Colleagues, here we are on Monday, March 23 - month three of the COVID-19 outbreak in Canada – a global pandemic of major proportions. To see previous reports 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.
I want to start by thanking you for reaching out to us with your experiences, your concerns and also your thanks. After reviewing and responding to most of today’s issues, PEE availability is undoubtedly today’s top concern. These is a concern for the protection of nurses, physicians, paramedics, midwives, lab technicians, other health workers and patients – with added urgency in long term care, primary care and home care.
Given the extensive community spread of COVID-19, and the evidence that persons, including health workers, became contagious before symptoms appear, one cannot assume that asymptomatic health workers are not spreading the virus. Thus, RNAO is recommending to health officials that all health workers, at this point, should be using surgical masks while at work. Given the limited stocks of masks, this should start in our view in nursing homes and other setting where patient populations are most vulnerable, and, as stocks of surgical masks increase, all health workers in all settings should be using them.
RNAO continues to urge government – in the strongest possible terms – to move aggressively to secure a supply chain for these products. International procurement is not a likely option at this time, as every country in the world is desperate to procure. Thus, government needs to obtain required health care supplies by immediately taking control of the domestic supply chain. Place a prohibition on the commercial sale either by internet or in stores, of a list of healthcare supplies. All privately-held stocks of defined list of supplies (i.e., drugstore chains) should immediately be handed to government through legal order. Most importantly, the federal and provincial governments should be moving at breakneck speed to mobilize technical know-how and production capacity in the private sector to procure the key items required. There is absolutely no time to lose and we should be hearing from both levels of government how they are implementing this. It is an evidence-based statement to say: Lives are on the line. At the end of this nightmare, it will be shocking to see the correlation between the availability of the required PPEs and equipment, such as ventilators, and the death rate. On Saturday, we issued a joint press release of RNAO and OMA RT.
We are working on many fronts. RNAO and OMA met today with the Coalition of Ontario Regulated Health Professions’ Associations (CORHPA) to share our intent to collect any available PPE stock. Indeed, for anyone ready this report – and residing in Ontario – if you have personal protective equipment (PPE*) that you are able to spare, please follow these instructions:
The Ontario government has set up a website where you can disclose the resources you have available.
Please contact firstname.lastname@example.org with the following information: a) Name of organization (college, university, etc); b)Location (please include postal code); c) Phone; d) Email; c) Supplies Available and Quantity.
PPE* includes the following: surgical/procedure masks, N95 masks, gloves, gowns, eye protection).
Today was the fifth day of the #TogetherWeCanDoIt campaign and the noise was even lauder to #cheer4healthworkers. My neighbours and I participated again from our own porches, thus keeping social distance and yet feeling a deep sense of togetherness. Please take a few minutes every day at 7:30pm local time, continuing every evening until we defeat COVID-19! This collective energy will continue to be necessary as we work together to get through this very tough pandemic. So, 7:30 pm local time, each evening, step out onto your porch, balcony or open a window and make some noise in honour of the heroes working on our behalf. You can bang some pots and pans, you can sing a song, you can applaud, ring your bike’s bell, and yes – you can honk. And then, of course, share in social media.
WHO and Global Citizen launched #TogetherAtHome, a virtual, no-contact concert series to promote physical distancing and action for global health. Chris Martin, lead singer of Coldplay, kicked it off earlier this week with a performance from his home. More Solidarity Sessions are planned to promote health, show support for people who are staying at home to protect themselves and others from COVID-19, and encourage donations to the COVID-19 Solidarity Response Fund.
As COVID-19 cases continue to increase, many countries are requesting individuals to stay at home in self-quarantine. WHO EURO has released a guide on how to stay physically active during self-quarantine. Information can be found here.
MOH EOC Situational Report #58 here for Monday, March 23 – EOC reports that the number of confirmed cases in Canada today is 1,508 cases, and 21 deaths including six persons in Ontario. EOC reports 78 new cases that bring our province to a total of 503 cases (of which 8 are resolved cases and 6 deaths). EOC reports that in Ontario, at this time, we have 8,417 persons under investigation with lab results pending. Additional Information from EOC includes:
Coronavirus COVID-19 Global Cases by Johns Hopkins -- CSSE reports a total of 503 cases in Ontario and 2,088 total cases in Canada as of March 22, at 11:50pm.
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).
Health Canada's website 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 63 from WHO updates that worldwide there are 332,930 confirmed cases (40,788 new) and 14,510 deaths (1,727 new). There are 59,138 confirmed cases (5,560 new) in Italy, 21,638 confirmed cases (1,028 new) in Iran, and 28,572 confirmed cases in Spain (3,646 new). Other countries to note are Germany (with 24,774) and France (with 15,821). China has 81,601 cases (with only 103 new), and 8,961 confirmed cases in South Korea (64 new), both countries clearly managing, at this point, to “flatten the curve”. The number of confirmed cases worldwide has reached one third of a million. The virus is now starting to spread in the South Asian and African regions, including many countries with very weak health systems, which is extremely worrisome. Joint Statement of Pharmacist, Nurses and Doctors on untested & potentially dangerous drugs for COVID-19
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 31,573 cases in the United States, CSSE reports 43,901.
Diagnostic testing for COVID-19 is critical to tracking the virus, understanding epidemiology, informing case management, and to suppressing transmission. WHO has updated the Laboratory Testing Strategy document according to the 4Cs transmission scenarios. All technical guidance can be found here.
Today we issued a Joint Statement of Pharmacist, Nurse Practitioner and Doctors on untested & potentially dangerous drugs for COVID-19. Specifically, the statement addresses the use of inappropriate use Hydroxychloroquine and Azithromycin for COVID-19 prophylaxis. Please RT.
WHO Regional Office for Europe has published interim guidance on how to deal with COVID-19 in prisons and other places of detention, available here.
As of today, 4,560 RNs and NPs responded to the RNAO survey with availability to provide virtual clinical care or non-clinical services. We have already deployed 59 to Ottawa Public Health and a good number to other places. RNAO is in the process of working with various other areas of need and will connect with you depending on the locations required. We also understand that Telehealth will necessitate additional staff. We know that you are ready and eager to help and thank you hugely for it!
Note to employers in Public Health Units and other call centres: If you are experiencing a staff shortage to answer phone calls following protocols or contact tracing - please let us know. Write to Daniel Lau email@example.com and we will connect you within hours with RNs and NPs in your locality.
Note to employers in Long Term Care Homes: Today, Monday, RNAO launched its partnership to supports LTC homes by facilitating the hiring of nursing students. Our leading team member for this is Daniel Lau, Director of Membership & Services at RNAO – he and his team connected already nursing students with 19 homes and tomorrow the work will be even more intense. I am inspired by seeing this awesome partnership with AdvantAge Ontario – Kudos to CEO Lisa Levin who reached out to us for support. Now, RNAO’s 5,000-strong nursing student members who completed year one of the BScN program are speedily beginning to move to fill-in spots as Personal Support Workers (PSWs) to increase the homes’ capacity to meet HR needs. We are here to support Nursing Homes that need help! Simply contact Daniel Lau firstname.lastname@example.org and he will connect with nursing students in their 2nd, 3rd and 4th year, that live in the vicinity. For the nursing students, this is an opportunity to put into action their knowledge and skills, gain valuable experience as well as an income, as these will be paid positions. This is another just-in-time service RNAO and AdvantAge provide to the people of Ontario and their members, a win-win-win for all parties.
URGENT STEPS FOR GOVERNMENT TO TAKE: RNAO’s VOICE
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 email@example.com. We are responding daily and are continuously solving your challenges. WE ARE HERE FOR YOU! 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.
Let’s thank our colleagues in the front lines in Ontario, Canada and in other countries – especially Italy, Spain and Iran – now hit the hardest. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!
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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