November 21 2021 COVID-19 report


Dear Colleagues: Welcome to my Sunday, November 21 blog during this twenty second month of COVID-19 in Ontario. You can find earlier update reports here, including thematic pieces in Doris’ COVID-19 Blog. And, for the many resources RNAO offers on COVID-19, please visit the COVID-19 Portal where you will also find RNAO media hits and releases on the pandemic here. Daily Situational Reports from Ontario’s MOH EOC can be found here. Feel free to share this report and links with anyone interested. Scroll down for policy updates and action alerts, as well as six RNAO webinars this week!

This week we share: (1) nurses gather in Toronto to rally – a recap of the #RepealBill124 rally; (2) an infectious disease doctor explains why we should not hesitate to vaccinate children who are 5 and older; and (3) vaccine injustice: rich countries only shared 14% of COVID-19 vaccine doses promised to poorer nations.

Nurses gather in Toronto to rally: Recap of #RepealBill124 rally and next steps

On Nov. 14, we took action and spoke up against Bill 124 – legislation that limits wage increases to one per cent and is a disgrace to nurses and other public sector workers.

Organized by Nursewithsign416 (@NurseWithSign on Twitter), RNAO CEO Dr. Doris Grinspun, President Morgan Hoffarth, President-Elect Claudette Holloway, Board members Debra Lefebvre (region 9), Anita Tsang-Sit (region 4), co-chair Black Nurses Task Force Corsita Garraway, as well as numerous RNAO members and other public sector workers, participated in the rally to #RepealBill124. 

Despite nurses’ tireless efforts to care for Ontarians over the past 22 Covid-19 months, nurses’ incomes are not keeping up with the cost of living. The lack of respect implied in Bill 124 is triggering many RNs to leave Ontario. Bill 124 must be repealed as an immediate first step for RN retention in the province.

“We are not heroes, we are health professionals and we deserve respect,” I said to media during the rally. Watch my full remarks on Twitter. We also announced that nurses are giving Premier Ford 30 days to repeal Bill 124, with the countdown beginning at the rally.  

It was a cold and rainy day, but nurses, nursing students and supporters gathered in Nathan Phillips Square to express outrage towards Bill 124 and to call on Premier Doug Ford to immediately repeal it. Many rally-goers held up signs, including ones that read:

  • “Nurses are the backbone of health care. Abolish Bill 124.”
  • “Senior RNs are leaving the profession. Who will be skilled enough to care for you when you are sick?”
  • “Honk for better pay for nurses”
  • “I’m worth more than 1%”
  • “If you call us heroes, pay us like one”
  • “No nurses = no health care”

Thank you to everyone who participated in this rally. Please continue to speak out about why Premier Ford must immediately act, using these hashtags #RepealBill124. #StandingWithNurses

See the Toronto Star Editorial: Please RT. Links to the extensive media coverage are here.

For more details about the rally, read RNAO’s media advisory and watch RNAO's public service announcement as well as the Small Talk episode. Please RT.

Sign and share RNAO's Action Alert: Repeal Bill 124, premier!

I’m an infectious disease doctor. Yes, I’m vaccinating our 5-year-old against COVID-19. Here is why you should too

Health Canada approved on Friday the use of the Pfizer-BioNTech COVID-19 vaccine in children 5 to 11 years of age. The following is a November 5 article by Alexander Wong, an associate professor of infectious diseases at the University of Saskatchewan. This article is republished from The Conversation under a Creative Commons license. Read the original article.

I am an infectious disease physician. When it is our turn to vaccinate our five-year-old son against COVID-19, I will do so with confidence and without hesitation. I am encouraging every parent with eligible children between ages five and 11 to do the same. Here is why.

The U.S. Food and Drug Administration (FDA) recently authorized the Pfizer-BioNTech vaccine for children between five and 11 years of age. Subsequently, members of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted unanimously to recommend vaccination for all children ages five to 11, a recommendation quickly endorsed by CDC director Dr. Rochelle Walensky.

The rush to vaccinate children in this age group in the United States has now begun.

Health Canada is reviewing a similar submission from Pfizer to allow its vaccine to be used in children aged five to 11. Approval is expected in the coming weeks [editor’s note: it was approved on Friday, November 19]. The National Advisory Committee on Immunization (NACI) will then provide guidance for its use in Canada, after which we expect to have the vaccine authorized for all children in Canada in this age group.

Reviewing the evidence

Many parents in Canada have indicated hesitancy to vaccinate their children, and understandably all parents have questions about weighing the risks and benefits. Let’s review the evidence.

Pfizer’s clinical trial conducted in the United States in kids aged five to 11 began early in 2021, and a significant surge of COVID-19 occurred soon after as the highly contagious Delta variant swept across the country. The data reported from the clinical trial thus far is encouraging.

The antibody responses in children aged five to 11 with two 10-microgram doses, given three weeks apart, were comparable to those in persons aged 16 to 25 who were given two 30-microgram doses three weeks apart. Being fully vaccinated reduced the chances of being infected with COVID-19 by over 90 per cent, an impressive number especially amidst the Delta surge.

No concerning safety events were identified in over 3,000 children who received the vaccine, although followup intervals were short.

Why vaccinate kids against COVID-19?

A question commonly asked by parents is this: “Kids don’t generally get very sick or die from COVID-19 compared to adults, right? So why vaccinate them if their risk is so low?”

Yes, the risk of children getting very sick or dying with COVID-19 is low, but the relative risk of severe outcomes and death that kids face when they acquire COVID-19 is extremely high. COVID-19 was the sixth highest cause of death from disease in children ages five to 11 in the U.S. in 2020, comparable to rates of death seen in children with heart or lung disease. If there were a way to prevent death in children with heart or lung disease as simple as a safe two-dose vaccine, there would be very little hesitation from parents to take advantage of it.

Besides hospitalization and death, COVID-19 infection poses other significant risks for children, including the risk of multisystem inflammatory syndrome in children (MIS-C) and longer-term post-COVID-19 complications (“long COVID”) similar to adults. MIS-C can occur two to six weeks after COVID-19 infection, nearly two-thirds of affected children will require critical care support, and between one and two per cent of affected children will die.

About seven per cent of children in the United Kingdom who recovered from COVID-19 infection reported ongoing symptoms 12 weeks after being diagnosed, which affected various aspects of their quality of life: missing school, being less able to perform physical activity and mental health concerns.

MIS-C and long COVID in children are best avoided through prevention of COVID-19 infection by being fully vaccinated.

Concerns about side-effects

The primary side-effect of concern in young children receiving the COVID-19 vaccine is myocarditis, or inflammation of the heart muscle. In one recent Israeli study, the risk of myocarditis was highest in male patients between ages 16 and 29 after a second dose of an mRNA vaccine, at roughly 11 out of every 100,000 males. A second Israeli study identified males between ages 16 and 19 as being at greatest risk. The risk of myocarditis in females across all age groups was negligible in both studies. Deaths due to vaccine-induced myocarditis are extremely rare, and nearly all cases recover fully.

In Pfizer’s clinical trial of children between ages five and 11, no cases of myocarditis have been detected, but ongoing surveillance will be necessary as cases of myocarditis in children of this age group are expected to be extremely rare, given that myocarditis is typically a post-pubertal phenomenon. Also, since the vaccine dose being given to children aged five to 11 is one-third the dose given to persons over 12, an even greater reduction in vaccine-induced myocarditis is likely in this younger age group.

The risk of damage to the heart from infection with SARS-CoV-2 is statistically much higher than the risk of vaccine-induced myocarditis. COVID-19 infection can lead to a variety of complications of the heart, some serious. Such complications include damage to heart muscle from myocarditis itself, as well as inflammation of blood vessels supplying the heart muscle caused by the virus.

Many parents worry about the possible effects of COVID-19 vaccine on fertility and future pregnancies. No evidence exists right now to demonstrate any concerns with COVID-19 vaccine and fertility, pregnancy or breast-feeding. Tens of thousands of women have received vaccine while being pregnant, and no safety signals have been identified.

Parents are concerned about the lack of long-term safety data available for the mRNA vaccines. No reasonable scientific basis exists to indicate that long-term side effects of mRNA vaccination will occur. mRNA is degraded in the body very quickly, which is why we would typically expect to see vaccine side effects like myocarditis within the first two months of vaccine administration, or not at all. Billions of doses of COVID-19 vaccine have been administered worldwide with no long-term side effects identified, providing further evidence for the long-term safety of mRNA vaccines.

Benefits of vaccination far exceed potential risks

Unfortunately, SARS-CoV-2 is not going to ever go away. Our best-case scenario is endemicity, and even that reality is unpredictable given the potential emergence of new viral variants. We cannot expect our children to live in “bubbles” forever. We must prepare them as best as we can to safely navigate this new reality.

Based on the scientific evidence at hand, the benefits of vaccination for my five-year-old son far exceeds any potential risk. That is why he will be vaccinated as soon as he is eligible, and also why practically every expert group on child health across the world has come out in favour of universal vaccination of children, including the American Academy of Pediatrics. We have not even brought up the significant societal benefit of moving closer toward herd immunity through universal vaccination of eligible children.

Navigating the COVID-19 pandemic has been difficult and disruptive for children and their families. We now give routine childhood vaccines to our kids without hesitation, and they have dramatically improved the quality of life and life expectancy of children worldwide. Getting every child between ages five and 11 fully vaccinated against COVID-19 helps bring us all one step closer towards normalcy and protects our children from severe outcomes of COVID-19 infection.

That is why I am going to vaccinate our five-year-old son with confidence, and why I will strongly encourage all parents to do the same.

Rich countries only shared 14% of COVID-19 vaccine doses promised to poorer nations

The rate of vaccination in the poorest countries remains dismal, and rich countries such as Canada continue to fail in their promises to help. The following is an October 22 CBC Radio article. The original article can be found here. It was written by Mehek Mazhar. Interview with Brittany Lambert produced by Katie Geleff.

A coalition of human rights organizations lays the blame on pharmaceutical companies and rich countries like Canada for contributing to vaccine inequality around the world.

In a new report, the People's Vaccine Alliance — which includes Oxfam, ActionAid and Amnesty International — found that only one in seven COVID-19 vaccine doses promised to low-income countries were actually delivered.

The report found 261 million doses, or 14 per cent, of the 1.8 billion doses were delivered — and only 1.3 per cent of people in those countries are fully vaccinated.

"It just seems so wrong and so morally reprehensible to have huge swaths of the world unvaccinated just because they have less money," Brittany Lambert, policy lead on the vaccine inequality file for Oxfam Canada, told As It Happens host Carol Off.

"And for those [pharmaceutical] companies to be able to, you know, continue prioritizing the wealthy countries that are going to pay lots of money for these vaccines... People in developing countries don't have any less right to life and to health than the rest of us."

Canada has delivered eight per cent of the 40 million doses it pledged, the report says, while the U.K. has delivered 9.6 per cent of the 100 million doses it promised. The U.S. has delivered 16 per cent of the 1.1 billion vaccines it pledged.

These countries pledged to share doses through COVAX, the United Nations' global vacine-sharing initiative.

Major vaccine developing companies, including AstraZeneca, Johnson & Johnson, Moderna and Pfizer, pledged 994 million doses to COVAX, but so far only 12 per cent have been delivered, according to the report.

In many low-income countries, Lambert said that even frontline health-care workers aren't vaccinated yet. 

Between January and May this year, COVID-19 may have killed between 80,000 and 180,000 health-care staff around the world, according to the World Health Organization (WHO).

Across Africa, less than one in 10 health-care workers were fully vaccinated, compared to eight in 10 in wealthy countries, the report found.

WHO director general Tedros Adhanom Ghebreyesus told BBC News that health-care workers must be prioritized for vaccines and criticized the distribution of doses. 

To Lambert, this global vaccine inequality was "entirely avoidable."

"The consequences of this, obviously, is tons of needless deaths, the ongoing toll on economies and on people's livelihoods in countries that were already struggling with poverty to begin with," Lambert said.

This week's report, titled "A Dose of Reality," calls on G20 leaders to lift patents, share vaccine technology and let developing countries make their own vaccines. 

"The core of the problem is that there just aren't enough vaccines being made," Lambert said.

She says AstraZeneca, Johnson & Johnson, Moderna and Pfizer have a monopoly over vaccine production and have refused to share their recipe with other manufacturers who could expand production.

But governments, she said, have a responsibility in an emergency situation like this one. She says countries should use their legal tools to force COVID-19 vaccine developing companies to share their knowledge and technology and waive intellectual property rights.

South Africa and India proposed this temporary waiver to the World Trade Organization last year. More than 100 countries, including the U.S., have backed the waiver since then, but a few, including the U.K. and Switzerland, are against it.

"Canada has been silent," Lambert said. "They haven't actively blocked it, but they haven't proactively endorsed it either…. I would urge Canada, you know, just to show global leadership."

International Development Minister Karina Gould told As It Happens in an emailed statement that "as a government, it is our priority to take care of our own citizens."

"By investing early into COVAX to respond not only to international needs but also our own needs, we contributed to building trust in the mechanism to deliver and reinforced the mechanism's purchasing power as a whole," the statement reads. 

"It is incorrect to imply that for some reason, we would be delaying the delivery of those surplus vaccine doses. We are committed to making them available as quickly as possible."

For people in Canada, COVID-19 vaccines have offered increased protection from the virus and, in some cases, the ability to return in-person to work, school and social gatherings.

But for Lambert, that does not mean things are back to normal.

"As long as the rest of the world isn't vaccinated, this pandemic will go on," she said. "It creates fertile ground for the virus to mutate.

"It's really in everybody's interest to vaccinate the world, as soon as possible, so that we can just move on once and for all from this pandemic."


What’s New in Best Practices Webinar 1: Vascular Access

Nov 22, 2021, 1:00pm - 2:00pm

This What’s New in Best Practices webinar is a two part webinar series designed for all nurses and health providers to learn about the Vascular Access, Second Edition best practice guideline (BPG). This BPG is applicable to all practice settings where care is provided for persons with vascular access devices (VAD) (such as, but not limited to, primary care, rehabilitation, long-term care, acute care and community care), and it is to be used for all health providers who insert, assess and/or maintain VADs.

Webinar 1 on Nov. 22 will focus on guideline development, including: describing the purpose and scope of the guideline; describing the guideline development process; and, highlighting guideline recommendations and their practical implications. Participants may also engage in a question-and-answer session during each webinar. Webinar 2 will be held on Nov. 29. 

For further details, go here. To register, go here.

NP Knowledge Exchange Virtual Symposium

Join us for RNAO's Annual Nurse Practitioner Knowledge Exchange Symposium! 

Nov 23, 2021, 9:00am - 4:00pm (virtual VIA Zoom)

On Nov. 23, 2021, RNAO is holding its eighth annual Nurse Practitioner (NP) Knowledge Exchange Symposium, titled "Powered by Change." This virtual event offers RNAO's NP members a unique opportunity to discuss matters important to their critical role in Ontario’s health system.  Hear from Ontario's Minister of Health, The Honorable Christine Elliott, about the government's vision for enhancing NP practice.  Share your ideas and discuss opportunities for mobilizing NP networks, igniting and sustaining the power of NPs and the impact of COVID-19 on vulnerable populations and NP practice. Hear from international colleagues about global and local initiatives impacting health transformation and the role of the NP.  

The NP Knowledge Exchange Symposium's objectives are to:

  • update knowledge about the NP Task Force's Vision for Tomorrow: recommendations, action and outcomes;
  • share and discuss how the clinical, policy and governance roles of NPs during COVID-19 are impacting the system and can power health transformation;
  • embrace the collaborative efforts and relationships between RNAO and its NP interest group (NPIG);
  • mobilize Ontario’s health transformation agenda incorporating opportunities and strategies to advance full NP supply, utilization and scope expansion;
  • galvanize NP engagement on global and local initiatives impacting health transformation and the role of the NP; and
  • showcase a vibrant public education campaign spotlighting the role and capacity of NPs.

View the 2021 NP Virtual Knowledge Exchange Symposium Agenda.


Related Documents:   NP Virtual Knowledge Exchange Symposium Agenda 2021

Virtual Clinical BPG Institute

Nov 23, 2021, 1:00pm - 3:30pm

Sign up today for RNAO's virtual Clinical BPG Institute!

The 19th Annual Clinical BPG Institute will be offered via Zoom video-conferencing in fall 2021.

The virtual BPG Clinical Institute has been designed for nurses and other health-care professionals interested in developing the knowledge and skills necessary to successfully introduce and sustain practice change in their organization through the implementation of best practice guidelines. The institute will feature strategies and approaches from the new Leading Change Toolkit™ and focus on creating evidence-based practice cultures within the workplace. The program is offered as a series of five webinars facilitated on a weekly basis. Don't miss out on this powerful opportunity to bring positive change and innovation to your workplace!

For further details, go here.

Wisdom in Wound Care Webinar Series: Pressure injury assessment

Nov 24, 2021, 12:00pm - 12:45pm

The Wisdom in Wound Care Webinar Series offers 11 monthly, 45-minute webinars hosted by RNAO and facilitated by wound care experts in Ontario. The webinar series will cover best practices in relation to acute and chronic wound prevention, assessment and treatment. 

The mission of the webinar series is to reduce the physiological, psychological and the fiscal burden of wounds throughout Ontario by building clinical expertise using best practices related to wound care. 

For further details, go here. To register, go here.

Best Practice Guidelines in the Palm of the Nurse’s Hand: Nursing Students Join Faculty to Develop an Innovative Implementation Strategy

Nov 25, 2021, 12:00pm - 12:45pm

This Champions Information Sharing Webinar is designed for nursing students, nurses, educators, faculty, nursing administrators, and all health-care providers, regardless of setting. Participants will learn the process to implement gap analysis findings in the creation of an innovative, student driven point-of-care best practice guideline (BPG) implementation/education intervention. 

For further details, go here. To register, go here.

Addressing Substance Use Level 2 Virtual Workshop - Session 2

Nov 25, 2021, 1:00pm - 3:00pm

*Please note, you must complete Session 1 prior to attending Session 2. This is a  two-part Addressing Substance Use Level 2 Virtual Workshop. Please register for Session 1 at

The RNAO Addressing Substance Use Level 2 Virtual Workshop is for nurses and health professionals with experience working with clients who use substances and who would like to advance their knowledge of this group.

This workshop consists of two sessions, each being two hours in length use the Zoom platform; these live sessions must be completed in sequential order by March 20, 2021, in order for you to become a Mental Health Champion and receive your Champion's certificate.  

For further details, go here. To register, go here.

MOH EOC Situational Report

We are posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you can access the Ministry’s guidance at any time.

For a detailed Ontario epidemiological summary from Public Health Ontario, you can go here.

According to the latest Situation Report #558 for November 19, the case count was as follows: 610,222 total, +793 change from yesterday; 9,959 deaths, +4 change from yesterday.

Update :

Staying in touch          

Keeping in touch and being part of a community helps us get through challenging times. Keep telling us how we, at RNAO, can best support you. Send us your questions, comments, and challenges. Recommend ideas for articles and webinars. Write to me at and copy my executive assistant, Peta-Gay (PG) Batten at RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you deeply for always being there for your community, everywhere and in all roles! Together, in solidarity, we are stronger. Thanks for encouraging your colleagues, their loved ones and your communities to be fully vaccinated. Let’s also remember about our privilege. Canada has purchased more vaccines than what it needs, while the majority of the world’s population has almost nothing. Like with other challenges we face – systemic discrimination and climate change – we are not safe until everyone is safe. Vaccines for all – literally for all, across the world – must guide policy in the upcoming months. Let’s learn from the 21-month pandemic and take real action to build a better world.

To everyone – THANK YOU! Please take care of yourself and know that RNAO always stands by you!

Here’s one constant throughout the pandemic. The silver lining of COVID-19 has been to come together and work as one people for the good of all. Let’s join efforts to demand that political leaders protect patients, students, and workers – and secure #Vaccines4All.

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


14 Nov - Nurses celebrate National Nurse Practitioner Week and call for scope expansion to improve access to the health system – go here.

14 Nov - Congratulations to all NPs during National Nurse Practitioner Week – go here.

14 Nov - Ontario nurses discuss the crisis in the profession during RNAO’s Fall Tour – go here.

14 Nov - Ontario’s RN understaffing crisis: Impact and solution – go here.

6 Nov - RNAO’s continuing media profile: The October 2021 report – go here.

6 Nov - Ontario’s economic statement signals government’s concerns with nursing human resources – go here.

6 Nov - RNAO deeply disappointed with Premier Ford’s decision on mandatory vaccination – go here.

30 Oct - Hospitals ‘bleeding out’ as nursing shortage intensifies – go here.

30 Oct - The Lancet calls for emergency action to tackle climate change, restore biodiversity, and protect health – go here.

24 Oct - Big tech has a vaccine misinformation problem – go here.

24 Oct - RNAO is deeply disappointed with government’s reopening plan – go here.

24 Oct- Misinformation is an urgent threat that prolongs the pandemic and puts people at risk – go here.

17 Oct - Health organizations around the world: Urgent climate action required – go here.

17 Oct - Climate change the new public health emergency – go here.

17 Oct - A crucial moment for global public health: The Glasgow climate conference – go here.

10 Oct - RNAO launches new, evidence-based online implementation toolkit – go here.

10 Oct - Media release: Mandate vaccinations and establish safe zones – go here.

10 Oct - A renewed call: Prime minister, stop the court battle with First Nations children! – go here.

10 Oct - The inherent racism of anti-vaxx movements – go here.

3 Oct - RNAO’s continuing media profile: The September 2021 report – go here.

3 Oct - RNAO commends move to mandate vaccination for long-term care staff; urges for more – go here.

3 Oct - Action Alert – Stop fighting First Nation children in court: Concrete action on Truth & Reconciliation – go here.

25 Sept - Accelerating knowledge uptake and sustainability – learning from the Leading Change Toolkit – go here.

25 Sept - Connecting the dots – far right extremism as a serious health threat – go here.

25 Sept - How anti-vaxxers, conspiracy theorists, and the far-right came together over COVID – go here.

25 Sept - The anti-vax movement is being radicalized by far-right political extremism – go here.

19 Sept - Nurses urge Canadians to vote – go here.

19 Sept - Keeping schools open and safe – learning from Spain’s exceptional experience – go here.

11 Sept - Vote in the federal election! Nurses vote for a healthy recovery for all Canadians – go here.

11 Sept - Federal election: Which party has the best climate plan? Here’s where they stand – go here.

11 Sept - Where the parties stand on gun control in the 2021 federal election – go here.

4 Sept - RNAO condemns protests outside health organizations – go here.

4 Sept - RNAO’s continuing media profile: The August 2021 report – go here.

4 Sept - RNAO welcomes important steps to implement vaccine certificates – go here.

We have posted earlier ones in my blog here. I invite you to look.