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Registered Nurses' Association of Ontario      

Good Friday RNAO members,

A reminder of RNAO’s updated daily communications for this second month of the COVID-19 outbreak in Canada. You are receiving summary updates on Tuesday, Thursday, Saturday and Sunday – inclusive of Ontario’s Ministry of Health’s Emergency Operations Centre (EOC) Situational Report, and World Health Organization (WHO) Situational Report. In addition, you are receiving on Monday, Wednesday and Friday, longer updates such as the one today, inclusive of an RNAO policy corner and more detail.

Brief Update on Repatriated Canadians: Canadians from the Diamond Princess cruise ship, who arrived on Feb. 21 from Japan, are in Cornwall and have 6 days left of their quarantine period. To date, there are no COVID-19 positive cases among the repatriated Canadians from Wuhan who were quarantined at CFB Trenton or who are currently in quarantine at the NAV Centre.

MOH EOC Situational Report #34 here. The number of confirmed cases in Canada reported by EOC is 14, with seven persons in Ontario and seven in British Columbia. In Ontario, at this time, there are 22 persons under investigation with lab results pending. There is, in addition, a first presumptive case in Quebec. We had an excellent meeting today with government officials and are eager to see advanced plans for future scenario planning, including how a potential pandemic (that we still hope can be avoided) may present itself in Canada. Further information will be communicated as the process evolves.

Situation Report 39 from WHO updates that worldwide there are 83,652 confirmed cases (1,358 new) and 2,858 deaths (54 new) in 51 countries (5 new). 75% of the new cases are outside China. There are 2,337 confirmed cases in South Korea (571 new); the majority of the cases were contracted in the country. Other countries to note are Italy (with 650 confirmed cases, 250 new), Iran (with 245), Japan (with 210), and Singapore (with 96). The total number of confirmed cases aboard the Diamond Princess cruise ship is 705. Five new countries (Belarus, Lithuania, Netherlands, New Zealand, and Nigeria) reported cases in the past 24 hours.

WHO has increased the assessment of the risk of spread and risk of impact of COVID-19 at the global level. The continued increase in the number of cases, and the number of affected countries over the last few days, are clearly of concern. Epidemiologists have been monitoring these developments continuously, and WHO has now increased their assessment of the risk of spread and the risk of impact of COVID-19 to very high at a global level. What we see at the moment are linked epidemics of COVID-19 in several countries, but most cases can still be traced to known contacts or clusters of cases. We do not see evidence as yet that the virus is spreading freely in communities. As long as that’s the case, we still have a chance of containing this virus, if robust action is taken to detect cases early, isolate and care for patients and trace contacts. There are different scenarios in different countries, and different scenarios within the same country; however, the key everywhere to containing this virus is to break the chains of transmission.

In his media report today, WHO Director-General Tedros Adhanom Ghebreyesus lists ten basic things we should know about the virus and how to diminish the risk of transmission. I reproduce them in full here:

First, as we keep saying, clean your hands regularly with an alcohol-based hand rub, or wash them with soap and water. Touching your face after touching contaminated surfaces or sick people is one of the ways the virus can be transmitted. By cleaning your hands, you can reduce your risk.

Second, clean surfaces regularly with disinfectant – for example kitchen benches and work desks.

Third, educate yourself about COVID-19. Make sure your information comes from reliable sources – your local or national public health agency, the WHO website, or your local health professional. Everyone should know the symptoms – for most people, it starts with a fever and a dry cough, not a runny nose. Most people will have mild disease and get better without needing any special care.

Fourth, avoid traveling if you have a fever or cough, and if you become sick while on a flight, inform the crew immediately. Once you get home, make contact with a health professional and tell them about where you have been.

Fifth, if you cough or sneeze, do it into your sleeve, or use a tissue. Dispose of the tissue immediately into a closed rubbish bin, and then clean your hands.

Sixth, if you are over 60 years old, or if you have an underlying condition like cardiovascular disease, a respiratory condition or diabetes, you have a higher risk of developing severe disease. You may wish to take extra precautions to avoid crowded areas, or places where you might interact with people who are sick. 

Seventh, for everyone, if you feel unwell, stay at home and call your doctor or local health professional. He or she will ask some questions about your symptoms, where you have been and who you have had contact with.

This will help to make sure you get the right advice, are directed to the right health facility, and will prevent you from infecting others.

Eighth, if you are sick, stay at home, and eat and sleep separately from your family, use different utensils and cutlery to eat.

Ninth, if you develop shortness of breath, call your doctor and seek care immediately.

And tenth, it’s normal and understandable to feel anxious, especially if you live in a country or community that has been affected. Find out what you can do in your community. Discuss how to stay safe with your workplace, school or place of worship.

We finish with Dr. Tedros’ wise words: “Together, we are powerful. Containment starts with you. Our greatest enemy right now is not the virus itself. It’s fear, rumours and stigma. And our greatest assets are facts, reason and solidarity.”

RNAO policy corner

We are calling on you, your colleagues and your organization to enroll into action to protect our valuable PPE stocks, and make sure they are used appropriately and don’t “take legs.”. We need to provide factual and professional information, as well as maintain calm and solidarity. Please 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.

We need to work for the best scenario and be prepared for the worst. WHO has indicated that we are not yet in a pandemic and hard, focused and resolute work around the world may still be able to avoid one. At the same time, we should be planning for the potentiality of a pandemic. There should be, at every level, detailed plans and preparation for such an eventuality.

RNAO hopes that at this time, every agency and institution has a task force specifically addressing these preparations and that chief nurse executives and chief nurse offcer are involved. 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 real 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.

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 ahead of it.

For our nursing and other health professional colleagues in the frontlines of the outbreak at home and abroad, we are with you. 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
Chief Executive Officer, RNAO

 

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