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Good evening RNAO members, After a fantastic two day training of Best Practice Guideline’s Champions from the East Toronto Health Partners BPSO OHT (Ontario Health Team), my RNAO colleagues and I marvel at their deep commitment and vibrant engagement. At this OHT training we had 110 participants from 17 organizations -- representing all sectors and services. This is the type of committed approach and practice we will need as we continue to tackle the COVID-19 outbreak, now in its second month. Let me apologize for the error in the number of deaths I wrote about in my update from yesterday: it was supposed to say 2,700 (2,666 in China and 34 outside of China). See details on today’s numbers below. I also want to thank several colleagues who have thanked us for tackling boldly and clearly stigmatization and discrimination. With permission of the writer, let me share one colleague’s thoughts: Hi Doris, A short note to say thank you very much for the COVID-19 updates. I am a Registered Nurse and certified Infection Prevention and Control Professional so I get volumes of information and I have enjoyed RNAOs' updates the most! I have enjoyed reading them in quiet every evening. I have been on the front lines in healthcare since 1984 and have lived through many waves of new illness. In 2003, I experienced stigmatization from affiliation as a health care provider. I was on work quarantine during SARs when my children were young and I was kept from my sister for a short time when she was dying of bone cancer just because I worked in a hospital. I am glad you are addressing stigmatization and I really appreciate and embrace your calm and measured approach, thank you! Have a wonderful week! Betty-Jean Macdonald BScN RN CIC -------------------------------------------------------------------------------------------------------------------------- Colleagues, if you see it, stop it! Stigma and discrimination are harmful and diminish us all as decent human beings. It also distracts our precious attention from staying on task, which we must, if we are to conquer this outbreak from spreading even more. Today’s update: Canadians from the Diamond Princess cruise ship, who arrived on Feb. 21 from Japan, are in Cornwall and have 09 days left of their quarantine period. So far all is well and we wish them an easy as possible time, filled with encouragement and good wishes. To date, there are no COVID-19 positive cases among the repatriated Canadians from Wuhan (quarantine completed at CFB Trenton) or at NAV Centre. Attached here is situational report #32 from the Ministry of Health’s Emergency Operations Centre (EOC), received this afternoon. The number of confirmed cases in Canada reported by EOC is 12, with five persons in Ontario and seven in British Columbia. This evening we learned of a new presumptive case in Ontario, and there are 14 persons under investigation with lab results pending. An updated case definition for COVID-19 with new regions of the world where community transmission is ongoing can be found here. This map here illustrates the impacted areas reflected in the updated case definition. A couple of you have asked for advice regarding travelling plans; for this we recommend you check the Health Canada travel advisory Situation Report 37 from the WHO updates that worldwide, there are 81,109 confirmed (871 new) cases and 2,761 deaths (61 new). For the first time there are more new cases outside of China (459) than in China (412). There are 1261 confirmed cases in South Korea (284 new); the majority of the cases were contracted in the country. Other countries to note are Italy (with 322 confirmed cases), Japan (with 164), Iran (with 95) and Singapore (with 91). The total number of confirmed cases aboard the Diamond Princess cruise ship is 691. There are now 38 countries affected by COVID-19 (including China), and four new countries were added in the past 24 hours (Algeria, Austria, Croatia, and Switzerland). Algeria is the first country in the African region. For healthcare workers and public health professionals, WHO has an online course titled Infection Prevention and Control (IPC) for Novel Coronavirus (COVID-19). You can access the course through the following link: https://openwho.org/courses/COVID-19-IPC-EN. This course provides information on what facilities should be doing to prepare to respond to a case of an emerging respiratory virus such as the novel coronavirus. The WHO-China joint mission concluded on 24 February. The team has made a range of findings about the transmissibility of the virus, the severity of disease and the impact of the measures taken. They found that the epidemic peaked and plateaued between the 23rd of January and the 2nd of February, and has been declining steadily since then. They have found that there has been no significant change in the DNA of the virus. They found that the fatality rate is between 2% and 4% in Wuhan, and 0.7% outside Wuhan. They found that for people with mild disease, recovery time is about two weeks, while people with severe or critical disease recover within three to six weeks. The team also estimates that the measures taken in China have averted a significant number of cases. The WHO Director-General also addressed the question of whether the COVID-19 epidemic has now become a pandemic. WHO has already declared a public health emergency of international concern – its highest level of alarm. However, for the moment, we are not witnessing the uncontained global spread of this virus, and we are not witnessing large-scale severe disease or death. So, does this virus have pandemic potential? Absolutely, it has. Are we there yet? From WHO’s assessment, not yet. What we see now are epidemics in different parts of the world, affecting countries in different ways and requiring a tailored response. In terms of how to tackle the spread of the virus, there is no one-size-fits-all approach. Every country must make its own risk assessment for its own context. But there are at least three priorities. First, all countries must prioritize protecting health workers. Second, we must engage communities to protect people who are most at risk of severe disease, particularly the elderly and people with underlying health conditions. And third, we must protect countries that are the most vulnerable, by doing our utmost to contain epidemics in countries with the capacity to do it. RNAO policy corner To ensure we reach most of you and enroll you into action, I want to repeat the message on stigma and discrimination, given the damaging effect they have on persons and on solidarity. Since the emergence of COVID-19 we have seen instances of public stigmatization among specific populations, and the rise of harmful stereotypes. Stigmatization could potentially contribute to more severe health problems, ongoing transmission, and difficulties controlling infectious diseases during an epidemic. The WHO Situation Report 35 provides an excellent guideline that we reproduce in the next few paragraphs. (For more information, visit EPI-WIN.com and download Social Stigma associated with COVID-19 – A guide to preventing and addressing social stigma.) Stigma occurs when people negatively associate an infectious disease, such as COVID-19, with a specific population. In the case of COVID-19, there are an increasing number of reports of public stigmatization against people from areas affected by the epidemic. Unfortunately, this means that people are being labelled, stereotyped, separated, and/or experience loss of status and discrimination because of a potential negative affiliation with the disease. Given that COVID-19 is a new disease, it is understandable that its emergence and spread cause confusion, anxiety and fear among the general public. These factors can give rise to harmful stereotypes. Stigma can drive people to hide the illness to avoid discrimination, prevent people from seeking health care immediately, and discourage them from adopting healthy behaviours. Such barriers could potentially contribute to more severe health problems, ongoing transmission, and difficulties controlling infectious diseases during an infectious disease outbreak. Do your part: Governments, citizens, media, key influencers and communities have an important role to play in preventing and stopping stigma. We all need to be intentional and thoughtful when communicating on social media and other communication platforms, showing supportive behaviors around COVID-19. Here are some examples and tips on possible actions to counter stigmatizing attitudes: • Spreading the facts: Stigma can be heightened by insufficient knowledge about how the new coronavirus disease (COVID-19) is transmitted and treated, and how to prevent infection. • Engaging social influencers such as religious leaders on prompting reflection about people who are stigmatized and how to support them, or respected celebrities to amplify messages that reduce stigma. • Amplify the voices, stories and images of local people who have experienced COVID-19 and have recovered or who have supported a loved one through recovery to emphasize that most people do recover from COVID-19. • Make sure you portray different ethnic groups. Materials should show diverse communities that are being affected, and show communities working together to prevent the spread of COVID-19. • Balanced reporting. Media reporting should be balanced and contextualized, disseminating evidence-based information and helping combat rumour and misinformation that could lead to stigmatisation. • Link up. There are a number of initiatives to address stigma and stereotyping. It is key to link up to these activities to create a movement and a positive environment that shows care and empathy for all. On a separate topic, and as reported in earlier days, with close to 80,000 cases of COVID-19 now confirmed across the globe, experts say the situation will soon reach a critical threshold. The world is fast approaching a tipping point in the spread of the coronavirus, according to experts, who warn that the disease is outpacing efforts to contain it, after major outbreaks forced Italy and Iran to introduce stringent internal travel restrictions and South Korea’s president placed the country on red alert. Some of the countries most affected by the virus are scrambling to halt its progress a few days after the director general of the World Health Organization (WHO), said the international community needed to act quickly before the narrowing “window of opportunity” closed completely. From RNAO’s perspective, although we hope not to face the situation, this means we need to accelerate the preparation for a possible COVID-19 pandemic. The heroic efforts to stop or limit the spread of the virus in China, Japan, South Korea, Italy, Iran and elsewhere have bought time and have slowed down the spread, providing more opportunity for preparations at every level, including assisting countries with weak health systems. In Canada, this preparation should happen at every level – federal, provincial and city governments and agencies, as well as each health care institution. RNAO hopes that at this time, every agency and institution has a task force specifically addressing these preparations. EOC has been fantastic in providing guidance, protocols and resources, while, at the same time, providing a flow of reliable, evidence-based information, maintaining calm, and avoiding negative expressions such as panic, stigma and discrimination. As we envision the possibility of a pandemic, the continuing safeguard of our supplies is more important than ever, so we have these when and if needed. Please continue to remind colleagues that personal protective equipment (PPE) is to be used only when there is a need, as per the EOC guidelines. Health care providers facing immediate supply needs regarding PPE can email the ministry at EOCLogistics.MOH@ontario.ca. A reminder to all to be up-to-date on EOC information: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx I encourage you to review the excellent online courses related to COVID-19 that have been added to the OpenWHO platform: A general introduction to emerging respiratory viruses, including novel coronaviruses Critical Care of Severe Acute Respiratory Infections Health and safety briefing for respiratory diseases - ePROTECT We are here for you and your teams if you have questions and/or experience challenges of any kind, and especially shortages of PPE. Send these emails directly to me at dgrinspun@rnao.ca. We also encourage you to access the health provider hotline and website regarding questions about the outbreak, protocols, preparedness, and more. The toll free number is 1-866-212-2272, and the health provider website, updated regularly with useful resources, can be accessed here. An important reminder that the health provider website and the toll free number are for you – as a health professional – and not for members of the general public. Ontario’s ministry’s public website on the COVID-19 exists to inform the general public – encourage your family and friends to access this public website. We also have information for the public on our website at www.rnao.ca which we update daily. The WHO has provided an excellent link for you to share with members of the public here. This has been and will continue to be an evolving public health emergency and we must keep on top of it. To our health professionals at home, RNAO wants to stress the need not to let your guard down, and continue to protect yourself and educate others to regular respiratory protection practices - see WHO here. This is prime time to get us and the public into healthy habits so these become the norm. For our nursing and other health professional colleagues in the frontlines of the outbreak, in China, South Korea, Italy, Iran, Singapore and other countries, we are with you sending energy and positive thoughts. To our BPSOs abroad, know we are with you and we hope our updates support you – feel free to share these with other health professionals. Warm regards and keep up the fantastic work! Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
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