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Good Sunday 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 you will receive tomorrow, 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 4 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 #36 here. The number of confirmed cases in Canada reported by EOC this evening is 20, with 11 persons in Ontario, eight in British Columbia, and one in Quebec. For details on the three new cases in Ontario check here. In Ontario, at this time, there are 4 persons under investigation with lab results pending. Government is working on scenario planning; including full preparedness for a potential pandemic (that we still hope can be avoided). We expect government officials to update us early this week and will share with you. Public Health Ontario maintains an excellent resource site on materials on COVID-19. It includes important resources for health care providers. Some of the most accessed ones include COVID-19 testing, a daily scan of materials from selected public health organizations, a synopsis of key articles on COVID-19, resources for the public, and more. This site is an essential resource for Ontario health providers; I encourage you to visit its resource site. Another essential resource is Health Canada's website on COVID-19. It 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. This is, again, a vital resource for those following the COVID-19 outbreak in Canada. Situation Report 41 from WHO updates that worldwide there are 87,137 confirmed cases (1739 new) and 2,977 deaths (53 new) in 58 countries (5 new). 67% of the new cases are outside China. There are 3,736 confirmed cases in South Korea (586 new). Other countries to note are Italy (with 1,128 confirmed cases, 240 new), Iran (with 593), Japan (with 239), Singapore (with 102), and France (with 100). In all these countries the main form of transmission is local. The total number of confirmed cases aboard the Diamond Princess cruise ship is 705. Five new countries (Azerbaijan, Ecuador, Ireland, Monaco and Qatar) reported cases in the past 24 hours. Infection prevention and control (IPC) is a major factor in preventive and mitigation measures for COVID-19. To ensure evidence-based quality guidance and prompt response to global demand for personal protective equipment (PPE), WHO has convened the IPC expert global network of specialists from around the world since the beginning of the outbreak. In consultation with this global IPC expert network, WHO has released three key IPC interim guidance materials. One of these is the Rational use of personal protective equipment (PPE) for COVID-19. This document summarizes WHO recommendations for the appropriate use of personal protective equipment (PPE) in health care and community settings, including the handling of cargo. In addition, OpenWHO launched the online course Infection Prevention and Control (IPC) for COVID-19 on 25 February which is being widely used. Please review the proper donning and doffing of PPE; guidelines can be found here. 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. We urge you to continue to educate yourself and others on how to diminish the risk of transmission. I reproduce here, again for those who didn’t see them yesterday, the WHO recommendations for prevention in full: 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.” 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. Onwards we go, to a new week, with calm and resolve to collaborate and be ready to beat this virus! Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
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