October 24 2021 COVID-19 report


Dear Colleagues: Welcome to our Sunday, October 24 report during this twenty first 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. As always, feel free to share this report and links with anyone interested. Scroll down for policy updates and action alerts, as well as RNAO’s upcoming webinars.

Take action on Bill 124 and sign the Action Alert. Add your voice to the 7,674 others calling on Premier Ford to exempt health-care workers from Bill 124. We join the call to #RepealBill124. This is urgent given the deterioration of nursing human resources as colleagues leave the profession or move to the United States where President Biden is eager to welcome our awesome RNs.

Save the date: November 14, 2021, noon at Nathan Phillips Square, Toronto. RNAO is joining the rally organized by @NurseWithSign bringing the public sector to call on Premier Ford to repeal Bill 124! Come and support the demand to end wage suppression! I am proud to be one of the guest speakers at the rally and our awesome RNAO president Morgan Hoffarth will be leading the RNAO contingency!  We hope you can come and invite your colleagues, family and friends. We will use masks, maintain physical distancing and abide by all public health measures.

This week we share: (1) RNAO’s deep disappointment with the Ontario government’s reopening plan; (2) misinformation as an urgent threat that prolongs the pandemic and puts people at risk; and (3) what we can do about the vaccine misinformation problem in social media.

RNAO is deeply disappointed with government’s reopening plan

RNAO has continued to push for mandatory vaccination of all health-care workers. RNAO issued a detailed response to questions from Premier Doug Ford regarding this matter. You can read RNAO’s response here.

RNAO issued the following media release in response to the Ontario government’s reopening plan.

Toronto, Oct. 22, 2021. The Ontario government is throwing caution to the wind and putting at risk the progress the province has made in keeping the spread of the COVID-19 virus in check.

The Registered Nurses’ Association of Ontario (RNAO) says the province’s ability to control the spread of infection as we head into the colder months is being gambled by a reopening plan that lifts capacity limits as of Monday, Oct. 25, and does away with public health measures – including requiring proof of vaccination – as early as January.

RNAO is also gravely concerned the government chose not to announce mandatory vaccination for all health-care workers in all sectors and settings. This directive is already in place for those working in long-term care, with a deadline to comply by Nov. 15. Many acute care hospitals are taking similar action. However, this patchwork approach to policy by the Ford government leaves patients and staff in most hospitals, home care and other community settings at an even higher vulnerability rate if unvaccinated staff leave one setting for another that has more lenient requirements.

Requiring all health-care and education workers to be fully vaccinated is a policy based on evidence, first called for by RNAO in July 2021, and recently supported by the government’s own Science Table. To ignore such advice defies logic, is irresponsible and compromises patient care and staff safety.

RNAO urges people to continue to sign its Action Alert demanding Premier Ford extend mandatory vaccinations to all health-care and education workers and establish safe zones around their places of work. The association argues these are essential measures needed to confront COVID-19 head on.

Misinformation is an urgent threat that prolongs the pandemic and puts people at risk

In June 2021 I posted an article from the WHO on the “infodemic” – the flood of information on the COVID-19 pandemic – and the need to address the spread of misinformation and disinformation in social media. I did so since I am convinced that misinformation is an urgent public health threat – and also a threat to democracy and values of social justice.

Big voices are tackling the issue. U.S. President Joe Biden warned last July that the spread of COVID-19 misinformation on social media is "killing people." He was responding to a question from a reporter about the alleged role of "platforms like Facebook" in spreading falsehoods about vaccines and the pandemic. The White House has been increasing its pressure on social media companies to tackle disinformation. "They're killing people," Biden told reporters at the White House. "The only pandemic we have is among the unvaccinated." US health officials have warned that the country's current spike in COVID-19 deaths and infections is exclusively hitting unvaccinated communities.

Biden was building on work done by his Surgeon General. In July, U.S. Surgeon General Dr. Vivek Murthy issued the first Surgeon General's Advisory of this Administration to warn the American public about the urgent threat of health misinformation. The remainder of this article is a segment from the text of the Surgeon General’s Advisory. For ease of reading, I have removed the citations in the text. You can find them by going to the source.  

During the COVID-19 pandemic, people have been exposed to a great deal of information: news, public health guidance, fact sheets, infographics, research, opinions, rumors, myths, falsehoods, and more. The World Health Organization and the United Nations have characterized this unprecedented spread of information as an “infodemic.”

While information has helped people stay safe throughout the pandemic, it has at times led to confusion. For example, scientific knowledge about COVID-19 has evolved rapidly over the past year, sometimes leading to changes in public health recommendations. Updating assessments and recommendations based on new evidence is an essential part of the scientific process, and further changes are to be expected as we continue learning more about COVID-19. But without sufficient communication that provides clarity and context, many people have had trouble figuring out what to believe, which sources to trust, and how to keep up with changing knowledge and guidance.

Amid all this information, many people have also been exposed to health misinformation: information that is false, inaccurate, or misleading according to the best available evidence at the time. Misinformation has caused confusion and led people to decline COVID-19 vaccines, reject public health measures such as masking and physical distancing, and use unproven treatments. For example, a recent study showed that even brief exposure to COVID-19 vaccine misinformation made people less likely to want a COVID-19 vaccine. Misinformation has also led to harassment of and violence against public health workers, health professionals, airline staff, and other frontline workers tasked with communicating evolving public health measures.

Misinformation can sometimes be spread intentionally to serve a malicious purpose, such as to trick people into believing something for financial gain or political advantage. This is usually called “disinformation.” But many people who share misinformation aren’t trying to misinform. Instead, they may be raising a concern, making sense of conflicting information, or seeking answers to honest questions.

Health misinformation is not a recent phenomenon. In the late 1990s, a poorly designed study, later retracted, falsely claimed that the measles, mumps, rubella (MMR) vaccine causes autism. Even after the retraction, the claim gained some traction and contributed to lower immunization rates over the next twenty years. Just since 2017, we have seen measles outbreaks in Washington State, Minnesota, New York City, and other areas. Health misinformation is also a global problem. In South Africa, for example, “AIDS denialism”—a false belief denying that HIV causes AIDS—was adopted at the highest levels of the national government, reducing access to effective treatment and contributing to more than 330,000 deaths between 2000 and 2005. Health misinformation has also reduced the willingness of people to seek effective treatment for cancer, heart disease, and other conditions.

In recent years, the rapidly changing information environment has made it easier for misinformation to spread at unprecedented speed and scale, especially on social media and online retail sites, as well as via search engines. Misinformation tends to spread quickly on these platforms for several reasons.

First, misinformation is often framed in a sensational and emotional manner that can connect viscerally, distort memory, align with cognitive biases, and heighten psychological responses such as anxiety. People can feel a sense of urgency to react to and share emotionally charged misinformation with others, enabling it to spread quickly and go “viral.”

Second, product features built into technology platforms have contributed to the spread of misinformation. For example, social media platforms incentivize people to share content to get likes, comments, and other positive signals of engagement. These features help connect and inform people but reward engagement rather than accuracy, allowing emotionally charged misinformation to spread more easily than emotionally neutral content. One study found that false news stories were 70 percent more likely to be shared on social media than true stories.

Third, algorithms that determine what users see online often prioritize content based on its popularity or similarity to previously seen content. As a result, a user exposed to misinformation once could see more and more of it over time, further reinforcing one’s misunderstanding. Some websites also combine different kinds of information, such as news, ads, and posts from users, into a single feed, which can leave consumers confused about the underlying source of any given piece of content.

The growing number of places people go to for information—such as smaller outlets and online forums— has also made misinformation harder to find and correct. And, although media outlets can help inform and educate consumers, they can sometimes inadvertently amplify false or misleading narratives.

Misinformation also thrives in the absence of easily accessible, credible information. When people look for information online and see limited or contradictory search results, they may be left confused or misinformed.

More broadly, misinformation tends to flourish in environments of significant societal division, animosity, and distrust. For example, distrust of the health care system due to experiences with racism and other inequities may make it easier for misinformation to spread in some communities. Growing polarization, including in the political sphere, may also contribute to the spread of misinformation.

Because it pollutes our information environment, misinformation is harmful to individual and public health. Together, we have the power to build a healthier information environment. Just as we have all benefited from efforts to improve air and water quality, we can all benefit from taking steps to improve the quality of health information we consume. Limiting the prevalence and impact of misinformation will help all of us make more informed decisions about our health and the health of our loved ones and communities.

This advisory lays out how the nation can confront health misinformation by helping individuals, families, and communities better identify and limit its spread, and issues a number of ways institutions in education, media, medicine, research, and government stakeholders can approach this issue. It also underscores the urgent need for technology and social media companies to address the way misinformation and disinformation spread on their platforms, threatening people's health.

[Read the full document that lays out what everyone can do to take action on addressing health misinformation].

Big tech has a vaccine misinformation problem – here’s what a social media expert recommends

Facebook and other social media platforms spread massive misinformation and bear huge responsibility for the urgent threat to public health raised by the U.S. Surgeon General. This is a July 29 article by Anjana Susarla, Omura-Saxena Professor of Responsible AI at Michigan State University. This article is republished from The Conversation under a Creative Commons license. Read the original article.

With less than half the United States population fully vaccinated for COVID-19 and as the delta variant sweeps the nation, the U.S. surgeon general issued an advisory that called misinformation an urgent threat to public health. The advisory said efforts by social media companies to combat misinformation are “too little, too late and still don’t go far enough.” The advisory came more than a year after the World Health Organization warned of a COVID-related “infodemic.”

There’s good reason to be concerned. A study in the U.K. and the U.S. found that exposure to online misinformation about COVID-19 vaccines reduced the number of people who said they would get vaccinated and increased the number of people who said they would not.

As a researcher who studies social media, I can recommend ways social media companies, in collaboration with researchers, can develop effective interventions against misinformation and help build trust and acceptance of vaccines. The government could intervene, but a bill to curb medical misinformation on social media filed in July is revealing some of the challenges – it’s drawing scorn for leaving to a political appointee decisions about what constitutes misinformation.

The threat

A serious threat in online settings is that fake news spreads faster than verified and validated news from credible sources. Articles connecting vaccines and death have been among the content people engage with most.

Algorithms on social media platforms are primed for engagement. Recommendation engines in these platforms create a rabbit-hole effect by pushing users who click on anti-vaccine messages toward more anti-vaccine content. Individuals and groups that spread medical misinformation are well organized to exploit the weaknesses of the engagement-driven ecosystems on social media platforms.

Social media is being manipulated on an industrial scale, including a Russian campaign pushing disinformation about COVID-19 vaccines. Researchers have found that people who rely on Facebook as their primary source of news about the coronavirus are less likely to be vaccinated than people who get their coronavirus news from any other source.

While social media companies have actively tagged and removed misinformation about COVID-19 generally, stories about vaccine side effects are more insidious because conspiracy theorists may not be trafficking in false information as much as engaging in selectively distorting risks from vaccination. These efforts are part of a well-developed disinformation ecosystem on social media platforms that extends to offline anti-vaccine activism.

Misinformation on social media may also fuel vaccine inequities. There are significant racial disparities among COVID-19 vaccine recipients so far. For example, though vaccine-related misinformation is not the only source of these differences, health-related misinformation is rife on Spanish-language Facebook.

Here are two key steps social media companies can take to reduce vaccine-related misinformation.

Block known sources of vaccine misinformation

There have been popular anti-vaccine hashtags such as #vaccineskill. Though it was blocked on Instagram two years ago, it was allowed on Facebook until July 2021. Aside from vaccines, misinformation on multiple aspects of COVID-19 prevention and treatment abounds, including misinformation about the health benefits of wearing a mask.

Twitter recently suspended U.S. Rep. Marjorie Taylor Greene for a couple of days, citing a post of COVID misinformation. But social media companies could do a lot more to block disinformation spreaders. Reports suggest that most of the vaccine disinformation on Facebook and Twitter comes from a dozen users who are still active on social media referred to as the disinformation dozen. The list is topped by businessman and physician Joseph Mercola and prominent anti-vaccine activist Robert F. Kennedy Jr.

Evidence suggests that infodemic superspreaders engage in coordinated sharing of content, which increases their effectiveness in spreading disinformation and, correspondingly, makes it all the more important to block them. Social media platforms need to more aggressively flag harmful content and remove people known to traffic in vaccine-related disinformation.

Disclose more about medical misinformation

Facebook claims that it has taken down 18 million pieces of coronavirus misinformation. However, the company doesn’t share data about misinformation on its platforms. Researchers and policymakers don’t know how much vaccine-related misinformation is on the platforms and how many people are seeing and sharing misinformation.

Another challenge is distinguishing between different types of engagement. My own research studying medical information on YouTube found different levels of engagement, people simply viewing information that’s relevant to their interests and people commenting on and providing feedback about the information. The issue is how vaccine-related misinformation fits into people’s preexisting beliefs and to what extent their skepticism of vaccines is accentuated by what they are exposed to online.

Social media companies can also partner with health organizations, medical journals and researchers to more thoroughly and credibly identify medical misinformation.

Researchers who are working to understand how misinformation spreads rely on social media companies to conduct research about users’ behavior on their platforms. For instance, what researchers do know about anti-vaccine disinformation on Facebook comes from Facebook’s CrowdTangle data analysis tool for public information on the platforms.

Researchers need more information from the companies, including ways to spot bot activity. Facebook could follow its own example from when it provided data to researchers seeking to uncover Russian fake news campaigns targeted at African American voters.

Data about about social media will help researchers answer key questions about medical misinformation, and the answers in turn could lead to better ways of countering the misinformation.


Nursing Leadership in Long-Term Care Homes

Oct 25, 2021, 2:00pm - 2:45pm

This Champions Information Sharing Webinar is designed for health-care professionals and nursing students who want to gain knowledge and skills about developing and sustaining nursing leadership. 

This webinar will highlight the strategies and tools used to develop nursing leadership in our long-term care homes. It will provide participants with the knowledge and skills needed to sustain nursing leadership at their workplaces and how to successfully implement best practice guidelines (BPGs).

During this presentation, participants will learn how to:

  • sustain nursing leadership in long-term care
  • utilize tools such as SBAR and PSW reporting check lists to help foster nursing leadership 
  • utilize evidenced-based practice to promote resident care 
  • build capacity and empowerment through Champions
  • promote collaborative practice
  • build resilience at the workplace


  • knowledge exchange between the presenters and participants in regards to developing and sustaining nursing leadership and collaborative practice


  • InderPreet Hundal, Professional Practice lead, Regional Municipality of Halton
  • Sisham Subedi, Senior Nursing Manager, Post Inn Village, Oakville

Register now.

October NP Insider Webinar

Oct 26, 2021, 4:30pm - 5:30pm

The NPIG Executive is pleased to invite NPIG members to our October nurse practioner (NP) Insider webinar on Oct. 26, 2021, where two insurance providers will be able to share the historical advancements NPs have made to get services covered. 

The October Insider is titled: “NPs and Insurance Claim Equity”.   


  • presentation and discussion with NP colleagues on Recommendation #7 in Vision For Tomorrow: Optimize access and continuity of care by ensuring all insurance benefit carriers, and other such payers, accept NP services analogous to physician counterparts. 


  • Andrew Pennycook, GBA, Employee Benefits Consultant, HUB International Limited
  • Robert Cross, Business Development Manager, Growth & Client Service, Group, Green Shield Canada (GSC)

Register now.

To become an NPIG member, connect with RNAO’s membership team online.

Addressing Substance Use Level 2 Virtual Workshop - Session 2

Oct 29, 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 RNAO.ca/events.

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, 202,1 in order for you to become a Mental Health Champion and receive your Champion's certificate.   

Workshop prerequisite: Completion of a Mental Health and Addiction Level 1 workshop or completion of the Engaging Clients Who Use Substances e-learning (Under Addiction and Mental Health). 

This online workshop will focus on appropriate evidence-based assessment tool to identify people with substance use disorders, therapeutic interventions and techniques to treat clients with substance use disorders and approaches to integrate best practices in clinical care and organizational processes.


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 #539 for October 22, the case count was as follows: 596,772 total, +492 change from yesterday; 9,839 deaths, +12 change from yesterday.


Staying in touch          

Keeping in touch remains important as ever. Feeling that we are part of a community and that we have each other’s backs helps us get through challenging times, becoming better people in the process. We are eager to hear 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!

We thanks you again and again for being there for your community – everywhere and in all roles! Together, in solidarity, we are stronger. Please keep encouraging your colleagues, their loved ones and your communities to be fully vaccinated. We must not forget, however, 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 20-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


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.

28 Aug - Mandatory vaccination in process; vaccine certificates coming to Ontario – go here.

28 Aug – MSF on boosting global vaccine supply – go here.

21 Aug - Nurses call on voters to vote for a healthy recovery for all – go here.

21 Aug – RNAO calls for a stronger vaccine mandate and action on vaccine certificates – go here.

21 Aug - WHO condemns rush by wealthy nations to give Covid vaccine booster – go here.

21 Aug - Calling on Canada to back WHO Moratorium on Booster Shots and Donate Vaccines – go here.

15 Aug - Why is Delta such a worry? – go here.

15 Aug - This is what we know about the Delta variant and kids – go here.

15 Aug - RNAO welcomes mandated vaccination for health care workers – go here.

8 Aug - COVID-19 vaccine boosters: is a third dose really needed? – go here.

8 Aug - RNAO calls to implement vaccine passports to help reopen Canada – go here.

8 Aug – School reopening plan: additional measures needed to stave off worst effects of fourth wave – go here.

1 Aug - RNAO’s continuing media profile: The July 2021 report – go here.

1 Aug - Preparing for the fourth wave – go here.

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