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Hello RNAO members, 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 like the one today. 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 #46 here No new documents received today. The number of confirmed cases in Canada reported by EOC today is 97 cases, and one dead. This includes five new cases in Ontario that brings our province to a cumulative total to 41 (of which 5 are resolved cases). All cases in Ontario so far have been travel related; with investigation ongoing to determine the source of infection for one case announced today. EOC reports that in Ontario, at this time, we have 465 persons under investigation with lab results pending. Health Canada reports a total of 103 cases in the country. Since we received the EOC report, media updates indicate the total has grown to 115 (42 in Ontario, 8 in Quebec, 19 in Alberta, and 46 in BC). BC announced today the opening of a 811 call centre to deal with call volumes. The Public Health Agency of Canada today announced a positive case in a Canadian who was repatriated to Canada from the Grand Princess cruise ship. The case was identified during the initial screening and medical assessments conducted when the passengers arrived at the Canadian Forces Base in Trenton, Ontario, where they will complete a 14-day quarantine. Only passengers who did not have symptoms upon boarding were permitted to return to Canada on the flight chartered by the Government of Canada. 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 51 from WHO updates that worldwide there are 118,326 confirmed cases (4,627 new) and 4,292 deaths (280 new) in 114 countries (4 new). The vast majority of the cases are local transmission. There are 10,149 confirmed cases (977 new) in Italy, 8,042 cases in Iran (881 new) and 7,755 confirmed cases in South Korea (242 new). Other countries to note are France (with 1,774), Spain (with 1,639), Germany (with 1,296), Japan (with 568) and Switzerland (with 491). The total number of confirmed cases aboard the Diamond Princess cruise ship is 696. 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 696 confirmed cases in the United States, CSSE reports 1,281. RNAO policy corner Dr. Bruce Aylward is the Newfoundland-born and raised physician who was appointed to lead the World Health Organization's efforts to contain the virus in China in January. In a CBC interview, he says the single biggest challenge we face in terms of preventing the spread of COVID-19 “is a misunderstanding and often a soft-pedaling of this at the level of the population.” He adds that “People are clever. People are concerned about their health. People will do the right things if they have the right information. What we've seen is people are cherry-picking data. So they look at the lowest possible case fatality rates and say, ‘Oh look, it's like seasonal flu.’ Or they pick, ‘Oh it doesn't spread so fast because of this,’ or ‘Oh it only affects the older ones, I'm safe.’ And none of those propositions are true.” He insists there's no reason to panic about this disease, but we have to be deeply concerned. This is not seasonal flu. It's an order of magnitude with tenfold — at least — higher mortality rate. Yes, it does strike vulnerable populations, but it can strike any age, especially between the 30s and 60s and the older population. “If the population understands all those things, it will play ball. And I find the single biggest challenge is the populations aren't always getting clear enough information,” he adds. “The important thing we learned in China, and I think this was a surprise for me and for the really top experts we had on the team, is that you can actually control a virus that spreads through a respiratory route with some old-fashioned public health measures. The virus that we know best in this regard is flu, and it moves so fast. The conventional wisdom is that it's not possible to slow these down this way. What we saw in China was with the rigorous approach and right population measures — that means hand washing, finding the cases, finding their contacts, etc. — you could actually really slow these things down, prevent an awful lot of illness and prevent a lot of deaths. Those lessons are really, really, clear.” That’s why, for Dr. Aylward, the bottom line is that “I expect people to operate on the evidence and reduce the risk.” This is exactly the thinking that RNAO has vigorously advocated for the past several weeks, and repeated over and over in these daily reports. This illness should be taken very seriously, and the communication and preparation should be systematic, intense and focused to be ahead of the curve. Consider that Italy went from 76 cases (lower than the current level in Canada) on 23 February to more than 9,000 today. That’s in a span of only 16 days.Although we should work to avoid the worst, we should not be complacent and consider the potential that in two weeks we could be in the midst of an enormous crisis with thousands of cases, an overwhelmed health system, and a completely paralyzed society. There is no time to lose and no space for those who say “the risk is low.” In the view of RNAO -- the risk is not low, at best is uncertain. In his daily media report, WHO Director-General says he is deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction. WHO has therefore made the assessment that COVID-19 can be characterized as a pandemic. Pandemic is not a word to use lightly or carelessly, he says. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death. Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus, it doesn’t change what WHO is doing, and it doesn’t change what countries should do. We have never before seen a pandemic sparked by a coronavirus. This is the first pandemic caused by a coronavirus, and we have never before seen a pandemic that can be controlled, at the same time. And we have called every day for countries to take urgent and aggressive action. Of the 118,000 cases reported globally in 114 countries, more than 90 percent of cases are in just four countries, and two of those – China and the Republic of Korea - have significantly declining epidemics. 81 countries have not reported any cases, and 57 countries have reported 10 cases or less. We cannot say this loudly enough, or clearly enough, or often enough, says Dr. Tedros: all countries can still change the course of this pandemic. If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission. Even those countries with community transmission or large clusters can turn the tide on this virus. Several countries have demonstrated that this virus can be suppressed and controlled. Dr. Tedros concludes that the challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same – it’s whether they will. Some countries are struggling with a lack of capacity, others with a lack of resources, and others with a lack of resolve. In RNAO’s view, in Canada we have both the capacity and resources. Let’s make sure we also have the resolve to tackle this epidemic before it hits us harder, and so we do it well prepared. To this end RNAO urges government to share publicly its full plan 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 patients, as well as the potential higher volume of COVID-19 compromised patients, 2) community care preparedness (primary care and home care) with virtual care capacity, 3) long-term care and retirement homes active screening and preparedness – which is now happening, 4) PPE evidence-based updated guidelines, and 5) urgent general public education through mainstream media so we can contain or at least delay spread, as well as public engagement 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. RNAO was very pleased to have been asked to review a confidential draft of the Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19. This is a Ministry of Health/ Public Health Ontario guidance document for the use of PPE for inpatient, outpatient and other settings. We did the review in consultation with public health, community and chief nurse executive colleagues – thanks to those of you who supported this work. We are very supportive and pleased with this important updated tool and are eagerly awaiting for its release by EOC. 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. The WHO has provided an excellent link for you to share with members of the public here. RNAO has updated its information page for the public. Please share it widely. As we continue to tackle COVID-19, let’s remain informed, calm and resolved – through collaboration we will tackle the COVID-19 Pandemic together! Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
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