As I went out today, April 1, 2020, for a twenty minute walk in the evening to clear-up my head, I reflected on this nightmare we are collectively experiencing. Suddenly, I heard a big noise, then another and another! Quickly I realized it was 7:30pm and these were neighbours in an adjacent street, responding to RNAO’s call to #cheer4healthworkers and prove that #togetherwecandoit - meaning, together, and only together, we can get through this. As I walked back home, three teenagers were playing street hockey. They saw me and quickly moved to the other side of the street, so as to keep physical distancing, and waved to me. Cheered up, I waved back at them with thanks. I thought to myself: this is our Canada – a mosaic of collective good that, more often than not, fills us with pride. I come back to this theme in the policy corner below.
As yesterday and the days before, essential supplies and equipment remain a central concern. Earlier this week we heard the federal government is mobilizing industry to fight COVID-19, increasing Canada’s ability to respond to the outbreak with necessary medical equipment and supplies, boosting capacity to manufacture items such as portable ventilators, surgical masks, and rapid testing kits. It is also investing $2 billion to support diagnostic testing and to purchase ventilators and PPE, including for bulk purchases with provinces and territories. Today the Ontario government announced a $50 million fund to help businesses manufacture essential medical supplies and equipment, including gowns, coveralls, masks, face shields, testing equipment and ventilators. The government has recently placed an order with O-Two Medical Technologies who, with the support of Ontario's manufacturing sector, will produce 10,000 ventilator units. Our response to both the prime minister and the premier is: FANTASTIC!!!! Now, we need breakneck delivery timelines as Canadians and healthcare workers’ lives are on the line. Months from now, no equipment or supplies will be of any help – there is not a single day to waste.
RNAO has been at the forefront, pleading to governments to procure PPE and ventilators to protect workers and save lives. We are glad to now see a sense of urgency and we deeply hope that it is not too late. Employers and staff need timelines. For now, they are doing their best to find PPE and arm their workers to carry-on the fight. Today, the Ontario Hospital Association added its voice to the plea for PPE with a statement regarding shortage of PPE.
RNAO has been also proactively leading expected – and now real - nursing human resource shortages related to the COVID-19 emergency. As RNs, NPs and PSWs are going into quarantine, falling sick, and staffing needs are growing. RNAO launched its COVID-19 ViaNurse on March 13 and it has already registered 149 nurse practitioners (NPs), 696 critical care RNs (who have experience and continued competency in the provision of critical care), 5,648 RNs for virtual/clinical care, and is actively staffing any nursing homes needing RN and needing PSWs. We urge CNEs, CNOs, and managers – in any and all sectors and regions of Ontario - to access this talent now - so you are not scrambling later on (see details below).
Every day we welcome new readers to this daily report: thank you deeply for the work you do during this health crisis, and also for keeping us well informed. You can see previous reports at RNAO updates and resources on COVID-19 for members and other health professionalsFeel free to share these updates with other health professionals at home or abroad. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here.
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While RNAO continues to call on federal and provincial governments to aggressively take measures to procure the required PPE, you can also donate PPE items. Please contact Heather McConnell
Today was day #14 of the #TogetherWeCanDoIt campaign (following is our pics for the day!). The noise is becoming louder and louder in streets, workplaces and social media to #cheer4healthworkers. Join-in this community building moment every evening at 7:30pm local time - until we defeat COVID-19! and post tweets from your communities and workplaces with your cheers, lights, claps, songs or pots and pansBecause: #TogetherWeCanDoIt.
MOH EOC Situational Report #67 here for Wednesday, April 1.
EOC reports 426 new cases in Ontario which brings our province to a total of 2,392 cases (this includes 689 resolved cases and 37 deaths). In Ontario, a total of 57,874 people have been tested. There are currently 3,135 tests under investigation. EOC reports the following actions taken:
You can 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. They report a total of 2,392 cases in Ontario and 9,731 total cases in Canada. There are 216,722 cases in the United States, topping China as the country with the largest number globally. Worldwide, there are 951,901 cases.
WHO has released a scientific brief on the off-label use of medicines for COVID-19. A number of medicines have been suggested as potential investigational therapies, many of which are now being or will soon be studied in clinical trials, including the SOLIDARITY trial co-sponsored by WHO and participating countries. More information can be found here.
WHO recognizes the importance of addressing the needs of refugees and migrants when preparing for or responding to the COVID-19 pandemic. WHO European Region has released a guidance document to assist healthcare working with refugees and migrants. More information can be found here.
Other Information Resources
Ontario’s health provider website is updated regularly with useful resources here. An important reminder that the health provider website is for you – as a health professional – and not for members of the general public.
Ontario’s public website on the COVID-19 is there 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.
Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide 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. Data will inform Ontario's ongoing response to keep individuals and families safe.
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.
RNAO policy corner – COVID-19 and the US health care system – Important Read
I mentioned in my introduction a sense of collective good and pride in Canada. This is real when we talk about COVID-19, at least in one powerful sense: nobody in Canada has to worry about paying their test, medical bills and hospitalization if they become sick with the virus. That is not the case south of the border.
Before the COVID-19 pandemic, 27.5 million Americans had no health insurance, but now, many more are at risk of losing their current coverage plans as businesses lay off workers because of COVID-19 physical distancing. States, advocacy organizations and health care professionals are taking steps to ensure that the uninsured can still get testing and treatment, but that hasn’t dissipated the confusion. If there are people who are not getting the screening, testing and treatment because of fear of a bill, that not only endangers themselves but also spreads the virus. In addition to U.S. citizens who lack health insurance coverage, there are also millions of undocumented immigrants who are not eligible. Another 2 million people who live in the 14 states that did not expand Medicaid under the Affordable Care Act also fall into a coverage gap. They are not eligible for Medicaid, but are also ineligible for federal subsidies that make health insurance affordable through the national exchange. In the words of an expert, “A crisis like this, where everyone is at risk and everyone can be affected, highlights the gaps in our health care system in a way that we don’t often see.”
The cost of a test for an uninsured patient could be close to $500 at a doctor’s office, while one at a hospital would likely be at least $1,000. The cost of care if one were to test positive, varies depending on a person’s insurance and its various cost-sharing components. Most insurance plans have deductibles that could be around $1,500 to $2,000. Many plans also have coinsurance charges of roughly 15% to 20%. Individuals who don’t require hospitalization will likely incur relatively small out-of-pocket costs, but patients who do require hospitalization could expect a hefty bill. This could be between $75,000 and $100,000 for 10 days, including hospital stay, drugs and treatments. While insurance – for those who have it – would cover some of that, it almost certainly wouldn’t cover the full price tag.
An independent journalist without health insurance says: “I haven’t gone to the doctor since 2013… Like 27.5 million other Americans, I don’t have health insurance. It’s not for a lack of trying – I make too much to qualify for Medicaid, but not enough to buy a private health insurance plan on the Affordable Care Act exchanges. Since I can’t afford to see a doctor, my healthcare strategy as a 32-year-old uninsured American has been simply to sleep eight hours, eat vegetables, and get daily exercise… When you multiply my situation by 27.5 million, you end up with a country full of people who won’t see a doctor unless they’re extremely sick. And when you combine a for-profit healthcare system – in which only those wealthy enough to get care actually receive it – with a global pandemic, the only outcome will be unmitigated disaster.”
Health Human Resource Capacity – RNAO’s COVID-19 ViaNurse Program
RNAO started its Via Nurse program to recruit RNs, NPs and nursing students on March 13.
As we continue our strong advocacy on the need to expand the capacity of Ontario’s health system to meet emerging health needs in tackling COVID-19, we need your help. The knowledge and skills of RNs, NPs and nursing students are needed to meet a range of health-care needs. For those of you who have already responded to our surveys asking for help, we thank you for your enthusiastic and generous response. Working in collaboration with the Ministry of Health, we are reaching out to RNAO’s network of RNs, NPs and nursing students asking for your willingness and availability. Our surveys/registry remain open for:
If you are available to help, please complete the appropriate survey listed on our COVID-19 webpage.
Critical Care survey
We asked for your help, and got it! We released a survey a week ago 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. We have received responses so far from 696 RNs with experience and continued competency in the provision of critical care. This response, while not unexpected, is truly heartwarming in these difficult times! We are already addressing the needs from several hospitals approaching RNAO for HHR augmentation and connecting these with you so they can proceed with the hiring processes. We have also connected respondents with an indigenous health authority in Northern Ontario who was very appreciative of RNAO’s timely assistance. Many, many thanks for your enthusiastic and generous response. Please note: The survey remains open.
The knowledge and skills of nurse practitioners are needed to increase Ontario’s capacity during the COVID-19 pandemic. NPs with experience, current competency and specialty certificates in primary care, adult care and paediatrics and who are able to return to work if retired or increase their hours of work, are asked in a survey RNAO launched on Friday, March 28 to share their availability in providing health-care services during this unprecedented emergency. Until now 149 NPs have filled out the survey to indicate their willingness and availability to work during the pandemic. The survey remains open.
Virtual and Clinical Care survey
RNAO’s survey on virtual clinical care and non-clinical services: As of today, 5,648 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!
PSW positions for nursing students
RNAO is helping to increase LTC Homes, Seniors’ Housing and Community Service Providers’ capacity to meet human resource needs to tackle the COVID-19 pandemic. The facilities listed in this are looking to fill personal support worker (PSW) positions. These are paid positions. They are looking for second, third or fourth year nursing students to fill these positions. The registry includes 293 senior’s residential care organizations, 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. A number of organizations, including several undergoing an outbreak, have already been served by accessing RNAO’s ViaNurse.
RNAO can help organizations increase their nursing human resource capacity to tackle COVID-19. To request RNs and NPs for your organization, fill out this . RNs and NPs in the city where your organization is located will be connected with you.
To request nursing students in second, third or fourth year for personal support worker (PSW) positions, fill out this and your organization will appear in a where students will select hiring organizations through this registry. (Your home will appear on the registry within 24 hours.) Nursing students will be able search the registry by city and name of the homes.
Worth repeating: COVID-19 and persons experiencing homelessness
RNAO's Director of Policy, Matthew Kellway, has been seconded to serve as Director, Public Affairs for Inner City Health Associates (ICHA). Matt will be working closely with Dr. Andrew Bond, ICHA's Medical Director, Dr Leigh Chapman, ICHA's Director of Nursing and former RNAO Communications Director, Sine MacKinnon. ICHA, who provides health care to many of Toronto's shelters and drop-in centres, has been funded by the province to urgently bring to life an innovative, nurse-led program, to provide care to Toronto's homeless population through this Covid-19 pandemic. Absent urgent intervention, Toronto's shelter system threatens to be the epicentre of this pandemic in the city given the vulnerability of the population and the impossibility of social distancing in existing shelter facilities. I am so proud that ICHA is staffing it's program with RNAO members using RNAO's VIANurse program and I have the utmost confidence in ICHA's commitment to keep its nursing staff as safe as possible as it fulfills its critical mission.
COLLEGE OF NURSES
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.
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!
THANK YOU DEEPLY colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and in other regions – especially New York, Italy, Spain, France, Iran and Germany – 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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