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Registered Nurses' Association of Ontario      

Hello RNAO members,

RNAO’s daily communications for this second month of the COVID-19 outbreak in Canada – now a pandemic. 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 #47 here - please review this situational report in detail as it contains links to important information. Also review the following materials 1) CMOH Directive #1 here, 2) Updated IPAC Measures for COVID-19 here, 3) Updated Case Definitions COVID-19 here, and 4) Memo from DM OH CMOH here. The number of confirmed cases in Canada reported by EOC today is 109 cases, and one death. This includes 17 new cases in Ontario (the largest single spike yet), which brings our province to 59 cases (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 yesterday. EOC reports that in Ontario, at this time, we have 536 persons under investigation with lab results pending. A statement was issued today indicating that, based on advice from Dr. David Williams, Ontario's Chief Medical Officer of Health and the experts at the COVID-19 Command Table, the Minister of Education has issued a Ministerial Order to close all publicly funded schools in Ontario for two weeks following March break, in response to the emergence in Ontario of COVID-19.

Health Canada reports  a total of 138 cases in the country, including 59 in Ontario, 46 in BC, 19 in Alberta, 13 in Quebec, and one repatriated Canadian. Saskatchewan, Manitoba and New Brunswick each report one probable case.

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.  Public Health Ontario posted today a technical brief Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 (in English and French).

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 52 from WHO updates that worldwide there are 125,048 confirmed cases (6,729 new) and 4,613 deaths (321 new) in 118 countries (4 new). The vast majority of the cases are local transmission. There are 12,462 confirmed cases (2,313 new) in Italy, 9,000 cases in Iran (958 new) and 7,869 confirmed cases in South Korea (114 new). Other countries to note are France (with 2,269), Spain (with 2,140), Germany (with 1,567), Japan (with 620), Switzerland (with 645), Netherlands (503), Sweden (461) and UK (460).

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 987 confirmed cases in the United States, CSSE reports 1,663.

RNAO policy corner (same as yesterday)

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 is supporting government officials to move full-speed in all fronts. RNAO is actively engaged with government to ensure the fast ramping-up of virtual care and for this we are asking Ontario’s RN and NPs to respond to our survey CLICK HERE (sent also to you as a standalone survey). 

We also continue to urge government to more aggressively engage in public education through mainstream media so we do all we can to delay community spread. We know that government officials are working very hard and we have offered our engagement in any and all that is required. To assist on this effort, RNAO is also engaging in public education through our website and though the media (please take to watch and retweet).

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 sharing the updated guidelines here with you in English and in French

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 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.

Together, we are and will continue to tackle COVID-19 with the best tools at hand: accurate information, calmness and determination. 

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer, RNAO  


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