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Hello Nurses and all Health Professional Heroes! To keep you well informed, here is RNAO’s daily communication for Tuesday, March 17 – 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. Today, the province has acted in the right direction. Premier Doug Ford has declared a state of emergency in Ontario, immediately ordering select closures of gatherings above 50 people. The measure announced closes indoor recreation centres, public libraries, private schools, parades, places of worship, licensed day-care centres, cinemas, theatres, concerts and the like until the end of March. Ford announced $304 million in “surge funding” to bolster the health-care system with an additional 75 critical-care beds, 500 post-acute care beds, and another 25 COVID-19 assessment centres at hospitals to keep potential patients out of emergency departments. There will be more resources for monitoring and testing as well as more personal protective equipment like masks, gloves, surgical gowns for healthcare providers as well as more ventilators. Nursing homes will share in the funding to augment infection control measures and cleaning and support in screening staff and visitors for the new coronavirus to help protect the vulnerable residents, who are at high risk for complications like potentially fatal pneumonia. The surge funding includes money for 1,000 nurses and 1,000 personal support workers to help look after COVID-19 patients. See here the various Orders in Council announcements: OC-518, OC-519, OC-520. Colleagues, now more than ever we MUST move forward boldly and practice - as well as demand from others - social distancing, to protect our health professionals and other essential services so they can protect patients and communities. Protecting RNs, RPNs and NPs – and indeed all healthcare workers -- and patients in all sectors during the pandemic is a TOP priority of RNAO, and we are addressing each and every concern identified by you – whether it is about PPE shortages in some primary care clinics, or contradictory messages about the need to self-isolate after traveling. On the latter, we urge you to consider postponing non-emergency travel at this time. First, because we need you here in Ontario, and also because traveling abroad means that upon your return you will need to self- isolate for 14 days – as health professionals in all other Canadian jurisdictions do. MOH EOC Situational Report #52 here – EOC reports that the number of confirmed cases in Canada, today, is 433 (up from 336 cases yesterday and 247 cases on Sunday), and five deaths including an Ontario man from Simcoe Muskoka. In Ontario, EOC reports 9 new cases which as per EOC brings our province to 186 cases (of which 5 are resolved cases). EOC reports that in Ontario, at this time, we have 1,567 persons under investigation with lab results pending. The Society of Obstetricians and Gynaecologists of Canada issued a committee opinion regarding COVID-19 during pregnancy. Information can be found in their website. Guidance for Long-Term Care Homes and Independent Health Facilities have been updated and are available in the Ministry of Health’s website. A checklist for Long-Term Care homes has also been uploaded. Public Health Ontario has updated their site related to COVID-19 testing including an updated list of accepted swab types. Lastly, the Ontario Government website is being updated throughout to reflect the evolving situation, including information about the province’s declaration of a state of emergency. Media Reports Today: 566 confirmed (including 8 deaths, 10 resolved), 30 presumptive. In Ontario: 189 confirmed (including one death and 5 resolved); British Columbia: 186 confirmed (including 7 deaths, 5 resolved); Alberta: 97 confirmed; Quebec: 74 confirmed; Canadians quarantined at CFB Trenton: 8 confirmed; Manitoba: 8 confirmed, 7 presumptive; New Brunswick: 2 confirmed, 6 presumptive; Saskatchewan: 8 presumptive; Nova Scotia: 1 confirmed, 6 presumptive; Newfoundland and Labrador: 3 presumptive; and Prince Edward Island: 1 confirmed. Coronavirus COVID-19 Global Cases by Johns Hopkins -- CSSE reports 596 total cases in Canada as of March 17, 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 179,112 confirmed cases (11,526 new) and 7,426 deaths (475 new). The vast majority of the cases are local transmission. There are 27,980 confirmed cases (3,233 new) in Italy and 8,320 confirmed cases in South Korea (84 new). Other countries to note are Spain (with 9,191), France (with 6,573), Germany (with 6,012), Switzerland (with 2,200), UK (with 1,547) and Netherlands (1,413). China has 81,116 cases (with 39 new). As mentioned yesterday, the total number of cases and deaths outside China, 97,996, 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 3,503 cases in the United States, CSSE reports 6,362. For Iran, WHO reports 14,991 while CSSE reports 16,169. WHO Director-General said today that, with the rapid escalation of cases outside China, there has also been a rapid escalation in social distancing measures, like closing schools and cancelling sporting events and other gatherings. But he is concerned we have not seen an urgent enough escalation in testing, isolation and contact tracing – which is the backbone of the response. Social distancing measures can help to reduce transmission and enable health systems to cope; handwashing and coughing into your elbow can reduce the risk for yourself and others. But on their own, they are not enough to extinguish this pandemic. It’s the combination that makes the difference. He keeps repeating that all countries must take a comprehensive approach. The most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, he says, you must test and isolate. “You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected. We have a simple message for all countries: test, test, test. Test every suspected case. If they test positive, isolate them and find out who they have been in close contact with up to 2 days before they developed symptoms, and test those people too.” [NOTE: WHO recommends testing contacts of confirmed cases only if they show symptoms of COVID-19] 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. As you know, EOC Report yesterday stated: that “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.” However, we hear from you that you have not been contacted. Please know that we are seeking to understand why Telehealth has failed to bring on board colleagues, especially given the very long wait times people are experiencing when calling. We know that you are ready and eager to help and have communicated this to government. 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. Please 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 two new technical guidance documents: Critical preparedness, readiness and response actions for COVID-19 and Risk Communication and Community Engagement (RCCE) Action Plan Guidance. Support for Vulnerable Populations and Workers. Protecting Ontarians experiencing homelessness and those living in crowded shelters are areas we are actively pursuing with government officials, and we are pressing for a plan. We also know that government is meeting with Indigenous leaders to discuss their preparations for COVID-19, and we are eager to hear the outcome of those discussions. We also want to see more measures to protect persons with precarious employment. While we are pleased with the 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, RNAO is urging for much more to be done to assist low-wage earners and those in precarious employment, who may transmit disease simply because they have no option. We believe that workers should not lose their jobs and 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. 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: Please take a second to retweet a YouTube I tweeted on your behalf to our BPSO colleagues in Spain, Chile, Colombia and Peru. Colleagues, 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
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