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Registered Nurses' Association of Ontario      

Hello Fellow Nurses and all Health Professional Heroes!  

Without you we are nothing! You keep us updated and well informed of what’s happening in the COVID-19 battlefield. In turn, we keep you updated and bring voice to inform action. So, this is RNAO’s daily communication for Sunday, March 15 – our 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 these updates with other health professionals at home or abroad.

MOH EOC Situational Report #50 here EOC reports that the number of confirmed cases in Canada, today, is 247 cases, and one death. This includes 41 new cases in Ontario, which brings our province to 142 cases (of which 5 are resolved cases). EOC reports that in Ontario, at this time, we have 1316 persons under investigation with lab results pending (as compared to 939 persons on Saturday and 580 persons on Friday). Minister Elliott released, today, a statement regarding elective surgeries. This was followed by a memo from DM Helen Angus, MOH Dr. David Williams and OH CEO Matthew Anderson: See in English and in French.

Media reports a total of: 324 cases of COVID-19 (306 confirmed, 18 presumptive, 11 resolved), in Canada as of March 15, 2020. In Ontario: 145 confirmed (5 cases resolved); British Columbia: 73 confirmed, including one death (6 cases resolved); Alberta: 39 confirmed; Quebec: 39 confirmed; Manitoba: 7 total (4 confirmed, 3 presumptive); New Brunswick: 6 (5 presumptive, 1 confirmed); Saskatchewan: 6 presumptive; Canadians quarantined at CFB Trenton: 4 confirmed; Nova Scotia: 3 presumptive; Prince Edward Island: 1 confirmed; Newfoundland and Labrador: 1 presumptive.

Coronavirus COVID-19 Global Cases by Johns Hopkins -- CSSE reports 339 total cases in Canada as of March 15, at 11: 33 pm.   

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.  Make sure to check the Public Health Ontario technical brief on the 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 55 from WHO updates that worldwide there are 153,517 confirmed cases (10,982 new) and 5,735 deaths (343 new) in 144 countries (9 new). The vast majority of the cases are local transmission. There are 21,157 confirmed cases (3,497 new) in Italy, 12,729 cases in Iran (1,365 new) and 8,162 confirmed cases in South Korea (76 new). Other countries to note are Spain (with 5,753), France (with 4,469), Germany (with 3,795), Switzerland (with 1,359), UK (with 1,144), Japan (with 780), Netherlands (959) and Sweden (924).

You can also find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.

WHO Director-General calls on all countries to take a comprehensive approach: not testing alone, not contact tracing alone, not quarantine alone, not social distancing alone – one must do it all.  He says any country that looks at the experience of other countries with large epidemics and thinks “that won’t happen to us” is making a deadly mistake. It can happen to any country.  The experience of China, the Republic of Korea, Singapore and others clearly demonstrates that aggressive testing and contact tracing -- combined with social distancing measures and community mobilization -- can prevent infections and save lives. Japan is also demonstrating that a whole-of-government approach led by Prime Minister Abe himself, supported by in-depth investigation of clusters, is a critical step in reducing transmission. 

WHO has clear advice for governments, businesses and individuals.

First, prepare and be ready.  Every person must know the signs and symptoms and how to protect themselves and others.  Every health worker should be able to recognize this disease, provide care and know what to do with their patients.  Every health facility should be ready to cope with large numbers of patients, and ensure the safety of staff and patients. 

Second, detect, protect and treat. You can’t fight a virus if you don’t know where it is. Find, isolate, test and treat every case, to break the chains of transmission.  Every case we find and treat limits the expansion of the disease. 

Third, reduce transmission.  Do not just let this fire burn. Isolate the sick and quarantine their contacts. In addition, measures that increase social distancing such as cancelling sporting events may help to reduce transmission. These measures, of course, should be based on local context and risk assessment, and should be time-limited. Even if you cannot stop transmission, you can slow it down and save lives. 

Fourth, innovate and learn. This is a new virus and a new situation. We’re all learning, and we must all find new ways to prevent infections, save lives, and minimize impact. All countries have lessons to share.

There are simple, effective things we can all do to reduce the risk of infection for ourselves and those around us. Clean your hands regularly with soap and water or an alcohol-based rub.  Cover your mouth and nose with your elbow if you cough or sneeze. Stay home if you’re sick.  Avoid unnecessary travel and large social gatherings. Comply with the advice of your local or national health authority. Find and share reliable information.

WHO has issued updated interim guidance on Clinical management of severe acute respiratory infection when COVID-19 infection is suspected. This document is intended for clinicians taking care of hospitalized adult and pediatric patients with severe acute respiratory infection. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen clinical management of these patients and provide to up-to-date guidance. Best practices including infection prevention and control and optimized supportive care for severely ill patients are essential.

RNAO’s ACTIONS:

RNAO is unwavering in our commitment to support Ontarians, all health professionals and in particular nurses and nursing students, and our health system during the COVID-19 pandemic. As you read yesterday, we issued on Thursday, 12 March a survey inviting RNs and NPs to share their availability to provide virtual clinical care or non-clinical services in their communities, when needed given the extraordinary demands created by the COVID-19 pandemic. Colleagues will receive appropriate training and protocols so they can support quality care and outcomes. We have received close to 2,300 responses and are working with Telehealth Ontario for the next deployment that will be to the Telehealth offices in North Bay and in London. To the nurses that responded, please know we THANK you hugely! We commit to keeping you fully informed.

Call to RNs & NPs: The survey will close tomorrow, Monday. If you are interested in getting involved, please CLICK HERE to complete our survey.

Note for employers in Public Health Units: If you are experiencing a staff shortage to answer phone calls following protocols, please let us know. Write to dgrinspun@rnao.ca and Daniel Lau dlau@rnao.ca and we will connect you within hours with RNs and NPs in your locality as we already did with Ottawa Public Health who over the weekend was on-boarding colleagues to work. THANKS, Daniel Lau from RNAO, Nurses who responded, and Esther Moghadam – CNE at Ottawa Public Health Unit for the stellar team work and leadership! Colleagues, together we will get through this pandemic – We are here for you!

URGENT STEPS FOR GOVERNMENT TO TAKE: RNAO’s VOICE

Strict social distancing. RNAO asks each of you to actively educate your family, friends and the public about the role of social distancing in slowing down community transmission in Ontario. Even if the number of people infected by the virus continues to climb, a slowdown in the progression can do a life-and-death difference for the healthcare system. As the tragic situation in Italy demonstrates, an overwhelmed healthcare system can have devastating implications for many people, particularly those vulnerable and sick. Italy has so far the highest rate of death with COVID-19 outside of China; it appears this is related to the incapacity of health services to respond to an explosive number of cases in a short period of time. Social distancing can slow down dramatically the spread of the virus and thus allow healthcare institutions to better respond by reducing the number of people requiring care at a particular time. An article in the Toronto Star reports on research about the effectiveness of social distancing during the 1918 Spanish flu in the United States. The city of St. Louis shut down public gatherings quickly when the flu hit. In contrast, the city of Philadelphia held a parade and saw death rates spike. The researchers found that US cities that acted quickly to shut down schools, churches, and ban social gatherings had peak death rates about 50 per cent lower than cities that didn’t and had “less-steep epidemic curves.”

Massive public education and enrollment. RNAO has been urging government for weeks to engage in large-scale public education through mainstream media to slow down community spread – which buys us time for the health system to respond. To assist on this effort, RNAO is retweeting government messages and we ask you do the same. We are also engaged in our own social media education, as well as public education through our website and though the media (please take a minute to watch and retweet).

We are pleased that the Government of Ontario announced today a planned approach to ramping down elective surgeries. RNAO has called for ready-to-go plans for postponement of elective surgeries and opening new emergency, step-down and ICU beds in our hospitals. There is a distinct possibility that the capacity of hospitals will be tested with possibly large number of patients arriving in emergency departments with severe respiratory infection. RNAO is calling to speed-up plans for postponement of elected surgeries, the redeployment of medical personnel and the opening of new emergency and ICU beds ready to receive those patients. RNAO believes that with ready-to-go plans now – RNs, NPs and physicians could be temporarily re-deployed and receive training to treat the specific conditions presented by COVID-19 and the required procedures and protocols – even if that’s not their specialty. These plans and essential training and preparation cannot wait until we have hundreds or thousands of critically sick patients arriving at Emergency. They must happen now so we can trigger execution if and when required. Better safe than sorry – that should be the call.  

Canada cannot and should not be caught in a tragedy such as the one unfolding in Italy. We have had plenty of time to plan and we are now working on “borrowed time.” An article in The Lancet published yesterday provides evidence for the “now grave concern regarding the Italian national health system's capacity to effectively respond to the needs of patients who are infected and require intensive care for SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be 30 000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed by mid-April, 2020.”

Colleagues, we urge you to continue to educate yourself and others on how to diminish the risk of transmission and that you act as a role model on social distancing. You can see the WHO recommendations for prevention here.   

Given that community spread already exists, here is an excellent guidance document for homes and residential communities, from the USA Center for Disease Control (CDC). 

At this time, RNAO is urging to replace face-to-face meetings with virtual meetings. RNAO has already moved to do so.  

Please continue to keep in touch and share questions and/or challenges of any kind, and especially shortages of PPE. Send these to me at dgrinspun@rnao.ca. We are responding daily and are solving your challenges. 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, determination and swift actions! 

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

 

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Registered Nurses’ Association of Ontario (RNAO)
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