The key factors that will greatly influence the days, weeks, months and perhaps years ahead depend mainly on two priorities. The first is how strongly the Ontario government implements policies aimed at controlling the virus. The second is how fast and effectively vaccination rollouts happen in Ontario, Canada and globally. As RNAO has repeatedly urged, we must keep our eyes on what happens beyond Canada’s borders, as it is the only way to keep down the spread and mutations from happening. The media and the public seem to be blind to what happens in countries such as Brazil, Mexico, South Africa, India and others where the virus is spreading rampant, and where mutations take foot. This affects us all, and it takes only one day for a virus to travel with an asymptomatic passenger. While most mutations may be concerning but may not stop us from progressing to a better future, it is only a question of time until mutations start to weaken the effectiveness of our vaccines. That’s why we must care about the global rollout of vaccinations, as stopping the spread of the virus everywhere will protect all anywhere.

RNAO’ commitment to vulnerable populations precedes this pandemic and will continue forward, as we tackle together the social inequities exposed and deepened by the virus. In doing so, we will be inspired by examples of tremendous strength. One of those is the work of Inner City Health Associates (ICHA). Inner City Health Associates (ICHA) was a group of more than 100 physicians working in over 50 shelters and drop-ins across Toronto until March 2020. Since the onset of the COVID-19 pandemic in Toronto, registered nurses (RNs), registered practical nurses (RPNs) and nurse practitioners (NPs) have joined ICHA in an effort to mitigate the spread of COVID-19 in Toronto shelter settings.

Preparing for the second wave of COVID-19: What is the plan?We proposed a detailed plan of how government must act to make sure the second wave is not a recurrent tragedy. I wrote: “Let me begin by repeating what I have begged government at all levels since January, and in particular from Ontario’s Chief Medical Officer of Health David Williams: We must prepare for the worst and hope for the best. During the first wave of COVID-19 in Ontario, we had it backwards – we hoped for the best, but engaged action late and at a slow pace, thus ending in the middle of the pack.”

Tragically, with over 4,200 new cases today, many ICUs at capacity, and health-care workers beyond exhaustion, RNAO’s concerns regarding the limitations of Ontario policy have been validated. And we have not yet seen the worst of this second wave. The lack of timely and stronger action is the reason we will see consistently over 4,000 new cases daily for the next two weeks, and a number possibly edging as high as 5,000 in February. This is why we continue to urge Premier Ford for immediate action – no time to wait

We have all worked day and night during the COVID-19 pandemic nursing Ontarians in need, supporting nurses and nursing students, and/or engaging with government and other officials. Together we will continue to fight with every ounce of our strength and expertise this unrelenting virus– until we conquer it.

The expanded lockdown measures should be started immediately and not wait until December 25, which appears to be the plan of the Ontario government. Setting December 25 as the starting date is an invitation for exponential growth of community transmission until the measures come into effect. The healthcare system is already under enormous pressure, and some sectors are collapsing, such as long-term care. Non-COVID interventions have been severely reduced or even stopped in many sectors, which will translate in increased morbidity and mortality as a result of cancer, cardiac illness, and other conditions. If the number of COVID-19 hospitalizations continues to increase, we will not be far from a situation where “ethical guidelines” will guide who receives treatment and who does not.

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.

In the midst of an aggressive resurgence of the virus with outbreaks in more than 115 homes (as of Dec. 3, 2020) and more than 2,300 residents losing their lives to COVID-19 since the pandemic began, RNAO is once again urging the government to make staffing, clinical supports and best practices in infection prevention and control measures top priorities.

Nurses and other healthcare workers in the frontlines of Ontario’s COVID-19 pandemic – especially in long term care, but increasingly in other sectors – are experiencing trauma. This is the result of sheer exhaustion, insufficient and late government action leading to escalating spread of COVID-19, episodes of public disregard for the necessary rules to contain the virus, and the excruciating loss of lives. And there is more – the muzzling of healthcare workers’ voices. There are hundreds, if not thousands, of untold stories of devastation, which workers keep for themselves for fear of repercussions.

COVID-19 is running rampant in several communities and decisive government action was essential as the virus continues to spread unabated in the community and the effectiveness of more targeted measures has fizzled. It is unfortunate that the measures announced today are once again incomplete. RNAO continues to call for an aggressive and all-encompassing lockdown, followed by an effective and concerted strategy to snuff out the virus – a “COVID-Zero” strategy. The longer we wait, the more painful these cycles will be.