COVID-19 always discriminates, targeting the frail, the weak, the poor and the vulnerable. Among these are persons experiencing homelessness. We reported earlier on the efforts to protect Toronto’s homeless population from COVID-19. We also emphasized the need to use sentinel surveillance and on-site testing for COVID-19. We continue with an update on work to provide health-care during the pandemic.  

A new COVID-19 facility for persons experiencing homelessness in Toronto

RNAO’s press release yesterday welcomes the announcement from Inner City Health Associates (ICHA) and partners that a dedicated facility for care and treatment of COVID-positive people who are experiencing homelessness in Toronto is imminent. We are thrilled with the news that Médecins Sans Frontières/Doctors Without Borders is bringing its global expertise in dealing with pandemics to Toronto to support ICHA’s efforts to scale up its vital role in providing health care to persons without housing.

While COVID-19 does not respect borders, it does discriminate if it is allowed to do so. Sadly, COVID-19 is and will continue to discriminate against those most vulnerable in our society: residents in nursing homes and retirement homes; correctional facilities, indigenous communities, and persons living in the shelter system. The latter are especially vulnerable because of the impossibility for physical distancing, which only the empowered authorities can urgently and decisively solve by securing adequate space for all. The protection of persons experiencing homelessness is a matter of individual and collective good. While they are confined to crowded shelters at night, during most of the day, our sisters and brothers are out and about. Thus, protecting them is important to ensure their health, that of staff, and that of our communities at large.

The program, funded by the province with municipal and community partnership, will provide health care to many who rely on Toronto's shelters and drop-in centres, bringing to life an innovative, nurse-led, collaborative care program that centres on the need for expert and dignified care of one of our most vulnerable populations. The provincially funded program has three component parts. The first component, CARE, is a risk stratification process that identifies those who are experiencing homeless that are in greatest need of isolation and protection because of pre-existing conditions and illnesses. The second component is a COVID-19 isolation facility for persons under investigation (PUI). The PUI facility is the result of essential interorganizational collaboration between the community health, hospital, public health unit and the City of Toronto. Fifty nurses have been recruited to provide care at the 200-bed facility in west Toronto, along with harm reduction workers from community partners.  

Today’s announcement of the third component of the program is of critical importance. There is clear urgency to bring a COVID-19 positive site online for those experiencing homelessness.  Those who test positive for COVID-19 at the PUI site and other facilities need a place to go to get the care they need. The COVID-19+ isolation centre is intended to be a safe place where people experiencing homelessness can be clinically supported and cared for without fear of spreading the virus to fellow residents and workers in the shelter system, where there is significant vulnerability to the virus. For more details see here and here.

Your messages: Voices and responses

Every day we welcome new readers to this daily report: thank you deeply for the work you do during this public 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 professionals. Feel free to share these updates with other health professionals and other organizations both at home and 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. Many of the articles you see here are posted in my blog, where you can catch up with earlier issues.

Thank you for your messages! Today I focus on one issue, next. You can read earlier responses here. 

Reprocessing of N95 – an update

The questions regarding reprocessing of N95 masks continue so here is an update.

RNAO wishes we would not need to consider this matter. Unfortunately, the reality of PPE shortages, in Ontario, requires having this alternative as a fallback option. Health Canada has developed considerations for the reprocessing of N95 masks. This is in addition to a notice Health Canada issued to industry on April 8^th. Health Canada is expected to move forward this week with approval of decontamination equipment and issuing guidance on this matter.

RNAO has been asked to review a draft document from Health Canada. Although COVID-19 is a novel virus, there are studies of other coronaviruses that can be applied to assess the safety and effectiveness of reprocessing strategies. The draft document states that “Health Canada’s evidence requirements will include sterility assurance; demonstration that respirator filter and fit performance are maintained; evidence that there is no residual chemical hazard related to reprocessing; and ensuring adequate labelling that describes the validated methods and reprocessing conditions applied to the respirator." This correctly identifies the key issues to consider. The expert opinion we have gathered suggests that, properly done, decontamination is not an issue – the virus is eliminated by the methods proposed. The more concerning question is whether reprocessing affects the physical characteristics of the mask eroding proper fit. There also needs to be confirmation there is no residual chemical hazard.  

The research is still ongoing (see, for example, here). Given that testing is done on specific models and brands of mask, there is no assurance that another model or brand will have different results. So guidance should be brand and model specific. RNAO asks for a careful explanation of the basis upon which the reprocessed N95s are being introduced.

RNAO insists that any documentation should address the issues mentioned above. The guidance should specify that the use of reprocessed masks be kept always as a last resort, and not as way to diminish costs. RNAO also strongly recommends the need for proper documentation and training on PPE use that is sector-specific. See my earlier updates here.

MOH EOC Situational Report #79 here for Monday, April 13

 Situation:

• 421 new cases were reported today in Ontario, bringing the cumulative total to 7,470 (this includes 3,357 resolved cases and 291 deaths).
• In Ontario, a total of 108,230 people have been tested, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 1,534 tests under investigation.
• 760 patients are currently hospitalized with COVID-19; 263 are in ICU; and 203 are in ICU on a ventilator.

EOC report #79 for April 13 informs of the following actions taken: 

• The Government of Ontario announced yesterday it is developing a new health data platform called the Pandemic Threat Response (PANTHR) that will allow researchers to better support health system planning and responsiveness, including the immediate need to analyze the current COVID-19 outbreak.
• Today, the Government of Ontario announced progress in procuring critical supplies and equipment to ensure that patients, frontline health care workers and first responders have what they need to protect themselves during the COVID-19 outbreak.
• The Command Table met today; a summary of the discussion is here.
• CMOH Directive #5 shared on April 10 has been uploaded to the ministry’s website.

RNAO’s ViaNurse Program

RNAO launched its COVID-19 ViaNurse program on March 13 and it has already registered 274 nurse practitioners (NPs), 1,000 critical care RNs (who have experience and continued competency in the provision of critical care) as well as 7,155 RNs for virtual/clinical care.

RNAO is actively staffing nursing homes and retirement homes requiring NPs, RN and PSWs; so far, 400 organizations have registered. We have also staffed many hospitals and indigenous communities. We urge CNEs, CNOs, and managers – in all sectors and regions of Ontario - to access this talent now to build HR surge capacity. For details and forms, please go here.

Staying in touch          

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 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 and the rest of the United States, 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
Chief Executive Officer, RNAO  

RECENT RNAO POLICY CORNER ITEMS:

13 April - Practical Tips for Safe Use of Masks – go here.

10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.

10 April - RNAO Action – Supporting Long-Term Care – go here.

10 April - Update For Nursing Students – NCLEX Exam – go here.

9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.

9 April - Guidance on use of N95 mask – go here.

7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.

7 April - Reprocessing of n95 – safe? – go here.

5 April - We must change the way we do testing and case definition – go here.

5 April - Ringing the alarm bells on critical care beds – go here.

4 April - COVID-19, stay at home and domestic violence – go here.

We have posted earlier ones in my blog here. Please go and take a look.

Information Resources

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers. 

Ontario’s health provider website is updated regularly with useful resources here.

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.

The World Health Organization plays a central role in addressing the COVID-19 pandemic. See here and here.

You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.

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