September 11 2020 COVID-19 report

Dear Colleagues: Welcome to our Friday, September 11 report – now in the seventh month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. Find earlier updates here, including thematic pieces in my blog. RNAO media hits and releases on the pandemic can be found 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.

RNAO joins global movement: A Just Recovery for All

RNAO has been particularly active in recent months addressing structural inequities that led to vulnerable populations suffering the brunt of the COVID-19 pandemic. RNAO is adding its voice to a campaign launched in June supported by hundreds of progressive organizations in Canada calling for a just and sustainable recovery from COVID-19. RNAO is the first large nursing organization in Canada to join, and we urge all other nursing organizations to add their voices to this tremendous international initiative. We can’t go back to business-as-usual after the COVID-19 pandemic. That’s why we’re building a movement for a #JustRecoveryforAll that puts people first.

See next RNAO’s press release issued on September 9. We urge you to sign RNAO’s action alert here and retweet here.

RNAO believes there is no recovery from COVID-19 if we leave the most vulnerable persons behind. This is why RNAO is joining a A Just Recovery for All – a global movement that puts people first and demands transformative action to build a more resilient, equitable society in the midst and after COVID-19. The six principles of the Just Recovery campaign are:

1. Put people’s health and wellbeing first, no exceptions.
2. Strengthen the social safety net and provide relief directly to people.
3. Prioritize the needs of workers and communities.
4. Build resilience to prevent future crises.
5. Build solidarity and equity across communities, generations, and borders.
6. Uphold Indigenous rights and work in partnership with Indigenous peoples.

RNAO endorses all six principles for A Just Recovery for All and will focus its own attention on two priority groups as part of this groundbreaking movement: the elderly, particularly those living in long- term care (LTC) homes, and persons who experience homelessness. Both of these groups were hardest hit by COVID-19, and both are in need of urgent policy and funding action.

These populations are embodied in the Just Recovery principles and respond to RNAO’s long-standing commitment to tackle the profound inequities exacerbated by COVID-19. To this end, RNAO issued a letter on Aug. 27, 2020 urging Prime Minister Justin Trudeau to substantively invest in 1) Canada’s elderly, especially those living in nursing homes, 2) persons who experience homelessness, and 3) reinstate the role of a national chief nursing officer.

“Our failure to protect our seniors who succumbed to COVID-19 must be addressed through a national response, and we implore the prime minister and MPs from all parties to support RNAO’s Nursing Home Basic Care Guarantee as a national standard in response to the crisis in LTC homes,” says RNAO CEO Dr. Doris Grinspun.

The guarantee includes:

1. Ensure each LTC home provides a minimum of four (4) worked hours of direct nursing and personal care for each resident per 24 hours, according to the following staff mix formula:

• a minimum of 48 minutes of worked hours of RN direct care
• a minimum of 60 minutes of RPN/LPN direct care
• a minimum of 132 minutes of PSW direct care

2. Ensure each LTC home employs a full-time equivalent (FTE) NP per 120 residents, as attending nurse practitioner (NP). In regions where there is a shortage of NPs, employ a clinical nurse specialist (CNS).
3. Ensure each LTC home employs an FTE nursing staff member (preferably an RN) to support the functions of infection prevention and control, quality improvement, staff education, on boarding and orientation.
4. Ensure each LTC home implements the following mandated human resources standards:

• mandate that LTC staff (RNs, RPNs/LPNs, PSWs) only work in one LTC home
• ensure nursing and personal care salaries in LTC are commensurate with those paid to health workers in other sectors, such as hospitals
• ensure full‐time employment with benefits is offered to staff who want full‐time work, enabling continuity of care for residents, and improved staff retention

5. Ensure each LTC home has a complement of interprofessional staff, including: physiotherapy, rehabilitation therapy, speech therapy, social work, dietary and dental care.

The pandemic also highlighted how those who experience homelessness are far more vulnerable to illness and disease than those with a place to call home. Public health advice during the pandemic reinforced the importance of housing as a defence against COVID-19. “Stay home, self-isolate, wash hands frequently,” has been the constant mantra for months. Yet each year, nearly 250,000 Canadians experience homelessness – 35,000 on any given night. “Homelessness is a product of decades of public policy choices by successive governments, and is not acceptable in a country as wealthy as ours,” says RNAO President Morgan Hoffarth.

RNAO says the federal government should adopt a community-based response to homelessness, which includes a basic income, housing, advocacy for homeless persons, a re-think of the financing of rental housing markets, and a greater focus on an Indigenous housing and homeless strategy. Such a plan is consistent with A Just Recovery for All, makes economic sense, and will spur Canada’s post-pandemic economic recovery by building housing infrastructure, creating jobs and saving taxpayers over $18 billion.

Ensuring A Just Recovery also means accounting for the expertise of Canada’s largest health-care workforce: nurses.

Calling nurses heroes, as it often happens during COVID-19, is not enough. On this, The Year of The Nurse, RNAO urges, once again, that our prime minister reinstate the role of a national chief nursing officer. Such a position will enable greater and more strategic deployment of nurses in our health system, and an expanded scope of practice for nurses to support a strong health system anchored in primary care. “The fight against COVID-19 is far from over. A second wave is inevitable, and we must be armed with the right resources and approaches to ensure lives are saved,” adds Hoffarth.

International Overdose Awareness Day: Statement from RNAO

RNAO issued the following statement on August 31:

August 31 is International Overdose Awareness Day. As nurses, we must take a moment to share and acknowledge the people in Ontario who die daily from opioid-related overdose and substance poisoning. As of April 2020, 647 people had already died in Ontario from an opioid overdose. Each victim was someone's loved one: a parent, a son, a daughter, a sister, a brother, a friend, a co-worker or a neighbor. Many were too young to die. 

We must reflect on the challenges of those who live the precarious cycle of use-overdose-use. They live a difficult and perilous life and often do so in silence. Some are even estranged from those whom they love. Persons who use substances look to others – sometimes a teacher, a nurse or other health professional – for support, resources and that glimmer of hope to keep them going.

COVID-19 has wreaked havoc on health systems globally, and has exacerbated the opioid crisis. RNAO has spoken up with and for victims and their loved ones, advocating for changes to reduce harm and provide supervised consumption services in any and all communities in need across the province. These consumption sites, and the free naloxone they provide, are vital to save lives. And, so is the urgent need for safe supplies. Without this, people will continue to die preventable deaths. 

Substance use can happen to anyone from any walk of life, and RNs are not immune. 

RN and RNAO member Kathy Moreland lost her 18-year-old son Austin to a fentanyl-related incident on June 26, 2020. Marilyn Muir, an RN and mother of two, was featured in RNJ, RNAO’s digital publication, in February 2019, detailing her traumatic story of addiction and the loss of her son Neal to overdose in 2016. In that same issue, RNAO CEO Doris Grinspun wrote a column about the death of Brad Chapman, the brother of RNAO members Dr. Leigh Chapman and RN mother Cori Chapman. The father of three died of overdose in 2015. RNAO played a leading role in the inquest following Brad’s death, participating as a witness and providing a submission alongside his courageous family with recommendations that were largely adopted by the jury. In 2018, RNAO’s best practice guideline titled Implementing Supervised Injection Services was released. 

Substance-use disorder is the result of many complex and sometimes intersecting factors, including medical mismanagement, genetic predisposition, and often a need to escape from trauma or mental health pain. These issues must be addressed in conjunction with issues of access to the street drugs that pose more threat to life than ever before.

We must all look at ourselves and think about our values and beliefs. Addiction is a disease like any other, and deserves the same compassion and universal access to health services. In this – the Year of the Nurse and the year of COVID-19 – let us commit with resolve and insistence to address this silent killer among us. 

#stopthestigma #compassionnotjudgment #substanceusetxforall #hisdeathisnotinvain
#onedeathistoomany

Update on Health System Transformation & COVID-19 webinars

On Monday, September 14, 6:45 - 8:00 pm, our upcoming webinar will be on: What kind of mindset and action is needed now?

Community-anchored care is one reason why some regions of the world have fared better that others in their COVID-19 response. Come hear about successes from places like Cuba and the Balearic Islands (Spain) and discuss how these lessons apply to Ontario Health System transformation.

Ontario is at a crossroads. We can slip back into a hospital dominated model of care or re-calibrate the system to focus on prevention, health promotion and surveillance in primary care, and a robust home care system that doesn't leave long-term care behind.

Come talk about the vision, mindset and action needed now for real health system transformation.

Registration and details are here.

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On Tuesday, September 15, 7:00-8:30 pm EDT, we present a webinar on Approaches to Mental Health and Substance use for Health-Care Providers Supporting Indigenous People and Communities During COVID-19. This webinar is in partnership with Siouz Lookout First Nations Health Authority (SLFNHA), Chiefs of Ontario (COO), Nishnawbe Aski Nation (NAN) and Indigenous Services Canada (ISC). During this presentation, participants will learn:

• an overview of mental health and substance use issues in Indigenous communities
• the impact of COVID-19 on these issues
• withdrawal management tools and resources
• prevention and management of opioid overdoses

Audience: registered nurses, nurse practitioners, registered practical nurses and nursing students across care settings, primary care providers, public health and health promotion professionals, allied health-care providers and policy-makers.

Note: Webinar will focus on nurses and health-care providers supporting First Nations communities and organizations; however, all are welcome to attend.

Presenters:

• Mae Katt, NP, Thunder Bay
• Dr. Sharon Cirone, Sioux Lookout First Nations Health Authority
• Dr. Lindsay Hancock, Sioux Lookout First Nations Health Authority

Registration and updates are here.

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Info on recent webinars:

• On August 10 we focused on nurses’ mental health and wellbeing. The global pandemic has exacerbated health and mental health concerns amongst nurses. Shortages of PPE, fear of infecting family members, isolation from family members, increased emotional and physical exhaustion, and inability to take time off – all exacerbated mental health concerns among nurses which predated the pandemic. We heard about the Healthy Professional Worker Partnership that aims to identify interventions to better support nurses’ mental health and facilitate healthy return to work. An article presenting the issues is here. The guest speakers were Abby Ayoub (University of Ottawa), Melanie Lavoie-Tremblay (McGill University) and Ivy Bourgeault (University of Ottawa). You can watch the video and see the presentations slides here.

• On July 6 we focused on Reuniting families and residents in LTC: What will it take? We heard from a panel as they discussed this critical and timely topic and heard about related updates from RNAO, including ECCO 3.0, Bill 175 and the Nursing Home Basic Care Guarantee. You can watch the video and see the presentations slides here.
• On July 1, we hosted Dr. Jennifer Kwan, a family physician and one of the organizers of #Masks4Canada. She spoke about what we need to do to have a successful re-opening of the economy, and the role that COVID-19 surveillance, good data and masking have in achieving that. You can watch it here.
• On June 22 we discussed the Impacts of COVID-19 on Indigenous Communities with three guest speakers: Ontario Regional Chief RoseAnne Archibald; Mae Katt, Nurse Practitioner with Temagami First Nation; and Marilee A. Nowgesic, CEO of the Canadian Indigenous Nurses Association. You can watch it here.

#Togetherwecandoit

Today is day #176 of RNAO’s #TogetherWeCanDoIt campaign. RNAO began this campaign on March 19 to cheer up health care workers and others in essential services. A central pillar of our campaign is #Maskathon to help spread the message and the actions of masks-for-all!

Now that masks are mandatory in all indoor places, let’s make sure we remind ourselves and others to wear a mask. For that, check these awesome pics posted by Donna Duncan, CEO of OLTC, Adrienne Spafford, CEO of AMHOnt and our RN colleague Bea Jackson.      

The #Maskathon campaign competed this week again with the Meet & Greet of our BPSO OHTs who sent over 100 tweets of their learnings from one another! Check some of them here, here, here, here, and here! And, this one is my pick for content and creative showing – thanks Dania Versailles!

Visit our website for #Maskathon message alongside RNAO’s Maskathon Portal where you can borrow graphics for your own social media play! And, join us on the #Maskathon challenge by wearing your mask correctly  as together we educate and encourage everyone – to wear a mask including children!

Post your pics using #Maskathon because #TogetherWeCanDoIt.

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 more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here.

Here is a segment from the latest Situation Report #230 for 11 September: 

Case count as of 8:00 am September 11, 2020 / Nombre de cas à 8h00 le 11 septembre 2020
Area / Région	Case count / Nombre de cas	Change from yesterday / Changement par rapport à hier	Deaths / Décès	Change from yesterday / Changement par rapport à hier
Worldwide total / Total mondial	28 363 975	+307 020	914 481	+5 826
Canada*	134 924	+630	9 163	+08
Ontario**	44 068	+213	2 813	-1***

 

Update:

• Directive #3 for Long-Term Care Homes has been updated with changes to the Managing Visitors section and is available on the Ministry’s website.

Staying in touch        

Please continue to keep in touch and share questions, comments and challenges. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten <pgbatten@rnao.ca>. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you deeply to each and all of you for being there for our communities – everywhere and in all roles! Together, in solidarity, we are stronger and more resilient. These continue to be tough times for many colleagues – especially those working in the front lines in the US, India, Brazil, Russia, Peru, Colombia, Mexico, South Africa, Spain, Argentina, Chile, Iran, and other places that are still hit hard by evil COVID-19!

Remember, during stressful and exhausting times, the only silver lining is -- coming together and working as one people – for the good of all!

As case numbers are now consistently increasing in Canada – in particular in Ontario and Quebec – we must redouble our efforts to tackle COVID-19 with the best tools at hand: full, accurate and transparent information, calm, determination and public health swift actions. 

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

 

PAST BLOG ITEMS:

28 August - RNAO letter to Prime Minister Justin Trudeau regarding Speech from the Throne – go here.

21 August - Black August and an update on RNAO’s Anti-Black Nursing Task Force – go here.

21 August - Winter Surge Planning: How one Ontario Health Team is Preparing – go here.

14 August - Insights from Cuba: Primary care as the focus of COVID-19 prevention – go here.

7 August - School reopening: Ontario government can still do the right thing on class sizes – go here.

31 July - Preparing for the second wave of COVID-19: Discussion – go here.

31 July - Important announcement regarding the VIANurse program – go here.

31 July - Government must immediately mandate hiring to avert second tragedy in LTC – go here.

24 July - Preparing for the second wave of COVID-19: What is the plan? – go here.

17 July - RNAO launches new social media campaign #Maskathon – go here.

17 July - RNAO calls on government to reunite families in LTC homes in Ontario – go here.

10 July - Nurses’ mental health, leave of absence and return to work experiences – go here.

10 July - RNAO continues to pursue family reunification in LTC – go here.

10 July - Support Zimbabwean nurses arrested and fired for protesting deteriorating pay and working conditions during pandemic – go here.

3 July -   RNAO launches task force to tackle anti-Black racism within the nursing profession – go here.

3 July -   Rather than praise, let’s protect our nurses – go here.

3 July -   Nurses celebrated diversity during Pride month – go here.

26 June - Nursing Home Basic Care Guarantee – go here.

26 June - Masks for all – the policy imperative in Canada – go here.

18 June - Annual General Meeting – an exhilarating week! – go here.

12 June - Petition on masks for Canada – go here.

12 June - LTC: RNAO releases list of 35 reports and recommendations dating back 20 years – go here.

6 June   - Statement – RNAO stands together with our Black sisters and brothers – go here.

3 June   - Adapting harm reduction during a pandemic – go here.

29 May - Foot care nurses – go here.

29 May - Update on pandemic pay; pandemic pay in consumption and treatment sites – go here.

28 May - RNAO Calls for Immediate Action in Response to the Canadian Armed Forces’ LTC report – go here.

26 May - Update on VIANurse – go here.

26 May - Ending homelessness: Will you join us to build a COVID-19 recovery for all? – go here.

24 May - Technology as a solution: Opportunities and pitfalls of COVID contact-tracing apps – go here.

21 May - Debunking PPE myths with Dr. Jeff Powis: Which masks should health care workers wear during COVID-19? – go here.

20 May - RNAO response to announcement of an independent commission into Ontario's long-term care system – go here.

19 May - With the pandemic curve flattening, VIANurse program will focus its effort on outbreaks – go here.

14 May - Nursing Week update – go here.

14 May - Pandemic puts health system to the test: Nurses have answers for shortfalls – go here.

14 May - Disappointment for not being included in pandemic pay – go here.

13 May - RNAO saddened by the loss RN Brian Beattie to COVID-19 – go here.

13 May - End racism and prejudice – go here.

12 May – Enhancing Community Care for Ontarians (ECCO 3.0) – go here

11 May - Nurses share their successes and challenges during National Nursing Week – go here.

10 May - A story of hope, ingenuity, support and genuine care for an LTC resident – go here.

7 May    - Counting the missing deaths: Tracking the toll of the coronavirus outbreak – go here.

5 May    - Life on the front lines of the pandemic: Profile of RNAO member NP Daria Gefrerer – go here.

5 May    - Addressing differential access to virtual care due to technology inequities – go here.

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.

 

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.