November 28 2021 COVID-19 report
Dear Colleagues: Welcome to my Sunday, November 28 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 several RNAO webinars this week!
This week we share: (1) a note to Premier Doug Ford calling to repeal Bill 124; (2) the nursing staffing crisis that is killing people in the UK; (3) what we know about the new Omicron variant; and (4) seeking nominations for the best in nursing – the 2022 Nursing Now Ontario Awards.
A note to Premier Ford: Repeal Bill 124!
As I write this note, I reflect with grave concern over the state of nursing in Ontario. The shortage of RNs in our province has reached a crisis and it’s spiraling out of control.
RNAO has been warning about this for years. Since December 2020 I have alerted that a looming major crisis was nearing. First to my own nursing community and then to Anthony Dale, my counterpart at the Ontario Hospital Association. I have also alerted – repeatedly – Minister of Health Christine Elliott, as well as you – Premier Doug Ford. I reiterated that this crisis in Nursing impairs the effective functioning of our health system as well as patient safety. We called for measures that support building nursing careers in Ontario.
To reiterate: Bill 124 – capping salary increases to 1%, far lower than the rate of inflation – does exactly the opposite. Bill 124 symbolizes what is wrong about Ontario’s approach to the nursing profession. It is an important reason why RNs leave for better opportunities elsewhere.
Ontario has had a shortage of registered nurses for decades. Yet this is the worst crisis I have seen in my entire career. The enormous stresses of the COVID-19 pandemic; the disdain of the Ontario government embodied in Bill 124 – these, have turned a serious shortage into a mega crisis.
Since January 2020, Ontario’s nurses have been at the front lines of the battle with COVID-19. About 617 thousand people have tested positive for the COVID-19 virus. We lost under 10 thousand lives and many more thousands are grieving. Throughout the pandemic, nurses have fought to protect themselves and their families. They have struggled, understaffed and unsupported, to save patient lives.
Bill 124, which has decreased nurses’ real pay by about 4% during the last year, is not the fault of the pandemic. Premier Ford, you are responsible for it.
Nursing colleagues resent Bill 124. It signals that our government devalues and disrespects us. Frontline nurses, managers and even hospital CEOs agree. RNAO and the Ontario Nurses Association (ONA) agree. Therefore, on November 14 we pleaded to you to #RepealBill124 within 30 days. Only 16 days remain, and we have heard nothing from you. What a shame!
We know that the Ontario Hospital Association also agrees. We know that several of your ministers support repealing Bill 124. We know the public stands with nurses. What are you waiting for, Premier Ford?
Ontario’s wait times for procedures and surgeries are at an all-time high. Hospitals are cancelling surgeries, and many are not scheduled for lack of RNs. People are dying because we don’t have enough RNs to provide safe care. COVID cases continue to increase. A fifth wave of this pandemic – driven by the Omicron variant – is possible. All this requires more, not fewer nurses.
Recruitment is important and RNAO has brought proposals and supported programs. Yet retention is critical. Indeed, the best recruitment tool is retention. It tells newcomers that they are entering a workforce that has inspired others to stay, and that they will have adequate mentorship to succeed.
RNs in Ontario are burnt out by excessive workloads and fed up with the lack of respect represented by Bill 124. Many are taking their knowledge and skills to other jurisdictions. They seek fair pay, reasonable workloads and governments that value nurses. Others are taking control over their careers by becoming self-employed. They are charging hospitals up to $120 an hour to work in ICUs. Many are retiring early, and some are leaving the profession.
Premier Ford: Your government didn’t start the RN shortfall – Premier Mike Harris did so in the 1990s. Consecutive governments have done little to solve the problem. Your government didn’t create the pandemic – a virus did. Yet, Premier Ford, you did establish Bill 124 and it is the straw that broke the camel’s back. You set up this powerful sign of disrespect and disdain toward the profession.
Nursing is the central pillar of a well-functioning health system. Enduring the hardships of a 22-month pandemic has turned, thanks to Bill 124, into an RN workforce crisis. Yet you, Premier Ford, seem oblivious and continue to ignore our calls. Is it because we are a female dominated profession? It makes me wonder, given that you exempted firefighters and police. (I am happy you did; nobody deserves Bill 124).
Premier Ford: you have an opportunity. Repair the damage and help rebuild the nursing profession. For the sake of Ontarians, you must repeal Bill 124. We are waiting for your action!
The NHS staffing crisis is killing people – and this winter it will be even worse
With staff quitting at the National Health Service (the publicly funded healthcare system in the UK, or NHS) over poor conditions and a recruitment black hole, a pay raise for nurses is the least Sajid Javid – the UK’s Secretary of State for Health and Social Care, should do. This is the main argument in a 26 November article by Polly Toynbee in The Guardian. Does it resonate regarding conditions in Ontario? Read my note, above, to Premier Doug Ford. I made minor editorial changes, marked in squared brackets, in the article below. The original article can be found here.
NHS politics tends to focus on easily measured inputs: how many beds have been cut as a result of austerity, how many nurses’ and doctors’ posts are empty, the lack of ambulances, MRI scanners and hospital repairs. But the ultimate output measure is how many people die needlessly as a result of these things.
An alarming number of excess deaths among people who were not suffering from Covid-19, analysed this week by the Financial Times, suggests the sheer magnitude of the current NHS crisis. The analysis finds that 2,047 more people died this year in the week ending 12 November than during the same period between 2015 and 2019, but only 1,197 of those people had Covid-19 on their death certificates. That’s just one week. This “raises the possibility that since the summer more people have been losing their lives as a result of the strains on the NHS or lack of early diagnosis of serious illness”. Cardiovascular disease and strokes are the most frequent causes of extra deaths, where every minute counts.
Put that together with last week’s Royal College of Emergency Medicine’s report. Desperate in tone, this showed how fast the NHS crisis is accelerating: the number of people waiting more than 12 hours in A&E [emergency departments] rose by 40% just between September and October this year. Overcrowding and long waiting times cause serious harm; the report counted 4,519 excess deaths in England due to these waits in the last year. The Association of Ambulance Chief Executives recently published its own harrowing analysis of the actual harm done by delays. District nurses [community nurse specialists] (whose number was cut by half in eight years), would not be surprised by a 30% rise in those dying at home, with nearly 6 million people waiting for hospital treatment.
The overwhelming reason for this crisis is a lack of staff. Doctor and nurse training places were the first casualty of [the fiscal] 2010 budget. A workforce plan has been promised, but this week [a parliamentary] amendment, which would require an independent assessment of future workforce needs, failed in the Commons…
Take nurses, the deepest black hole in NHS staffing… The government boasts that recent nursing figures show that “more than ever” have joined the register: another 24,000 in the past six months. Unfortunately, more nurses than ever have left the profession, too: at 14,000, the highest ever attrition rate. Almost all the new nurses are not trained in the UK; some 7,500 were hired after a huge campaign in India and the Philippines. Many may only be stopping off in the UK to qualify for higher pay in the US. Naturally, none chose to come here from post-Brexit Europe.
The pandemic encouraged more UK student applications to become nurses, but the drop-out rate is at its highest, too, with 30%-50% leaving when they discover the working conditions, says Prof Alison Leary from South Bank University in London. “Too many students are being treated as just another pair of hands.” She says experienced nurses are leaving, replaced with “rookies” daunted by finding themselves alone with overwhelming responsibilities in understaffed wards. Everyone is forced to act up beyond their training, with cheaper health care assistants and nursing associates doing registered nurses’ work. An amendment to protect the word “nurse” to mean trained nurses was also voted down this week.
The register is deceptive: half of registered nurses don’t work in the NHS, says Leary, but take easier jobs with agencies, charities, in the medical industry or teaching, leaving almost 40,000 NHS vacancies. But that “vacancy” number is a deception, too. “It represents posts that trusts can afford, not the number they actually need,” says Prof Anne Marie Rafferty, former president of the Royal College of Nursing. What’s needed to retain nurses, she says, is a strong professional career path upwards, recognising “both intellectual and emotional intelligence”…
The Royal College of Nursing [the UK’s nursing union and professional body] – which has never gone on strike in England – sent out an indicative ballot on action in support of a 12.5% pay claim. Nurses have had a real-terms cut since 2011. With inflation currently heading for 5%, their 12.5% claim is modest. The real test is whether it will be enough to hire and retain future nurses.
A strike is highly unlikely, but even a vote against working extra shifts would be crippling. So the health secretary, Sajid Javid, needs to pay up. Here’s the Treasury wickedness: any pay for NHS staff, as for all the public sector, causes more cuts – as it’s taken from existing budgets. On target for a promised 50,000 more nurses by the next election? Unlikely. Two things should alarm Tory MPs: the billowing cost of living and an NHS collapse caused by their decade of underfunding.
Omicron edition: Uncertainty, uncertainty, uncertainty
What do we know about the Omicron variant of concern? The following is a 28 November article by Zeynep Tufekci that appeared in her blog Insight. She is an associate professor at the School of Information and Library Science at the University of North Carolina at Chapel Hill with an affiliate appointment at the Department of Sociology. The original article can be found here.
We have a new variant in town, Omicron.
I was hoping to avoid learning the Greek alphabet, but here we are.
I’ve written a piece about it at the New York Times, calling for early, precautionary action.
More on that in a bit, but the first key point is that this is very different than where we were with Delta or even Alpha when they came on the scene. I wrote about both of them in a hurry, as soon as it became clear they were a threat—end of December 2020 for Alpha, end May 2021 for Delta.
My New York Times article on Delta has the depressing headline that the pandemic’s deadliest phase could be ahead of us. I was pretty certain by the end of May that Delta, especially, was going to be terrible because it had already left a wide swath of death and suffering in India, and systematic data from the United Kingdom confirmed it wasn’t a fluke. My December 2020 article on Alpha for The Atlantic is titled “The Mutated Coronavirus Is a Ticking Bomb.”
Here, it’s very, very different.
Thanks to South African scientists, their public health infrastructure, their talent and dedication and the transparency of their government WE HAVE AN EARLY WARNING. A VERY EARLY WARNING.
I cannot overemphasize how valuable this is, and what a gift they have given us.
Thank you, thank you, thank you, South African scientists, medical workers, public health employees.
But an early warning on what? Ah, that is the beauty of it. The earlier the warning, the less we know. I’ve done my best to keep up on all the information being shared by scientists on this (amazing! so much open science!) and my current conclusion is that everything is on the table, including that this just fizzles out or turns out to be a catastrophe.
There are three open questions: transmissibility, immune evasion, disease course in infected people.
Of the three, I think some level of immune evasion in terms of antibodies is the clearest prediction: this looks like it could cause more breakthrough infections in vaccinated or previously-infected people. But that is not, by itself, a catastrophe if the virus doesn’t make people very sick, or if it doesn’t transmit well. Both are still unknown, and all the possibilities are more or less on the table.
For example, South Africa has had huge outbreaks, so for all we know, they’re detecting re-infections because of immune evasion, hence the rapid rise in cases: not the same as straightforward more transmissible.
If the re-infections are then very mild to asymptomatic, it likely will not mean much. If they turn out to be severe as well, that’s a terrible outcome.
Or, maybe it is more transmissible and the disease it causes is more severe and it has immune evasion on top. We don’t have enough data to rule this out. Having had some cases that show up be mild isn’t enough to draw any conclusions. Maybe it is mild as a re-infection and severe if no previous immunity from vaccination or previous infection. Maybe this is just an outbreak among a younger population.
With so few detected cases, who can know?
That is why my piece calls for an early, aggressive response until we know more, but we need to understand this is precautionary because we really don’t know.
For all we know, this was first detected in South Africa, and is already widespread elsewhere.
That’s why my New York Times piece today is titled: “We Got a Head Start on Omicron, So Let’s Not Blow It.”
"There’s very little we know for sure about Omicron, the Covid variant first detected in South Africa that has caused tremors of panic as winter approaches. That’s actually good news. Fast, honest work by South Africa has allowed the world to get on top of this variant even while clinical and epidemiological data is scarce.
"So let’s get our act together now. Omicron, which early indicators suggest it could be more transmissible even than Delta and more likely to cause breakthrough infections, may arrive in the United States soon if it’s not here already.
"A dynamic response requires tough containment measures to be modified quickly as evidence comes in, as well as rapid data collection to understand the scope of the threat."
The piece calls for restrictions, testing, quarantine and a massive early effort to both understand what’s going on, and act like it could be terrible, but be ready to reverse quickly.
If it is not a big threat, we can, and we should quickly reverse restrictions that are specific to it. If it is, it is much better to have acted early than to wait till clarity arrives but it’s too late to contain the threat. But precautionary action shouldn’t be unnecessarily sticky.
Unfortunately, there are already a few signs that we will do theatrics and haphazard measures, rather than a comprehensive effort.
Many countries have started issuing travel bans, but targeting passports rather than the virus.
The one in the United States doesn’t even start till Monday (viruses don’t work on the weekends?) and isn’t paired with testing or quarantine at the border—just a blanket ban on a few nationalities.
That’s pandemic theatrics, and we have had too much of that already for two years.
"The United States, the European Union and many nations have already announced a travel ban on several African countries. Such restrictions can buy time, even if the variant has started to spread, but only if they are implemented in a smart way along with other measures, not as pandemic theatrics."
As I conclude the piece:
"All this requires leadership and a global outlook. Unlike in the terrible days of early last year, we have an early warning, vaccines, effective drugs, greater understanding of the disease and many painful lessons. It’s time to demonstrate that we learned them."
An early alert like this is the difference between calling firefighters at the first sign of an ember versus waiting to see if the house goes up in flames. To have the gift of this early warning about Omicron without taking fast aggressive action would be as if those firefighters waited for billows of smoke before responding.
South Africa has given the world a precious gift, and along with our gratitude and support and resources so that they can better battle their own outbreak, this gift deserves to be treated with the respect it deserves, by acting on it.
2022 Nursing Now Ontario Awards: Celebrating nursing's best
Nov. 25, 2021. Nominations are open for the 2022 Nursing Now Ontario Awards
The work nurses do each and every day to improve people's health deserves recognition and celebration. COVID-19 has revealed to us how resilient Ontario nurses are and their enduring commitment to ensuring people receive the care they need despite the obstacles a global pandemic presents.
Timed to coincide with International Nurses' Day on May 12, the anniversary of Florence Nightingale's birth, the Nursing Now Ontario Awards recognize a registered practical nurse (RPN), a registered nurse (RN) and a nurse practitioner (NP) who demonstrates the qualities of an exceptional nurse – high professional standards, superior clinical skills and a compassionate practice.
The Nursing Now Awards are jointly presented by the Registered Practical Nurses Association of Ontario (WeRPN), the Registered Nurses' Association of Ontario (RNAO) and the Ontario Nurses' Association (ONA). These awards were inspired by Nursing Now, a global campaign to improve health through nursing launched by the World Health Organization and the International Council of Nurses.
"Nurses are the backbone of Ontario's health care system," says Dianne Martin, CEO of WeRPN. "While these awards single out three exceptional nurses for recognition this year, I can say, without hesitation, that all nurses deserve our accolades for performing their duties with bravery, skill and compassion."
"The award honours nurses work in improving Ontarian's health and quality of life during the best and worst of times," says RNAO CEO Dr. Doris Grinspun, RN. "The past 22 months highlight the centrality of nurses to our health system. Ontario's RNs, NPs and RPNs continue to provide exceptional knowledge and compassion despite the shortfalls in staffing; and we want to celebrate their unwavering commitment and expertise."
"As demonstrated every day – and throughout the COVID-19 pandemic – front-line RNs, NPs, and RPNs go above and beyond the call of duty. That is why ONA is delighted to partner with RNAO and WeRPN to recognize our colleagues who provide such excellent, high-quality care to patients, residents and clients," said Vicki McKenna, RN, ONA President.
Nominations must be submitted via an online form, no later than Friday Feb. 25, 2022. Entries will be judged by a volunteer panel of nurses.
The awards will be presented during Nursing Week May 6-12, 2022.
POLICY UPDATES FOR ALL TO ACT ON & MUST JOIN EVENTS – OPEN TO ALL
What’s New in Best Practices Webinar 2: Vascular Access
Nov 29, 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 2 on Nov. 29 will focus on implementation and evaluation of the guideline, including: describing implementation strategies related to the BPG, and highlighting and providing an overview of evaluation measures. Participants may also engage in a question-and-answer session during each webinar.
For further details, go here. To register, go here.
Virtual Clinical BPG Institute
Nov 30, 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.
Best Practice Champions Virtual Workshop - Session 1
Dec 2, 2021, 1:00pm - 4:00pm
The Best Practice Champions Network team has established a new, two-part Best Practice Champions Virtual Workshop to replace the in-person champions workshops. This free, online educational opportunity consists of a brief pre-recorded introductory video, and two live virtual sessions to be completed in sequential order.
The Best Practice Champions Virtual Workshop series will be offered monthly, with Session 1 and Session 2 taking place once a month. This will provide you with ample opportunity to select the live session that best suits your work schedule. This online educational opportunity can be completed individually or as a group.
For further details and registration, 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 #563 for November 26, the case count was as follows: 615,197 total, +927 change from yesterday; 9,991 deaths, +6 change from yesterday.
Update:
The COVID-19 Vaccine Administration Guidance has been updated to provide guidance for individuals experiencing chest pain or shortness of breath prior to vaccination.
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 dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten at pgbatten@rnao.ca. 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
RECENT BLOG ITEMS:
21 Nov - I’m an infectious disease doctor. Yes, I’m vaccinating our 5-year-old against COVID-19. Here is why you should too – go here.
21 Nov - Rich countries only shared 14% of COVID-19 vaccine doses promised to poorer nations – go here.
21 Nov - Nurses gather in Toronto to rally: Recap of #RepealBill124 rally and next steps – go here.
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.
We have posted earlier ones in my blog here. I invite you to look.