May 24, 2020 COVID-19 report

Dear Colleagues: Welcome to my Sunday, May 24 report – now in the fifth month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. You can refer to earlier update reports here, including thematic pieces in my blog. Feel free to share this report or these links with anyone interested – they are public.

Join us tomorrow Monday May 25 from 6:45 to 8:00pm for an update on COVID-19 and to learn about re-opening the province and safe practices with guest speaker Dr. Jeff Powis, Chief of Infection Prevention and Control at Michael Garron Hospital. Don’t miss it – register here and share with others. We invite you to send questions in advance to owilson@rnao.ca or bring your questions to the webinar.

One of the most worrisome aspect of the current opening of the economy and increased mobility is that we have not developed sufficiently the infrastructure for surveillance, identification of clusters, containment, testing, case and contact tracing and isolating. The purpose of the lockdown was twofold; 1) to mitigate community transmission and prevent hospitals from crumbling, and 2) to build the public health infrastructure for testing and tracing required to go back to some level of normality. In Ontario, we made important gains toward the first goal but have done very poorly on the second, which means we are creating a serious risk of another surge. Today, I explore one tool being used in many jurisdictions to help with contact tracing.

Technology as a solution: Opportunities and pitfalls of COVID contact-tracing apps

Many jurisdictions, including Ontario, are using or considering the use of smartphone apps that can help trace and contact people who may have been exposed to the virus. If the virus’s path can be tracked, even predicted, the hope is that more people will be able to resume at least part of their normal routines — and fewer will need to confine themselves at home.

At their core, the apps are intended to gather information about the movements of people who have tested positive for the virus, alert others who might have crossed their paths, and in some cases make sure infected people stay quarantined. They use smartphone technologies, such as GPS and Bluetooth, to collect and share the data, which make them agile and easy to use but also provide an enticing target for hackers or government surveillance.

This concern about privacy is well-placed. Civil liberties groups have warned that the rush to adopt virus-tracking technologies may entrench new forms of government surveillance and social control even if the apps do not prove effective in fighting the coronavirus.

India is using at least 19 apps to track and trace Covid-19, including Aarogya Setu, an app heavily promoted by the central government. The Aarogya Setu requires a user to provide access to location data at all times and also asks for a user’s name, gender, profession, and countries visited in the last 30 days. This is an “excessive collection and use of sensitive personal data”, according to a centre that works on ensuring digital rights.

Aware of the concerns, Apple and Google announced last month they were creating software that public health authorities could use to make apps. The tool will allow different apps to work together and has the support of many privacy experts. But several technology law scholars expressed concern that even well-intentioned digital surveillance tools could become problematic and are difficult to withdraw.

Even if the privacy and surveillance concerns can be addressed, there is still a question of how effective can an app be for contact tracing. The first problem is getting a meaningful number of people to install the app and make sure Bluetooth is on and the app active when they leave home. If, say, 12% of the population download the app, the likelihood that two people talking to one another both have the app installed is 1.44%. Forcing (instead of recommending) the installation of a particular app by the authorities is unlikely in a democratic state, and most Canadians oppose it.

A second concern is how many false positives the app will elicit, given the limitations of Bluetooth technology (e.g., you were close to a person with a wall or Plexiglas standing in between, but the app is still showing you may have been exposed). A large number of false positives mean thousands of people self-isolating for no reason. A third concern is the lack of sufficient testing. In general, epidemiologists say contact tracing won't be effective without widely available testing.

The implementation of a contact-tracing app in Iceland shows it can be helpful as part of a comprehensive, well-coordinated and well-resourced effort to test, trace and isolate. However, it is not a panacea. When Iceland got its first case on February 28, an entire apparatus sprang into action, and it began rapidly rolling out public testing on a wide scale. A team of contact tracers was put in place to interview those with a positive diagnosis and track down people they’d been in contact with.

Within a few weeks, Iceland unveiled its app. Rakning C-19 was hailed as a way to “make the tracing of transmissions easier” at the time. And it gained traction quickly; it has the largest penetration rate of all contact trackers in the world, having been downloaded by 38% of Iceland’s population of 364,000. But despite this early deployment and widespread use, one senior figure in the country’s covid-19 response says the real impact of Rakning C-19 has been small, compared with manual tracing techniques like phone calls. “The technology is more or less … I wouldn’t say useless,” he said. “But it’s the integration of the two [app-based and manual tracing] that gives you results. I would say it [Rakning] has proven useful in a few cases, but it wasn’t a game changer for us.”

In Canada, the federal, provincial and territorial privacy guardians issued a joint statement calling on governments to ensure that COVID-19 contact tracing applications respect key privacy principles. “If done properly, tracing applications can achieve both privacy and public health goals at the same time. Everything hinges on design, and appropriate design depends on respect for certain key privacy principles, “says Commissioner Therrien.

Ontario Premier Doug Ford says technology to assist with contact tracing will play a critical role in the province’s strategy as they endeavour to ramp up testing for COVID-19. “We’re coming up with new apps when it comes to contact tracing and testing. It’s absolutely critical that that’s part of it,” Ford said this past Tuesday (May 19th). The province is still in talks over the potential use of new technology for contact tracing, alone and with federal and provincial counterparts, says the ministry of health.

Alberta recently launched a voluntary mobile contact tracing app to assist with public health efforts — which is believed to be the first of its kind in North America. The app, called ABTraceTogether, uses Bluetooth to identify other nearby phones with the same app, and records information when two such phones are within two metres for 15 minutes within a 24-hour period.

On May 22, Prime Minister Justin Trudeau said that he is hoping Canada will adopt just one contact tracing app, based on the Apple-Google technology, with consideration of privacy concerns, to encourage its use across the country to slow the spread of the novel coronavirus.

RNAO’s view: An app approved by the privacy commissioners can be a useful tool in the arsenal required for return to mobility, but it should not detract the focus from one of our greatest failures so far: to build large scale, agile, effective public health capacity for testing, case and contact tracing and isolation. Technology is not a panacea and will not save us from COVID-19.

Your messages: Voices and responses

Each day we receive numerous messages and phone calls. Each day we also welcome new readers to this daily report: Thank you deeply for the work you do always and especially during this public health crisis, and also for keeping us well informed. You can see previous reports here. Feel free to share these updates with other health professionals and other organizations both at home and abroad. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. Many of the articles you see here are posted in my blog, where you can catch up with earlier issues. The COVID-19 Portal is here.

I have received several questions in recent days regarding our international reporting. Margarita Rose Noble McBurnie best articulates the view:

Why is RNAO no longer updating on the WHO situation report? I'm just wondering why the data being presented is now restricted to only Canadian sources? I thought it was beneficial to track the increase in cases and compare the fatality rate in other countries at the beginning of this pandemic. It was very interesting to compare articles in Germany when they had only a 0.2 fatality rate. I noticed now, during their second wave the fatality rate is much, much higher. 

Is there a specific reason the data being shared now is only from Canadian sources? For example, the MOA situation report is being shared rather than the WHO situation report. The WHO situation reports provides the amount of new cases and new deaths per day in each country around the world, where as the MOA situation does not. 

RNAO’s response: Dear Margarita, your feedback is appreciated. The table with numbers in each report (see below) is prepared by EOC based on data from WHO, providing a picture of cases in the each continent, the US and Canada. The direct link to WHO situation reports is here and you can also find it in each report at the very end, under Information Resources. More generally, we can appreciate your interest in international comparisons, and will try to include more of those in future issues (every time we have to make hard decisions about what to include in the report, as there are more important topics than we can practically handle). Today, in the article on app technology above, there is a discussion of Iceland and their experience with COVID-19 that I hope you find interesting.  Best regards and keep safe, Doris

Together we can do it

Today is day #66 of RNAO’s #TogetherWeCanDoIt campaign… RNAO began this campaign on March 19 to cheer up health care workers and others in essential services. The campaign has gone far and wide. I want to thank Irmajean Bajnok for being a “dependable cheerer,” posting every evening an upbeat and meaningful message. Another dependable cheerer is, of course, Susan McNeil who leads for us the campaign. I also want to welcome RNAO’s finance and admin director and new cheerer Nancy Campbell for her and Lily’s cheer and for reminding us to use a mask! THANK YOU! The noise is loud and fun in homes, workplaces and social media to #cheer4healthworkers! Please remember to join-in this community building moment every evening at 7:30pm local time - until we defeat COVID-19! And we need you to always post tweets from your communities, your children, workplaces art and memory places - with your messages, cheers here, pots & pans, songs and other expressions of love, thanks, solidarity, and more music: #TogetherWeCanDoIt.

MOH EOC Situational Report #119 here for Saturday, May 23

Situation:

Case count as of 8:00 a.m. May 23, 2020
Area	Case count	Change from yesterday	Deaths	Change from yesterday
Worldwide total	5,328,653	+109,951	340,427	+5,357
Europe	1,879,901	+20,309	168,631	+1,614
China	82,971	0	4,634	0
Middle East	495,584	+10,950	13,105	+130
Asia & Oceania	355,092	+13,854	9,269	+272
Africa	106,299	+4,028	3,205	+87
Latin America and Caribbean	680,680	+35,341	37,670	+1,856
North America	1,728,126	+25,469	103,913	+1,398
United States	1,645,646	+24,313	97,663	+1,300
Canada	82,480	+1,156	6,250	+98

 

• 412 new cases were reported in Ontario today, bringing the cumulative case count to 25,040 (this includes 19,146 resolved cases and 2,048 deaths).
• In Ontario, a total of 599,986 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 5,871 tests under investigation.

• 912 patients are currently hospitalized with COVID-19; 147 are in ICU; and 119 are in ICU on a ventilator.

EOC report #117 for May 21 informs of the following actions taken:

•  The Ontario government is quickly moving forward with innovative research to prevent, detect and treat COVID-19. These projects, part of the government's $20 million Ontario COVID-19 Rapid Research Fund, focus on areas of research such as vaccine development, diagnostics, drug trials and development, and social sciences. Additionally, Ontario is leading the country with 22 clinical trials investigating COVID-19 vaccines and treatments.
• The CMOH Directive 3 has been revised to provide additional direction on hospital transfers to retirement homes and long-term care homes, testing within 24 hrs of new admissions and re-admissions, minimizing work locations of volunteers and contractors, and sharing of IPAC assessment results and reports. It can be seen here.

• The Ministry continues to work on the revision of Directive 2 and related requirements to support the gradual restoration of health services. Please note that CMOH Directive 2 is still in effect. Providers are encouraged to continue planning and further details will be provided once confirmed.  

EOC report #118 for May 22 informs of the following actions taken:

• As the economy gradually reopens, the Ontario government is helping people affected by COVID-19 get back to work. The province is investing in Ontario's first Virtual Action Centre, an online counselling and training portal, to support laid off and unemployed hospitality workers, and is helping apprentices by providing grants to purchase tools, protective equipment and clothing for their trade, along with forgiving previous loans to purchase tools.
• The guidance for Primary Care Providers in a Community Setting was updated (see here).  Highlights of changes include expanded guidance for in-person care for essential visits, testing and specimen collection, and occupational health and safety.  A list of key resources is also included within. The updated document will be posted to our ministry website shortly.
• The Ministry continues to work on the revision of Directive 2 and related requirements to support the gradual restoration of health services. Please note that CMOH Directive 2 is still in effect. Providers are encouraged to continue planning and further details will be provided once confirmed.  

EOC report #119 for May 23 informs of the following actions taken:

• Minor corrections were made to Directive 3 to update dates within the document (see here).
• The Ministry continues to work on the revision of Directive 2 and related requirements to support the gradual restoration of health services. Please note that CMOH Directive 2 is still in effect. Providers are encouraged to continue planning and further details will be provided once confirmed.  

Staying in touch        

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. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you deeply colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and around the world. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!

Together, we must redouble our efforts to tackle COVID-19 with the best tools at hand: full, accurate and transparent information, calmness, determination and swift actions. 

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

 

RECENT RNAO POLICY CORNER ITEMS:

19 May - With the pandemic curve flattening, VIANurse program will focus its effort on outbreaks – go here.

14 May - Nursing Week update – go here.

14 May - Pandemic puts health system to the test: Nurses have answers for shortfalls – go here.

14 May - Disappointment for not being included in pandemic pay – go here.

13 May - RNAO saddened by the loss RN Brian Beattie to COVID-19 – go here.

13 May - End racism and prejudice – go here.

12 May – Enhancing Community Care for Ontarians (ECCO 3.0) – go here

11 May - Nurses share their successes and challenges during National Nursing Week – go here.

10 May - A story of hope, ingenuity, support and genuine care for an LTC resident – go here.

7 May    - Counting the missing deaths: Tracking the toll of the coronavirus outbreak – go here.

5 May    - Life on the front lines of the pandemic: Profile of RNAO member NP Daria Gefrerer – go here.

5 May    - Addressing differential access to virtual care due to technology inequities – go here.

3 May    - Being person-and-family-centred during COVID-19 – go here.

1 May    - Migrant agricultural workers and the COVID-19 crisis – go here.

30 April - COVID-19 pandemic in provincial institutions and correctional centres – go here.

28 April - Supporting First Nation Communities during COVID-19 – go here.

27 April - Responses to COVID-19 for persons experiencing homelessness in Toronto: An update – go here.

25 April - Lessons learned through a COVID-19 nursing home outbreak – go here.

25 April - Letter from a retired RN to Premier Ford: The problems with LTC were evident long before COVID – go here.

23 April - Working with seniors in long-term care requires specialized knowledge – go here.

22 April - Shaking the stigma: We need a proactive COVID-19 response for mental health and addiction – go here.

21 April - We Require Expanded and Accessible COVID-19 Data in Ontario – go here.

20 April - Can Loss of Smell and Taste Help Screen for COVID-19? – go here.

18 April - COVID, Trump and the World Health Organization – go here.

16 April - A Home Based Model To Confront COVID-19 – The Case Of The Balearic Islands – go here.

15 April - COVID-19 and the Challenges in Homecare – go here.

14 April - Reprocessing Of N95 – An Update – go here.

14 April - A New COVID-19 Facility For Persons Experiencing Homelessness In Toronto – go here. 

13 April - Practical Tips for Safe Use of Masks – go here.

10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.

10 April - RNAO Action – Supporting Long-Term Care – go here.

10 April - Update For Nursing Students – NCLEX Exam – go here.

9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.

9 April - Guidance on use of N95 mask – go here.

7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.

7 April - Reprocessing of n95 – safe? – go here.

5 April - We must change the way we do testing and case definition – go here.

5 April - Ringing the alarm bells on critical care beds – go here.

4 April - COVID-19, stay at home and domestic violence – go here.

We have posted earlier ones in my blog here. Please go and take a look.

RNAO’S policy recommendations for addressing the COVID-19 crisis: We presented 17 recommendations for government, last revised on April 2. Read them here.

 

Information Resources

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers. 

Ontario’s health provider website is updated regularly with useful resources here.

Ontario’s public website on the COVID-19 is there 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.

Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. Data will inform Ontario's ongoing response to keep individuals and families safe.

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.

The World Health Organization plays a central role in addressing the COVID-19 pandemic. See here and here.

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