RNAO gravely concerned about the second pandemic wave

The government released two days ago the projections in the latest Ontario modeling of the pandemic, and issued today additional measures that bring new regions in the province into lockdown.

RNAO and others remains gravely concerned by the late and insufficient efforts to control the second pandemic wave, which is once again overwhelming long term care (LTC) institutions, in particular nursing homes across the province, adding anguish to residents, staff and the families of both. This “too little, too late approach” continues to disadvantage populations compromised by their social conditions. These are the communities at risk due to precarious employment or unemployment and low income that often also live in tougher housing conditions. These are the same communities that suffered the burden of illness during the first wave of this pandemic. In this second wave the lateness in acting is overwhelming also Ontario hospitals, and this will have renewed repercussions on thousands of Ontarians needing diagnostics and procedures for non-COVID illnesses, who will see delays in access to health-care services.  

This grim reality is unacceptable because it was fully preventable given the public health tools available to government. We as individuals also bear responsibility. While many of us strive to act according to the best public health evidence and encourage our families, friends and co-workers to do the same, not all do. And, while I understand people are tired of restrictions and want to get on with life and celebrate holidays – I too want the same –, we simply can’t. Thus, when we see crowded public places, whether these are malls, stores or parks, we must remind people that we are all on this together, for good or for bad. The consequences of our actions will be felt in the form of excess deaths, and in the form of missing loved ones at our future celebration tables.   

For nurses and other health professionals working on the front lines, the disconnect between what they are called to do, and what they see the government and some sectors of the public doing, adds to their stress and exhaustion. 

The government’s approach is distorted and belated because it focuses on ICU occupancy as their key indicator for taking action. Basically, the province is taking action when hospitals, and particularly critical care units, are becoming overwhelmed in a particular region. This approach accepts that there will be widespread community transmission and all it wants is to diminish those rates of transmission just below the levels that overwhelm critical care capacity.

This is an approach of planned failure to control the virus that ignores the societal impact, in particular the burden of illness on the most vulnerable. The idea that somehow this approach “saves the economy” is wrong-headed – it simply does not. It also ignores the LTC “collective PTSD” resulting from the traumas of the first wave and the worsening human resources crisis. I ask that no one be surprised as we start to experience shortages of ICU RNs, NPs and CNS – as they can’t continue working at this pace. RNAO begged action during the summer: hire, hire, hire – it never happened and it is still not happening. Shortages of staff during the pandemic, in any sector, result in additional deaths. It also means more illness amongst staff, as they let down their guard when they are rushed and exhausted.

It is sad that the Ontario government is using the vaccination excitement as a political tool to distract the public from the horrors of this second wave. Canada is the country with the largest secured provision of vaccines per capita in the world, and one of the best prepared vaccination campaigns. Both the federal and provincial governments deserve kudos for this enormous achievement. But while the provincial government wants to see “all political hands on deck” for the vaccination campaign, it seems to be quietly suggesting “all political hands off deck” in addressing this second wave of community transmission.

The sobering reality is that it will take many months – likely till the summer or fall – to reach levels of inoculation that will allow normalcy to gradually take hold. Vaccination in other parts of the world will advance at much slower speed, so real normalcy is still far away. In the meantime, we must tackle the urgent pandemic crisis at hand. We can take comfort that with the arrival of warmer weather in the spring, at a time when the most at-risk citizens should already be vaccinated, we will start to see tangible improvement in the situation.  

Finally, let’s keep together – demanding from ourselves to uphold the public health rules and abstaining from getting together for the holidays. And let’s keep together urging government action towards a more severe and expansive lockdown encompassing all the major urban areas in the province, especially during the holiday period, with the purpose of effectively diminishing the rates of mobility and contact. The short-circuiting of virus transmission requires a number of measures, such as curbing movement between regions at different levels of COVID-19 restriction, and directing big box stores to sell only groceries and basic household goods. Governments should also provide the necessary protection to those who must continue to work in essential services, and adequate supports for vulnerable groups who most suffer the consequences of lockdowns. Without addressing these structural barriers, the lockdown measures cannot be successful. The further strengthening of testing (including rapid testing), contact tracing and isolation (including the provision of isolation places for those with inadequate housing conditions) remain priorities as well. In short, we require a comprehensive, science-based public health framework to control the community spread of the virus that enacts a COVID-Zero strategy.

RNAO issued on December 8, in conjunction with the Ontario Hospital Association, Ontario Medical Association, Registered Practical Nurses Association of Ontario, and Respiratory Therapy Society of Ontario a media statement.