Wednesday, March 25. A beautiful spring day outside, being robbed from our lives by COVID-19. I was speaking with nurses and doctors in Spain, last night, as they were preparing to vacate non-COVID-19 patients from Vall d'Hebron University Hospital in Barcelona, since most of the hospital becomes COVID-19. One of my colleagues said: “We must keep in mind this is not a bottomless pit, but a tunnel… there is light at the end of it, and we will come out.” We will, my Ontario colleagues. While a good number of you are already in the frontlines of delivering care, and others are at the planning and execution tables, it is most remarkable how we have come together, as a people, like never before.
Yet, not all is ready, especially the essentials to carry this battle with the highest degree of success to sustain lives: ventilators as life-saving equipment, and personal protective equipment (PPE) to keep our health professionals and others facing patients safe. Today, RNAO issued a public statement that I want you to read.
Thanks again for reaching out to us with your experiences and your concerns. Thanks also for your thanks and generosity – it inspires us all! After reviewing and responding to most of today’s issues, PEE availability continues to be the top concern. This is a concern for the protection of nurses, physicians, paramedics, respiratory therapists, midwives, medical laboratory technologists and assistant/technicians, and other health workers, patients, clients and residents. This concern is especially urgent in long-term care, home care, and primary care sites. We address PPE availability towards the bottom of this report.
Today was the seventh day of the #TogetherWeCanDoIt campaign and the noise was loud in various streets, workplaces and social media to #cheer4healthworkers. Please remember this community building moment every evening at 7:30pm local time - until we defeat COVID-19! 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 and enjoy a moment watching the fun pics and videos at #TogetherWeCanDoIt.
MOH EOC Situational Report #60 here for Wednesday, March 25 – EOC reports that the total number of confirmed cases in Canada today is 2,892 cases and 28 deaths. EOC reports 100 new cases that bring our province to a total of 688 cases (this includes eight resolved cases and 13 deaths). EOC reports that in Ontario, at this time, we have 10,489 persons under investigation with lab results pending. EOC reports the following actions taken:
Coronavirus COVID-19 Global Cases by Johns Hopkins -- CSSE reports a total of 688 cases in Ontario and 3,404 total cases in Canada as of March 26 at 2:00 am.
Kudos for the new assessment tool: With the increasing severity of the COVID-19 outbreak, Ontario has now launched an enhanced and interactive self-assessment tool. This new easy-to-use tool takes the public through a series of questions to inform those who are concerned they may have contracted COVID-19. In a matter of seconds, this tool will help people determine if they are negative or it will provide them with guidance on where to seek care based on their needs. Critically, the enhanced tool provides the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. This data will help inform Ontario's ongoing response in order to keep individuals and families safe.
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 64 from WHO updates that worldwide there are 414,179 confirmed cases (40,712 new) and 18,440 deaths (2,202 new). There are 69,176 confirmed cases (5,249 new) in Italy, 51,914 cases in the United States (9,750 new), 24,811 confirmed cases (1,762 new) in Iran, and 39,673 confirmed cases in Spain (6,584 new). Other countries to note are Germany (with 31,554) and France (with 22,025). China has 81,848 cases (with only 101 new), and 9,137 confirmed cases in South Korea (100 new), both countries clearly managing, at this point, to “flatten the curve”. The number of confirmed cases worldwide is close to half 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. There are enormous concerns regarding the impact of the pandemic in refugee camps, conflict zones, slums in large cities, and other populations at extremely high risk around the globe.
You can also find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. These numbers are more updated than those of WHO. While WHO indicates there are 51,914 cases in the United States, CSSE reports 66,132. Worldwide, WHO reports 414,179 while CSSE reports 468,523.
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.
This week 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. This statement has been extremely well received by the healthcare community and the media. Sadly, a patient in the USA self-prescribed himself with Hydroxychloroquine and died.
RNAO Policy Corner:
RNAO welcomed today the economic measures announced today by the Ontario government while cautioning they represent the first essential steps needed to fully confront the outbreak facing the province and its people. This pandemic has exposed gaps in our health system. We applaud the government for responding quickly to help fill the gaps we know exist. However, we are only in the early days and more help is needed, in particular to ensure adequate supplies of personal protective equipment and ventilators. Such health measures include:
RNAO survey on virtual clinical care and non-clinical services. 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 continue to deploy colleagues as requested. We know that you are ready and eager to help and thank you hugely for it!
RNAO survey on critical care services. We need your help. The need for the provision of critical care services is anticipated to likely exceed our current capacity, based on the trajectory other countries have encountered with COVID-19. RNAO is seeking RNs and NPs who are experienced and have continued competency in the provision of critical care health services in Emergency Rooms, Recovery Rooms, Intensive Care Units, Step Down Units or other relevant clinical areas, who are not currently working in these settings, or who are able to increase their hours of work, to share your availability in providing health care services during this unprecedented emergency. RNAO is releasing a survey tomorrow Thursday to establish a registry of the available health human resources in these specialty areas. Please stay tuned for a survey in your email.
The College of Nurses of Ontario (CNO) is working quickly to help support Ontario’s health care system during this unprecedented and rapidly changing situation. To enhance Ontario’s nursing resources, it is expediting registration for non-practicing nurses, including those who have retired or have an expired registration implementing an emergency class for nurses who work or have worked in other jurisdictions in Canada or the U.S. For more details see here.
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: On Monday, RNAO launched its partnership to support LTC homes by facilitating the hiring of nursing students. Our leading team member is Daniel Lau, Director of Membership & Services at RNAO. Soon after RNAO and AdvantAge announced and launched the initiative to connect 2nd, 3rd and 4th year nursing students to work as PSWs in senior's residential care facilities, RNAO has connected 3,706 students with 21 facilities (some students connected to multiple homes which are in close proximity to each other). Within two days, over 135 homes have contacted RNAO looking to augment their human resource capacity to tackle the pandemic. Requests continue to pour in. RNAO is modifying the way students are connected to the facilities to expedite the process in order to provide more timely connection for the high demand. Stay-tuned for an email to you.
The Ontario government informed that it is implementing enhanced measures to protect the safety of residents in long-term care homes. See here for details.
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 firstname.lastname@example.org. We are responding daily and are continuously solving your challenges. RNAO’s Board of Directors and our entire staff want you to know: 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.
Our arsenal of tools to beat COVID-19 includes information – factual, current information. This, is the intent of this report. For those of you that would like to read previous reports at 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.
THANK YOU colleagues in the front lines in Ontario, Canada and in other regions – especially Italy, Spain, Iran and in New York – 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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