Hello Fellow Nurses and all Health Professional Heroes!  

As I said yesterday – and it’s worth repeating today: Without you we are nothing! You keep us updated and well informed of what’s happening in the COVID-19 battlefield. You are there – nurses, doctors, pharmacists, midwives, paramedics, clerks, and so many other health professionals in Ontario – serving the public selflessly and without reservation. Please know that we have your backs! RNAO is constantly bringing your voice to inform action – and our voice is getting through with government and becoming public action. The social distancing announcements today represent concrete action that is urgently needed to protect you to do your work.

To keep you well informed, here is RNAO’s daily communication for Monday, March 16 – 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 #51 here – EOC reports that the number of confirmed cases in Canada, today, is 336 (up from 247 cases yesterday), and four deaths (all in BC). This includes 32 new cases in Ontario, which brings our province to 177 cases (of which 5 are resolved cases). EOC reports that in Ontario, at this time, we have 1,537 persons under investigation with lab results pending (as compared to 1,316 on Sunday, 939 persons on Saturday and 580 persons on Friday). Working closely with Telehealth Ontario, Ontario Health and the Registered Nurses’ Association of Ontario, the province has announced it is expanding TeleHealth service capacity to help address the increased daily call volumes and reduce call wait times. Please review carefully the Update on COVID-19 Preparations and Actions here.

Media Reports Today: 425 confirmed (including 4 deaths), 16 presumptive, 10 resolved in Canada as of March 16, 2020 (as compared to a total of 324 cases of COVID-19 yesterday). In Ontario: 177 confirmed (5 cases resolved); British Columbia: 103 confirmed, including four deaths (5 cases resolved); Alberta: 74 confirmed; Quebec: 50 confirmed; Manitoba: 7 confirmed and 1 presumptive; New Brunswick: 2 confirmed and 5 presumptive; Saskatchewan: 2 confirmed and 5 presumptive; Canadians quarantined at CFB Trenton: 8 confirmed; Nova Scotia: 1 confirmed and 4 presumptive; Prince Edward Island: 1 confirmed; Newfoundland and Labrador: 1 presumptive.

Coronavirus COVID-19 Global Cases by Johns Hopkins -- CSSE reports 439 total cases in Canada as of March 16, at 11: 13 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 167,511 confirmed cases (13,903 new) and 6,606 deaths (862 new) in 152 countries (4 new). The vast majority of the cases are local transmission. There are 24,747 confirmed cases (3,590 new) in Italy, 14,991 cases in Iran (2,262 new) and 8,236 confirmed cases in South Korea (74 new). Other countries to note are Spain (with 7,753), France (with 5,380), Germany (with 4,838), Switzerland (with 2,200), UK (with 1,395), Netherlands (1,135) and Belgium (1,085) and Japan (with 814). China has 81,077 cases (with 29 new). For the first time, the total number of cases and deaths outside China, 86,434, has overtaken the total number of cases in China.

You can also find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. These numbers appear to be more updated than those of WHO. For example, while WHO indicates there are 1,678 cases in the United States, CSSE reports 4,661.

Worth Repeting: 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 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:

Endless THANKS to the 3,336 RNs and NPs who responded to the RNAO survey with your availability to provide virtual clinical care or non-clinical services in your communities, when required given the extraordinary demands we face. We have already deployed 59 to Ottawa Public Health and a good number to other places.

Note to employers in Public Health Units and other call centres: If you are experiencing a staff shortage to answer phone calls following protocols, please let us know. Write to Daniel Lau dlau@rnao.ca and we will connect you within hours with RNs and NPs in your locality -We are here for you!

URGENT STEPS FOR GOVERNMENT TO TAKE: RNAO’s VOICE

Strict social distancing. We are pleased that our urgent call was heeded. We now ask each reader of this update to become a #SocialDistance Champion by educating your families, friends, colleagues and members of your community. #SocialdistancingNOW works to slow 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. Please also help neighbours who leave alone, exchange phone numbers with others, and help make sure that social distance doesn’t translate into social isolation.

Massive public education and enrollment. RNAO will continue to urge government to engage in large-scale public education through mainstream media to slow down community spread – this buys time for the health system to respond. 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). On a related matter, WHO issued today two new technical guidance documents: Critical preparedness, readiness and response actions for COVID-19 and Risk Communication and Community Engagement (RCCE) Action Plan Guidance.

Please take a minute to retweet this powerful tweet from Natrice  

We are pleased that the Government of Ontario announced yesterday 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. As  said yesterday, we have had plenty of time to plan and we are now working on “borrowed time.” While we can’t move back in time, I feel very encouraged with the actions by the Ontario government today – and by the tremendous response from the public to engage in social distance and together flatten the curve. An article in The Lancet published on Saturday 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.”

We are very pleased that Public Health Ontario is moving ahead with policies as urged by RNAO for social distancing. Authorities acknowledge community transmission is now a fact at least in Toronto, London and Ottawa. Chief Medical Officer Dr. David Williams told an afternoon news conference today that assessment and testing capacity is being ramped up in the province to deal with the ever-increasing numbers of new cases. Dr. Williams also said all bars and restaurants should close, except for take-out and delivery services. Ontario has already ordered all public schools to stay closed for two weeks after March break, and Dr. Williams is now recommending that all private schools and daycares also close, along with recreation programs, libraries, churches and other places of worship. He said people should not gather in groups larger than 50, in line with a federal recommendation.

We are also pleased with initial measures announced earlier by the premier to protect workers from losing their jobs as businesses suspend operations or they have to stay home to take care of children. However, much more is required to assist low-wage earners and those in precarious employment, who may transmit disease simply because they have no option. Not only workers should not lose their jobs, but also immediate action is required to pause mortgage payments, stop evictions, help with heating bills and provide economic support to those who need it most. As reported by the Canadian Centre for Policy Alternatives, workers face the possibility of getting sick, face reduced hours or even layoffs. Canada’s income support systems need to respond, and make sure sick workers are at home and not working. This matter requires urgent attention from both the federal and provincial governments.

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). 

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.

Colleagues, WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, makes a heartfelt plea for solidarity. He says: “This is the defining global health crisis of our time. The days, weeks and months ahead will be a test of our resolve, a test of our trust in science, and a test of solidarity. Crises like this tend to bring out the best and worst in humanity. Like me, I’m sure you have been touched by the videos of people applauding health workers from their balconies, or the stories of people offering to do grocery shopping for older people in their community. This amazing spirit of human solidarity must become even more infectious than the virus itself. Although we may have to be physically apart from each other for a while, we can come together in ways we never have before. We’re all in this together. And we can only succeed together. So the rule of the game is: together.”

A special shout out from RNAO to our BPSOs in Italy and Spain who are working under incredible stress and exhaustion: We STAND by you and are HERE for you!!!!!!!!!!!!

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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