report this afternoon, we have received media updates of new cases. As we stand, Ontario has three new cases today (23 total), British Columbia has eight new cases (21 total), Quebec has two cases (2 total), and Alberta has its first case of COVID-19. This brings Canada to a total of 45 cases (up from 33 yesterday). Of particular concern is that one case in BC is believed to have been contracted through community contact. “This is a community case, and we are doing a detailed investigation right now to try and determine where her source of infection was,” said Provincial Health Officer Dr. Bonnie Henry. This would mean a new evolution of COVID-19 in BC.

Colleagues, as many of you have written to us, we need to move faster and be ahead of the curve for the eventuality of a COVID-19 Pandemic, and RNAO has committed to keeping you fully abreast of developments. The enhanced response structure announced earlier this week by Minister Elliott to safeguard the public from COVID-19 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. The new structure is tapping into the necessary clinical expertise, experience and capacity to ensure extensive plans are in place to quickly and effectively respond to every possible scenario. The various tables have been meeting -- see details here. RNAO is heavily involved in the Collaboration Table which provides advice to the Command Table. At our meeting today, RNAO raised issues related to 1) PPE (the need to have evidence-based guidance on when to use surgical masks versus N95); 2) the need for mobile mask testing (for walk-in and small family practice clinics); 3) the need to work on virtual care modalities (to assess, monitor and support patients in self-isolation); 4) the need to immediately designated hospitals with an attached overflow assessment centre. 5) We need to continue educating the public on prevention through respiratory hygiene. We also need to enroll the public into understanding and demystifying what a “scenario B” will look like should there be spread in the community and should we enter a pandemic phase. We heard the Command Table and the regional tables are working on these issues and we should hear of next steps in a few days.

Colleagues, I want to thank you for bringing these issues to our attention and also want to thank the Ministry staff for their hard work, for listening, and for responding. The more we work together and are on the same page -- including all health professionals, the public and the media -- the less fear there will be of the “what if,” and the more clarity we will have of what we will do to beat COVID-19 – together as a team.

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 yesterday’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 45 from WHO updates that worldwide there are 95,333 confirmed cases (2,223 new) and 3,282 deaths (84 new) in 85 countries (5 new). 94% of the new cases are outside China. There are 5,766 confirmed cases in South Korea (438 new). Other countries to note are Italy (with 3,089 confirmed cases, 587 new), Iran (with 2,922 cases, 586 new), Japan (with 317), France (with 282), Germany (with 262), Spain (with 198), Singapore (with 110), USA (with 129). 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.

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

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.

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 as you can see by the issues we raised at the Collaboration Table, we are addressing them all. Keep sending your ideas, questions and/or concerns 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