September 19 2021 COVID-19 report


Dear Colleagues: Welcome to our Sunday, September 19 report during this twentieth 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.

In this update we focus on the federal election and on school reopening. We share: (1) RNAO’s media release on the federal elections, and (2) an article on how Spain managed to maintain their schools open during the whole 20-21 school year, and the lessons for us in Ontario and elsewhere in Canada.

REMINDER: The Canadian federal election is tomorrow Monday. Vote! Every vote counts to build a vibrant democracy!  

Nurses urge Canadians to vote for a government that will guide the country through the pandemic and oversee a healthy recovery

RNAO sent a questionnaire to each of the major political parties running candidates for their input on RNAO’s 11 recommendations in our policy platform. We received responses from each of the four major parties: the Liberal Party of Canada, the Conservative Party of Canada, the New Democratic Party, and the Green Party of Canada. You can read the responses under each of the four areas of our platform. We invite you to go through each topic area so you can inform yourself.

Here is the media release from RNAO on Sept. 15:

As the federal election campaign enters its final days, Ontario’s registered nurses (RN), nurse practitioners (NP) and nursing students are calling on all eligible Canadians to cast an informed vote.

Polls show the race is tightly contested with the major parties jockeying for position as the Sept. 20 election approaches. To help people make a choice that reflects the federal government’s key role in shaping health and health-care policy, the Registered Nurses’ Association of Ontario (RNAO) is asking voters to review its policy platform, released Aug. 20. Political party responses to a questionnaire based on RNAO’s 11 recommendations – focused on better access to health care, social determinants of health, environmental determinants of health and fiscal capacity – are also available to read online. RNAO sent the questionnaire to each of the major parties.

“The next federal government has to hit the ground running. COVID-19 is not over and we must continue to tackle it to prevent death and suffering. At the same time, the pandemic has revealed deep cracks in our country. It has exposed inequities among Canadians and laid bare the challenges of populations that remain vulnerable, including those who live in long-term care homes, Indigenous communities, and those struggling with opioid addiction. Our climate is also at stake – now more than ever – as evidenced by the weather we have witnessed this summer. All of these are priorities we have highlighted in our platform,” says Dr. Doris Grinspun, RNAO’s CEO. “The pandemic requires strong leadership to guide the country and Canadians through the weeks and months to come.”

“Health care may be administered by the provinces, but keeping Canadians healthy is something that requires leadership at the federal level, a deep understanding of the factors that affect one’s health and a commitment to close devastating societal gaps,” says RNAO President Morgan Hoffarth, adding an increase in health transfer funding to the provinces and territories as well as national standards for long-term care are core elements of RNAO’s platform. “It is so important that votes are cast based on the evidence and careful consideration of each party’s election promises and the challenges ahead of us.”

RNAO encourages Canadians to check for information on where they can vote in their communities.

Keeping schools open and safe – learning from Spain’s exceptional experience

Substantial parts of this article are adapted from an August 4, 2021 article in The Conversation by Fernando Trujillo Sáez; Jonatan Castaño Muñoz; Riina Vuorikari, and Romina Cachia, entitled Portrait of the school experience in Spain during more than a year of pandemic (in Spanish). The original article can be found here. It summarizes the Spanish findings from a study launched from the European Commission's Joint Research Center in five countries to better understand how the 20-21 academic year worked in Europe. In addition, I draw from several articles in the Spanish media (see here, here, here, here, here, here, and here).

If we ask any teacher, student or family, it is not difficult to realize how stressful the school experience has been during the last year and a half, almost anywhere in the world. The closure of educational centers caused by COVID-19 and the exceptional conditions under which the 20-21 school year took place have posed fundamental challenges for educational systems, especially as they prepared for the current school year, which started in Europe and North America this month.

Spain has been hit particularly hard by the pandemic and is experiencing a fifth wave of COVID-19 that arrived earlier than Canada’s fourth wave but is similarly driven by the delta variant and has seen a significant spike in cases among young unvaccinated people. The opening of the new school year in September 2021 arrives in Spain, however, with more confidence than in many other countries, including Canada. This confidence arises from their positive experience during the past year.

The Spanish case is, internationally, quite exceptional. Within Europe, only Sweden and Spain managed to keep their schools open for the entire academic year. We can draw lessons from Spain’s experience on combatting the pandemic and improving our educational systems in Canada and elsewhere.

The Spanish exceptionality began at the end of August 2020 guided by a social consensus over the importance of face-to-face teaching. The educational authorities by consensus decided to keep the schools open with face-to-face teaching, at least up to tenth grade. This was a reaction to their earlier difficult experience of having more than eight million students in the country off the classroom from mid-March to September 2020.

Several policies and directives guided the opening of the school year in September 2020. The ministries of Health and Education – in coordination with the autonomous regions (like the provinces in Canada) – established a strict protocol that saw fewer students in each class to increase social distancing. To stop the spread, the federal government established safety and hygiene measures that affected school operations: All students aged six and over required to wear a mask in class; class sizes reduced; students assigned to ‘bubbles’ to avoid mixing; desks placed at least 1.5 meters apart; improved indoor ventilation; hand sanitizing stations; restricted mobility within the school; reinforced cleaning of facilities; temperature checks; protocols for positive cases; requirement for full class confinement when a positive case detected; etc. In September 2020 vaccines were not available, but for the current school year Spain contemplates all teachers to be fully vaccinated.

These COVID protocols shaped the development of the 20-21 school year. As a general conclusion, the schools appear to have been safe spaces with very few outbreaks and have not contributed significantly to the spread of the virus, while it has been possible to advance quite normally in the teaching and learning process. This has been achieved thanks to strict adherence to protocols by teachers, students and staff. Indeed, experts assess that protocols have been followed in exemplary ways.

On the other hand, compliance with COVID protocols has also generated difficulties and problems. The forced interpersonal distance and reduced mobility in the classroom have favored methodological strategies more focused on the lecture than on innovative strategies such as cooperative learning or project-based learning, which this year seem to have been put on hold.

However, the bubbling of students and the presence of many more teachers – 35,000 additional teachers hired as “COVID teaching staff” across the country – allowed working with a lower ratio. Teachers and students participating in the research pointed out that the reduced ratio and the adjustment of the curriculum to core elements – given the restrictions of time and space – compensated some of the difficulties generated by the pandemic and the COVID protocol.

There is consensus that the reduction in class sizes (capped at 16 for daycare and kindergarten and 20 from first grade and up), the requirement for a 1.5-meter distance between desks, and the hiring of the 35,000 “COVID teachers” to comply with the capacity limits and physical distancing, were instrumental for a safe reopening in 20-21. Upper-level secondary students studied through a combination of blended – face-to-face and remote – teaching, thus allowing reduced number of students in-person and substantial physical distancing in classrooms.  

Another crucial factor in the success of the 2020-21 school year in Spain was the early recognition of aerosol transmission – an area that has not been taken seriously in Ontario despite the calls for action from epidemiologists such as David Fisman. In Spain, given that many schools are in old buildings with poor ventilation, guidance was provided to increase ventilation through every possible means, including maintaining windows open in the classrooms, even in winter. Spain has the benefit of a warmer climate and milder winters, and children were allowed to bring jackets and blankets to class in case the room got colder. In Ontario, ventilation work began late this summer, and government has never directed smaller class sizes.

Issues of equity remained salient in Spain, even if COVID crisis situations were largely avoided. Structural problems prior to the pandemic and the demands on teachers during the pandemic meant that those who have suffered the most educationally during the academic year 20-21 have been, precisely, those who need the most help and support: the students in vulnerable situations and students with specific educational support needs. The authors call for an in-depth evaluation of the structures and resources required for attention to diversity in Spain. The commitment to educational inclusion and equity are essential to also guarantee the quality of the educational system.

The blended model of teaching in secondary school, with alternating days or hours, has faced severe criticism by both teachers, students and their families. The alternation has not worked satisfactorily and there are complaints about the difficulties of the students to maintain their routines and their work rhythm, contributing to anxiety and learning difficulties among the students.

Both the experience of remote school after March 2020 and the experience during the 20-21 school year have raised awareness about the importance of digital competence for all students. Technological infrastructures in many schools and the use of virtual learning platforms have been valued as a complement to face-to-face teaching. The research suggests the need to advance the technology so that it contributes not only to the sending and receiving of tasks through a platform, but also to a more meaningful, deep and memorable learning.

The 20-21 school year ended in Spain with the feeling that the enormous effort made by governments and the educational community was well worth it. Educational centers remained safe and became guarantors of equality and the right to education, despite the structural problems and difficulties.

Precisely having such a clear image of the problems and difficulties experienced can allow us in Canada and Ontario – even at this late stage but with only a few weeks into the new school year -- to adjust action plans so as to face these challenges and improve the educational system. We want it to guarantee quality education for all students and to be prepared for the challenges of a delta-driven fourth wave, and a potential fifth wave in the horizon.


RNAO Action Alerts

Sign the Action Alert calling on premier Ford to Implement the 3 Mandatory Asks of Nurses: 1) #MandatoryVaccination for health-care workers (unless medical exemption); 2)  #MandatoryVaccination for teachers and educational staff (unless medical exemption); and 3)   #MandatoryVaccinePassports for everyone (unless medical exemption). In addition, we are asking for indoor masking for children two years old and up.

Take action on Bill 124 and sign the Action Alert. Add your voice to the 5,302 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. President Biden is eager to welcome our awesome RNs.

Take action on global vaccine access: Sign an Action Alert calling on Prime Minister Trudeau to ensure global vaccine access. Let’s also make sure we urge Prime Minister Trudeau to match President Biden’s commitments to Covax.

Call on elected leaders to step up and end the opioid crisis: Sign an Action Alert calling on politicians at all orders of government to work together to save lives and bring this crisis to an end.

Enshrine a nursing home basic care guarantee in legislation, premier, set the path forward! Sign an Action Alert! Call on the premier to enshrine in legislation RNAO’s Nursing Home Basic Care Guarantee.

Let’s Talk About Anti-Black Racism and Discrimination in Nursing

Sep 20, 2021, 2:30pm - 4:00pm

This is a webinar series designed for members of the public interested in receiving updates on RNAO’s Black Nurses Task Force and to engage them in meaningful conversations that will inform the work of the Task Force. The Black Nurses Task Force has a mandate to tackle anti-Black racism and discrimination within the nursing profession.

Upcoming webinar

Sept. 20, 2021, 2:30-4:00 pm

Topic: The Lived Experiences of Black Nurses Using Mental Health Services in Ontario


Dania Versailles, RN, MScN, CPMHN (C), Director of Clinical Services of Outreach, Canadian Mental Health Association – Ottawa

Register now.

Watch and read about earlier webinars here.

Indigenous Mental Wellness Webinar

Sep 22, 2021, 7:00pm - 9:00pm

This webinar is in partnership with the RNAO, Nishnawbe Aski Nation (NAN), Chiefs of Ontario (COO), the Centre for Addiction and Mental Health (CAMH) Shkaabe Makwa, the Canadian Indigenous Nurses Association (CINA) and Ontario First Nation Young Peoples Council (OFNYPC). 

The First Nations Mental Wellness Framework (FNMWC) will provide a foundation for this presentation as it provides guidance for addressing the unique needs of First Nations from within the social determinants of health. Understanding the link between trauma and unique needs of First Nations will enable more effective policies and culturally safe program support. Building from the inherent strengths of individuals provides a starting place to come together on a journey of wellness.

This webinar will offer two discussions: one on problematic substance use and a second on child and youth mental wellness. Each presentation will be 40 minutes and offer the participants:

  • a description of the link to the FNMWC as a way of addressing problem statements and assumptions
  • key factors influencing culturally safe services 
  • recommendations for achieving Indigenous wellness: hope, belonging, meaning and purpose


Carol Hopkins, O.C., MSW LL.D(hons), Chief Executive Officer, Thunderbird Partnership Foundation

Brenda M Restoule, Ph.D., C.Psych, Chief Executive Officer, First Peoples Wellness Circle

Check here for full bios.

Target audience: RNs, NPs, RPNs 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.


Webinar: COVID-19 Webinar Series

Oct 4, 2021, 2:00pm - 4:00pm

When: Every second Monday of the month.

RNAO's CEO Doris Grinspun will be hosting COVID-19 webinars for health providers.

Topics include:

  • updates on COVID-19 and the health system: latest news and pressing issues
  • guest speakers (as available)
  • questions and answers
  • calls to action

Health providers from Ontario, Canada, and anywhere in the world are welcome to join at no cost.

Register now.

Watch the September 13 webinar:

Topic: COVID-19 amidst back to school and a federal election

School is back in session, vaccine mandates and passports are being rolled out, and the federal election is upon us. What does this mean for Ontario nurses, families, teachers, community members and those deciding how to vote on Sept. 20?

Join us for a discussion with RNAO CEO Dr. Doris Grinspun who will share updates, latest news and pressing issues related to COVID-19. Learn how to use RNAO’s non partisan federal election policy platform to inform your election decisions, and hear about current calls to action that support a Just Recovery for All.

Watch the webinar here. See the slides here.

Watch and read about earlier webinars 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 more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here.

Here is a segment from the last Situation Report #516 for September 17:

Case count as of September 17, 2021 / Nombre de cas le 17 septembre 2021

 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


578 048

+  795

9 637

+  5

 No updates today

Staying in touch          

Keeping in touch remains important as we face the pandemic and other challenges in Ontario, in Canada and elsewhere – in particular, in Africa and Latin America – two of the continents most affected by COVID-19 and its variants – delta and lambda. Feeling that we are part of a community and that we have each other’s backs helps us get through these challenges, 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 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 for being there for your community – everywhere and in all roles! Together, in solidarity, we are strong and resilient. In Canada we see hope at the end of this long pandemic tunnel. 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 9 out 10 countries have almost nothing. Like in other challenges we face, such as racism, Islamophobia, and other forms of discrimination, we are not safe until everyone is safe. Vaccines for all – literally for all, across the world – must guide policy in the upcoming 12 months. Let’s learn from the 17-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 political leaders bring about #Vaccines4All!

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


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.

25 July - Action Alert: Mandate COVID-19 vaccination for all health-care workers, premier! – go here.

25 July - Are we preparing for a safe school reopening? – RNAO asks once again – go here.

17 July - Mandatory vaccination for health-care workers – Exploring issues, challenges and supports – go here.

17 July - #FullyVaccinated campaign and mandatory vaccination for health-care workers – go here.

10 July - A Detailed Study of Patients with Long-Haul COVID – go here.

10 July - Prolonged brain dysfunction in COVID-19 survivors – go here.

3 July - RNAO’s continuing media profile: The June report – go here.

3 July - RNAO celebrates virtual 96th Annual General Meeting – go here.

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