Thursday, March 26. I took a walk this evening and was the sole person in the street. I was thrilled to see that people take the “stay at home” seriously. I then began reflecting on what is yet to come and felt myself overwhelmed by the intense feelings of pride about my colleagues in the front-lines of care, and each and every single support staff and administrator behind you. You, working in all sectors and all roles, are the true heroes of this horrible war against COVID-19.
I call this a “war with COVID-19” as I called it back then, in the early 2000s, “a war with SARS” – because a war it is. Although the health system is immensely better coordinated than during SARS, and we, as nurses, have the ear of all – we are still moving at too slow a pace for COVID-19. We are still not assured of the tools to fight this battle and save all the lives we can: ventilators as life-saving equipment, and personal protective equipment (PPE) to keep health providers and patients safe. Yesterday RNAO issued a public statement (read here). My media interviews focused on these key issues of life and death. We will not stand until we are assured we have those life-saving tools. For more on PPEs and ventilators, see later on in this report.
Thanks again for reaching out to us. PEE availability continues to be your top concern, as it relates to the protection of all health professionals and other workers facing patients, clients and residents. Today we heard from a number of nursing homes, several hospitals, and four top home care agencies – all desperate to avail themselves of PPE protection. We are told help is on its way; they need to know when. Thus, once again I wrote a message to Minister Elliott, who always answers, and I hope to have an answer for you in tomorrow’s report.
Today was the eight 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 #61 here for Thursday, March 26 – EOC reports that the total number of confirmed cases in Canada today is 3,849 cases (957 new) and 35 deaths. EOC reports 170 new cases in Ontario which brings our province to a total of 858 cases (this includes eight resolved cases and 13 deaths). EOC reports that in Ontario, at this time, we have 10,965 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 858 cases in Ontario and 4,046 total cases in Canada as of March 26 at 12 midnight.
Kudos for the government’s new assessment tool: 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 helps 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. Please, do become a champion of sharing with as many people as you can about the tool.
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 (including places of worship and funerals).
Situation Report 66 from WHO updates that worldwide there are 462,684 confirmed cases (49,219 new) and 20,834 deaths (2,401 new). There are 74,386 confirmed cases (5,210 new) in Italy, 63,570 cases in the United States (11,656 new), 27,017 confirmed cases (2,206 new) in Iran, and 47,610 confirmed cases in Spain (7,937 new). Other countries to note are Germany (with 36,508) and France (with 24,920). China has 81,961 cases (with only 113 new), and 9,241 confirmed cases in South Korea (104 new), both countries clearly managing, at this point, to “flatten the curve”. The number of confirmed cases worldwide is 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 63,570 cases in the United States, CSSE reports 83,836, topping China as the country with the largest number of cases globally. Worldwide, WHO reports 462,684 while CSSE reports 532,692 cases.
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.
I want to reinforce the statement we issued with our colleagues at the OMA and OPA Joint Statement of Pharmacist, Nurse Practitioner and Doctors on untested & potentially dangerous drugs for COVID-19. Specifically, we addressed the inappropriate use of Hydroxychloroquine and Azithromycin for COVID-19 prophylaxis; please RT. This statement has been extremely well received by the healthcare community and the media. As I shared last night, a patient in the USA self-prescribed himself with Hydroxychloroquine and died.
RNAO Policy Corner
The situation in the United States continues to deteriorate, quickly becoming the focal point of the global pandemic. CNN reports Gov. Andrew Cuomo saying that New York's surge in cases should serve as a warning for the rest of the country. "Where we are today, you will be in three weeks or four weeks or five weeks or six weeks," he said. "What we do here will chart the course." New York has a tally of more than 30,000 cases, several times that of any other state, and the majority of the state's cases are in New York City. Cuomo said 12% of New Yorkers who have tested positive are in the hospital and 3% of those people are in intensive care. Cuomo attributed the high numbers to international tourism and the fact that New Yorkers live and work in close proximity to each other. The state and city are making appeals to the federal government for more medical supplies. New York's hospitals have enough personal protection equipment for only the next two weeks, Cuomo said. The state also needs about 30,000 ventilators. As of noon Wednesday, the state had 4,000 ventilators in hospitals, had 4,000 more on the way from the federal government, had purchased another 7,000 and is "still shopping," the governor said. The ventilators are the "difference between life and death for thousands of New Yorkers," New York City mayor Bill de Blasio said. In addition, the state needs another 140,000 beds and 40,000 intensive care beds, on top of the roughly 53,000 beds it already has, Cuomo has said.
A tragedy is unfolding in New York. A doctor, who spoke to CNN on condition of anonymity out of concern for his job, described a hospital in the city that was woefully unprepared for an influx of Covid-19 patients that started roughly two weeks ago -- which has already stretched the hospital's resources thin and led to severely ill patients outnumbering ventilators. "We don't have the machines, we don't have the beds," the doctor said. "To think that we're in New York City and this is happening," he added. "It's like a third-world country type of scenario. It's mind-blowing."
RNAO surveys on virtual clinical care and non-clinical services.
Virtual care survey
RNAO’s survey on virtual clinical care and non-clinical services: As of today, 5,124 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!
Critical Care survey
We asked for your help, and got it right away – YOU are inspiring! In my update yesterday, I announced that we were releasing a survey today (Thursday, March 26) to establish a registry of the available health human resources in the critical care areas of Emergency Rooms, Recovery Rooms, Intensive Care Units, Step Down Units or other relevant clinical area. Your response was immediate, and strong. Within 12 hours of releasing the survey, we received responses from 470 nurses with experience and continued competency in the provision of critical care health services in these specialty areas. This response, while not unexpected, is truly energizing at these very difficult times! As we receive requests from hospitals in your area, we will make connections so you can start the necessary HR hiring processes. To those of you who already responded: Many, many thanks for your enthusiastic and generous response. To others: The survey remains open.
We created a web page listing the homes that have reached out to RNAO looking to hire PSWs since the initiative was launched on Monday. We sent an email to the nursing students we have on file and provided a link for them to apply to the homes they want to work for. The listing can be searched by city and organization. Students can apply from the page and the DOC or HR person of the home will receive the student’s application and take it from there. Organizations that are not on the list can fill out a web form here and will be added within 24 hours.
This survey is going live at noon on Friday.
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, contact tracing, etc. - 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.
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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