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Good evening 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 see 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 3 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 #37 here. The number of confirmed cases in Canada reported by EOC this evening is 27, with 18 persons in Ontario, eight in British Columbia, and one in Quebec. For details on the four new cases in Ontario check here. In Ontario, at this time, there are 12 persons under investigation with lab results pending. Minister of Health Christine Elliott announced today it is implementing enhanced measures to safeguard the public from COVID-19. There will be an enhanced response structure that formally brings together a wide range of partners to review, strengthen and implement provincial and regional plans and ensure their responsiveness to the specifics of COVID-19. Local public health units, hospitals, emergency health services, nurses and primary care providers, among others, have been critical in managing the early phases of this new coronavirus. This new structure will tap into an even broader network of clinical expertise, experience and capacity across the health sector to ensure extensive plans are in place to quickly and effectively respond to any and every possible scenario. The new response structure will comprise a number of tables with specific mandates each one (for details, see here). RNAO is heavily involved in the Collaboration Table which provides advice to the Command Table. We will continue to keep you well informed as plans evolve further. Public Health Ontario maintains an excellent resource site on materials on COVID-19. Today I want to emphasize the useful materials on What We Know So Far About… Coronavirus Disease 2019 (COVID-19). “What We Know So Far” documents are intended to provide an overview of knowledge on the subject, done through ongoing scanning of the published literature, scientific reports, as well as media articles. Current topics include: zoonotic origins, infection in children, risks to health care workers, fecal-oral transmission, bloodborne transmission, incubation period, as well as asymptomatic infection and transmission. More generally, the Public Health site is an essential resource for Ontario health providers; I encourage you to visit it. 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. Please note that the Public Health Agency of Canada has released guidance for schools (k-12) and childcare programs (COVID-19), see here. Situation Report 42 from WHO updates that worldwide there are 88,948 confirmed cases (1804 new) and 3,043 deaths (66 new) in 64 countries (6 new). 88% of the new cases are outside China. There are 4,212 confirmed cases in South Korea (476 new). Other countries to note are Italy (with 1,689 confirmed cases, 561 new), Iran (with 978 cases, 385 new), Japan (with 254), Singapore (with 106), 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 706. Six new countries (Armenia, Czechia, Dominican Republic, Luxembourg, Iceland, and Indonesia) reported cases of COVID-19 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. RNAO policy corner In his latest update, WHO Director-General, Dr. Adhanom Ghebreyesus Tedros says that containment remains the top priority for all countries. Management for COVID-19 globally, however, is not a one-size-fits-all approach and must be tailored to the transmission scenario a country faces. Early robust measures are key to saving lives and halting transmission, notes the WHO Director-General. WHO reports that the number of cases in China continues to decline. Yesterday, China reported 206 new cases, the lowest since January 22; only 8 cases were reported outside Hubei province. Outside China, a total of 8739 cases have been reported to WHO from 61 countries, with 127 deaths. The epidemics in the Republic of Korea, Italy, Iran and Japan are the greatest concern. The Republic of Korea has now reported more than 4200 cases and 22 deaths, meaning it has more than half of all cases outside China. However, the cases in the Republic of Korea appear to be coming mostly from suspected cases from the 5 known clusters, rather than the community. That’s important because it indicates that surveillance measures are working and Korea’s epidemic can still be contained. Knowing and understanding your epidemic is the first step to defeating it, says WHO Directors General. Korea’s situation also underlines that this a unique virus with unique features; this virus is not influenza. We are in unchartered territory, says Dr. Tedros. We have never before seen a respiratory pathogen that is capable of community transmission, but which can also be contained with the right measures. If this was an influenza epidemic, we would have expected to see widespread community transmission across the globe by now, and efforts to slow it down or contain it would not be feasible. But containment of COVID-19 is feasible and must remain the top priority for all countries. With early, aggressive measures, countries can stop transmission and save lives. This is not yet a pandemic, but it could become. We need to see this in perspective. Of the 88,913 cases reported globally so far, 90% are in China, mostly in one province. Of the 8739 cases reported outside China, 81% are from four countries. Of the other 57 affected countries, 38 have reported 10 cases or less, 19 have reported only one cases, and a good number of countries have already contained the virus and have not reported in the last two weeks. There is no one-size fits all approach. Different countries are in different scenarios. More than 130 countries have not detected any cases yet, some just received their first cases yesterday, some have clusters of cases, with transmission between family members and other close contacts, some have rapidly expanding epidemics, with signs of community transmission, and some have declining epidemics, and have not reported a case for more than two weeks. Some countries have more than one of these scenarios at the same time. For example, China had community transmission in Wuhan, but relatively small numbers of cases in other provinces. WHO is advising countries on actions they can take for each of the “three Cs” scenarios – first case, first cluster, first evidence of community transmission. The basic actions in each scenario are the same, but the emphasis changes depending on which scenario a country is in. WHO’s message to all countries is: this is not a one-way street. We can push this virus back. 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 before, 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.” Colleagues, 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. Let’s remain informed, calm and resolved – through collaboration we will tackle the COVID-19 challenge together! Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
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