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Onwards to another week, entering a critical phase of COVID-19 in Ontario, RNAO’s 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 are receiving today, which includes more details. To see previous updates visit RNAO updates and resources on COVID-19 for members and other health professionals. Feel free to share any and all updates with other health professionals at home or abroad. MOH EOC Situational Report #44 here inclusive of six important attachments which we urge you to review and share with other health professionals: 1) LTC ADM Memo, 2) Poster in English for LTC, 3) Poster in French for LTC, 4) DM OH CMOH Memo, 5) Poster for the Public in English, and 6) Poster for the Public in French. The number of confirmed cases in Canada reported by EOC today is 63 cases. This includes a new case reported today in Ontario that brings our province to a cumulative total to 35 (of which 4 are resolved cases). EOC reports that in Ontario, at this time, we have 22 persons under investigation with lab results pending. New cases in Ontario will be announced twice daily, at 10:30am and 5:30pm, in Ontario’s website. It includes relevant information about each of the new cases and this will be updated seven days a week. A news release about this change can be found here. Sadly, COVID-19 claims a first death in BC. This was a man in his 80s who lived at a North Vancouver nursing home and had existing health problems prior to contracting the coronavirus. Since we received the EOC report, media updates indicate a total of 78 COVID-19 cases in Canada (35 in Ontario, 4 in Quebec, 7 in Alberta and 32 in BC). We also have news that the Canadian Government is repatriating Canadians passengers aboard the Grand Princess cruise ship in the eastern seaboard of USA. Public Health Ontario maintains an excellent resource site on materials on COVID-19. This 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. The Public Health Agency of Canada has developed two new guidance documents for health system partners. The first, regarding community-based measures to mitigate the spread in Canada, and the second on informed decision making related to mass gatherings. Situation Report 48 from WHO updates that worldwide there are 109,577 confirmed cases (3,993 new) and 3,809 deaths (225 new) in 105 countries (3 new). The vast majority of the cases are local transmission. There are 7,375 confirmed cases (1,492 new) in Italy, 7,382 confirmed cases in South Korea (248 new) and 6,566 cases in Iran (743 new). Other countries to note are France (with 1,116), Germany (with 1,112), Japan (with 488), Spain (with 589) and Switzerland (with 332). The total number of confirmed cases aboard the Diamond Princess cruise ship is 696. Three new countries (Bangladesh, Albania and Paraguay) have reported cases in the past 24 hours. You can also find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. These numbers appear in some cases to be more updated than those of WHO. For example, while WHO reports 213 confirmed cases in the United States, CSSE reports 607. RNAO policy corner The WHO Director-General in his latest media update, acknowledged that with 100,000 reported cases in 100 countries, the threat of a pandemic has become very real. But given the particular characteristics of this virus, it might be the first pandemic in history that could be controlled. The experience so far shows that decisions made can influence the trajectory of this epidemic, and that with decisive, early action, we can slow down the virus and prevent infections. Among those infected, most recover. Of the 80,000 reported cases in China, more than 70% have been discharged. It’s also important to remember that of all the cases reported globally, 93% are from just four countries. This is an uneven epidemic at the global level, with different countries experiencing different scenarios. It’s not about containment or mitigation, which is a false dichotomy, but about both. All countries must take a comprehensive blended strategy for controlling their epidemics and pushing this deadly virus back. WHO has consolidated guidance for countries in 4 categories: 1) those with no cases; 2) those with sporadic cases; 3) those with clusters; and 4) those with community transmission. For all countries, the aim is the same: stop transmission and prevent the spread of the virus. For the first three categories, countries must focus on finding, testing, treating and isolating individual cases, and following their contacts. In areas with community spread, testing every suspected case and tracing their contacts becomes more challenging. Action must be taken to prevent transmission at the community level to reduce the epidemic to manageable clusters. Depending on their context, countries with community transmission could consider closing schools, cancelling mass gatherings and other measures to reduce exposure. The fundamental elements of the response are the same for all countries: 1) Emergency response mechanisms; 2) Risk communications and public engagement; 3) Case finding and contact tracing; 4) Public health measures such as hand hygiene, respiratory etiquette and social distancing; 5) Laboratory testing; 6) Treating patients and hospital readiness; 7) Infection prevention and control; and 8) An all-of-society, all-of-government approach. There are many examples of countries demonstrating that these measures work. China, Italy, Japan, the Republic of Korea, the United States of America and many others have activated emergency measures. Singapore is a good example of an all-of-government approach – Prime Minister Lee Hsien Loong’s regular videos are helping to explain the risks and reassure people. The Republic of Korea has increased efforts to identify all cases and contacts, including drive-through temperature testing to widen the net and catch cases that might otherwise be missed. Nigeria, Senegal and Ethiopia have strengthened surveillance and diagnostic capacity to find cases quickly. In Canada, we could be on the edge of community spread, and the next two weeks are crucial in the coronavirus fight, says Ontario’s chief medical officer of health, Dr. David Williams. One concern noted is March break travel that will bring its own risks as people transit through airports and foreign locations — particularly with younger children who don’t understand why it’s unwise to touch a handrail and touch their face without washing their hands first. To this end RNAO has been urging for several weeks to prepare all sectors for a possible large-scale spread so we are confident we can effectively respond. Amongst the issues we have raised are the need to: 1) designate hospitals as well as off-site assessment centres so we don’t clog hospitals for their everyday work, and for compromised COVID-19 patients, 2) community care preparedness (primary care and home care) with virtual care capacity, 3) long-term care active screening and preparedness, 4) PPE evidence-based guidelines, and 5) urgent general public education so we can contain or at least delay spread, as well as public preparedness for possible spread and what to do. We know that government officials are working very hard and we have offered our engagement in any and all that is required. Colleagues, we urge you to continue to educate yourself and others on how to diminish the risk of transmission. You can see the WHO recommendations for prevention here. Continue to keep us informed of questions and/or challenges of any kind, and especially shortages of PPE. Send these to me at dgrinspun@rnao.ca. You can also use 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 is all for today. 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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