May 5, 2020 COVID-19 report

Dear Colleagues:  Welcome to my Tuesday, May 5, COVID-19 report – now in the fourth month of COVID-19 in Ontario. For the many resources RNAO offers on COVID-19, visit the COVID-19 Portal. In particular, VIANurse is your go-to page if you need to augment your nursing and personal support worker human resources. 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.

I want to begin by asking each reader to take a moment of silence to mourn the loss of Sharon Roberts. Sharon is the third personal support worker and the fourth health care professional to give their lives to the care of others in Ontario. Like our three other colleagues, Sharon was a beautiful human being, an outstanding professional and will be missed by all. Please read about   Sharon’s passing. May she rest in peace.

Life on the front lines of the pandemic: Profile of RNAO member NP Daria Gefrerer

The Toronto Star has profiled Daria Gefrerer, an RNAO member. Here is her story:

Daria Gefrerer is a nurse practitioner who helps oversee Sunnybrook’s COVID-19 Assessment Centre. Up until March 16, Gefrerer was a nurse in the hospital’s birthing unit, taking care of mothers and families during labour, delivery and their postpartum stay. Though she loved her nine years in the birthing unit, Gefrerer wanted to step up to the front lines during the pandemic and applied for a leadership position at the Assessment Centre. This marks the end of her seventh week in her new job. In her voice:

I knew I was the right fit for this role. Many of my nursing colleagues have young families or older parents and they’d find it hard to be on the front lines of the virus. For me, I don’t have those same ties. I live close to Sunnybrook, I have a supportive husband and I don’t have children. To do this job, I wouldn’t have to make the difficult decision to live apart from my family. I also thought of it as a challenge that I was ready to take on.

When we first started, all the staff at the assessment centre were a bit hesitant. We didn’t know what to expect with the virus or how the screening process would look. It was all unfamiliar. But once the first flow of patients went through our clinic, it eased our worries. Now we feel safe; our small team has really come together to support one another.

When our clinic opens for the day, we often have a line of patients just outside our door. We screen them one at a time and we assume everyone who comes is COVID-positive. Each day, our team double checks we are on the same page for the current testing criteria so we know the patient population we should be swabbing.

At first, the testing criteria included someone’s travel history. Within weeks, it didn’t matter that someone travelled; it was clear you could pick up the virus at the grocery store.

We have a fair number of people who come to us with “typical” COVID symptoms: fever, cough, breathlessness. But we also have people show up with just gastrointestinal symptoms, such as diarrhea, and nothing respiratory in nature. It’s been interesting to see all the symptoms presenting with the virus.

Every now and then we need to turn away someone from getting a swab. It’s a hard thing to do. It’s human nature to want to know if you have COVID-19.

Some people are very persistent in wanting a swab after we tell them they don’t fall into the testing criteria. Having to tell them ‘no’ is very challenging. A lot of education goes into those explanations, but it’s still hard to be the bearer of bad news and sometimes we’ve had to get security involved with people who really want a test and can’t have it.

We do see patients who come to us that truly look unwell. I think it goes back to nursing intuition, that gut feeling a lot of nurses have, where someone comes into the clinic and you just know they don’t look right.

Almost every day, we ask someone to go to Emerg. And there are times we physically put someone in a wheelchair because they are unstable and we accompany them to the emergency department ourselves. We just had to do that today with a woman who came in very short of breath. We didn’t swab her because she needed more acute care than we could provide; we took her straight to the emergency department.

It’s those times that I feel thankful for this opportunity. As a nurse, it’s ingrained in you to want to help people and that’s what I think I’m doing during this tumultuous time.

Addressing differential access to virtual care due to technology inequities – Please help 

We appreciate the following contribution from North Western Toronto Ontario Health Team BPSO OHT – an OHT supported by RNAO.

COVID-19 has challenged the health care system to move towards virtual care for so many community services. The North Western Toronto Ontario Health Team BPSO OHT has collectively identified issues related to inequitable access to care with this shift. Some of our most vulnerable clients who need services to deal with mental health and addictions, chronic health issues, and other health issues also struggle with added barriers at this time when care is primarily virtual. Clients who do not have cell phones or computers, or cannot purchase enough data on their devices for a virtual appointment, are not able to continue their care and this increases their health risk. Adding to this inequity is availability of technology devices to health care agencies. Smaller agencies that may not have the ability to provide their workforce with additional laptops or cell phones will not be in a position to provide virtual care.

We want to work with others to problem solve this issue. We are aware that Telus is offering free cell phones to clients unable to access technology. More information about this can be accessed here. We have also learned that Shaw has made Shaw hotspots available without a login or Shaw ID. More information can be found here. Additionally, Rogers Communications is offering support to customers through flexible payment options and other offerings listed on their website here. Bell is also supporting their customers and Canadians through their services and donations, which can be viewed here.

Are there other resources available to our clients? If you are a company who provides technology products or support, is there help you can offer to clients or health care agencies at this time?

We invite the readers of this blog to work with us to problem solve this issue. If you have resources or ideas, please let us know. We will share the information more broadly and work to enable more of our clients to continue much needed care. Contact Oliwia Wilson <owilson@rnao.ca>

For information about RNAO’s BPSO OHT program, see here and here.

For information about North Western Toronto Ontario Health Team, see here and here.

Your messages: Voices and responses

Each we receive numerous emails 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 at RNAO updates and resources on COVID-19 for members and other health professionals. 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.

Pandemic pay

Several of the emails and calls we received at RNAO over the past few days relate to pandemic pay. Please know that I am seeking clarification regarding which sectors are in and which ones are out. For RNAO, all sectors are equally important. I am also seeking clarity regarding managers who also carry out clinical work such as those in nursing homes and in correctional facilities. Stay tuned as I will for certain keep you fully informed.

RNAO’s work being recognized

“Hello, Thank you for highlighting the vulnerable! This is what we nurses are here to do. I appreciate your work and feel a sense of calm and understanding and hope for the future with each email I read from you, as you look ahead and say what can be done to make this better. Keep RNAO checking in on our world’s accountability and effects. Keep bringing us nurse leaders to help raise people.

I wanted to share the agricultural article and couldn’t find it on a couple of searches. I have a friend who isn’t a nurse but feels her community in Bradford is very judgemental against migrant workers and she feels unable to help her community see their worth. She sees the inequality and their needs. Her bank has extended hours and translators working to help them get their money to their families. They face a tough life. Thanks and keep shining!” Joni Eriksen, RN.

Thanks, Joni, for the recognition. Here is the link to the blog article on migrant workers.

Together we can do it

Today was day #41 of RNAO’s #TogetherWeCanDoIt campaign, started on March 19. Here are my picks for today on noise that is becoming louder and louder in streets, 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 and memory places - with your messages, cheers here, pots & pans, songs and other expressions of solidarity, reminders and more music -- Because: #TogetherWeCanDoIt.

MOH EOC Situational Report #101 here for Tuesday, May 5

Situation: 

Case count as of 8:00 a.m. May 5, 2020
Area	Case count	Change from yesterday	Deaths	Change from yesterday
Worldwide total	3,663,959	+79,852	252,756	+4,105
Europe	1,481,696	+20,982	142,377	+1,548
China	82,881	+01	4,633	0
Middle East	326,630	+8,165	10,676	+162
Asia & Oceania	178,820	+8,397	5,021	+292
Africa	48,186	+2,602	1,850	+44
Latin America and Caribbean	271,964	+14,223	14,420	+568
North America	1,273,782	+25,482	73,779	+1,491
United States	1,213,010	+24,184	69,925	+1,319
Canada	60,772	+1,298	3,854	+172

 

• 387 new cases were reported today in Ontario, bringing the cumulative total to 18,310 (this includes 12,779 resolved cases and 1,361 deaths).
• In Ontario, a total of 352,714 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 6,023 tests under investigation.
• 1,043 patients are currently hospitalized with COVID-19; 223 are in ICU; and 166 are in ICU on a ventilator.

EOC report #100 for May 4 informs of the following actions taken:

• Guidance for Essential Workplaces has been posted on the ministry’s website.
• The Home and Community Care Guidance Document has been updated with revised screening procedures and masking recommendations for care providers – see here.
• A new Residential Hospice Guidance Document has been created directed at palliative and end-of-life care provided in residential hospice settings – see here.
• Friday’s Command Table memo is here.

EOC report #101 for May 5 informs of the following actions taken:

• Ontario has significantly increased testing and contact tracing capacity, allowing health experts to identify cases of COVID-19 and support efforts to stop the spread of the virus in the community, long-term care homes, and other congregate settings. In partnership with Ontario Health, Public Health Ontario, local public health units, and hospital and community laboratories, the Ontario government has developed an integrated laboratory system which has established the province as a national leader in daily testing volumes per capita.
• Updated documents for the following have been uploaded to the ministry’s website: Provincial Testing Guidance, Patient Screening Guidance, and Reference document for Symptoms.
• The Government of Ontario announced it is expanding virtual mental health services to help thousands of Ontarians experiencing anxiety and depression, including frontline health care workers, during the COVID-19 outbreak.
• The Command Table met yesterday; a summary is here.

RNAO’s ViaNurse Program             

RNAO’s VIANurse program, launched on March 13, has already registered 7,366 RNs for virtual and clinical care, 1,024 critical care RNs (who have experience and continued competency in the provision of critical care), and 287 NPs. RNAO is continuously responding to requests from health organizations. So far, we have served 283 organizations, of which 215 are nursing homes and retirement residences. RNAO has also offered the government to identify NPs and RNs who can help manage LTC organizations that are in crisis, and assist with urgent interventions where severe outbreaks are ongoing. For any nursing HHR needs go to RNAO’s VIANurse program

** Seeking RNs, NPs and nursing graduates ready to work in nursing homes in active outbreak

RNAO launched on Friday, April 24th a fourth survey for RNs, NPs and nursing graduates urging them to register for work in nursing homes that are on an active outbreak. The availability of these colleagues is already fastening even more the matching of nursing staff to homes in dire need. For example, between April 20th and May 4, we deployed RNs, NPs and/or PSWs to 109 organizations, including 102 nursing homes, with some of these organizations having been served multiple times. On Saturday, on a matter of hours from request we responded to the staffing needs of 11 additional organizations. Also important to know is that VIANurse has no backlog requests, and we also respond after hours and on weekends – as we understand the urgency of each request. Please retweet the following urgent tweet to have many more RN, NP and new graduates enrolled.  

For those of you ready to work in a nursing home with an outbreak – we need you –please CLICK HERE and complete our survey ASAP. We need your response as soon as possible given the rapidly evolving situation, and the urgent need in nursing homes across the province. The government has now improved the compensation, recognizing your critical role – see Ontario’s press release here.

So far we have got 362 responses: 270 RNs and 39 NPs and 43 nursing students – ready to go to nursing homes in an active outbreak - plus, 10 RNs who can do non-clinical work. These colleagues are being deployed as we speak, including over the weekend.

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:

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. Some of these, such as #15, continue to be of grave concern to RNAO. 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.