Dear Colleagues:  Welcome to my Saturday, April 18, COVID-19 report. We are now entering the fourth month of COVID-19 in Ontario, and RNAO’s leadership – including our expert staff, board of directors, assembly of leaders and over 44,000 RNs, NPs and nursing students – has been stellar. This level of deep engagement in the front-lines of practice, at the management and executive decision-making tables is worthy of a standing ovation. Albeit virtual, to all of you: BRAVO! You have and continue to be there, day in and day out, for patients and for one another, with knowledge, compassion and courage! Please know, that RNAO, as the professional association for RNs, NPs and nursing students in Ontario, has been at your side and we will continue to do so. Together, we are serving the people of Ontario and our health organizations in an unprecedented way.

For those of you who are new to my blog, or others who wish to see RNAO’s analysis and recommendations throughout the crisis, you can refer to earlier reports here, including thematic pieces in my blog. Feel free to share this report or these links with anyone interested – they are public. As always, a huge thanks to those of you who have submitted invited segments for my blog, and the many nurses and other health professionals who continue to send questions, concerns and solutions. Our team is always eager to respond to each of you individually.

Nursing Now

Nursing Now 2020 has recognized Ontario’s nursing strength before and is doing so again. Nursing Now is a three-year global campaign (2018-2020) that aims to improve health by raising the profile and status of nursing worldwide. Run in collaboration with the World Health Organization and the International Council of Nurses, Nursing Now calls on governments worldwide to place nurses at the heart of tackling 21st century health challenges and maximize their contribution to achieving universal health coverage.

Nursing Now asked RNAO to share our COVID-19 expertise and work with nurses and other health professionals from around the world. The RNAO Nursing Now webinar will take place this coming Wednesday, April 22, at 11am, Toronto time (4 pm, London time). Here is the link for any of you to register. See a description here: https://www.nursingnow.org/covid-19-speaking-out-for-health-speaking-out-for-nursing/

COVID, Trump and the World Health Organization

One of the challenges Canada faces in addressing the pandemic is the resonance of policies south of the border, including the irrationalities of the US health care system and the dysfunctional response of the Trump administration. Today we focus on the latest chapter of the latter.

Considering president Donald Trump’s many irresponsible and perverse actions, it is difficult to match the decision to cut funding to the World Health Organization (WHO) in the midst of a global pandemic. Late on Tuesday president Trump declared US funding would be put on hold for 60-90 days pending a review “to assess the World Health Organization’s role in severely mismanaging and covering up the spread of the coronavirus”.

Leading health experts have labelled Donald Trump’s decision as a “damnable” act that will cost lives. Richard Horton, the brilliant editor-in-chief of the Lancet medical journal, tweeted that Trump’s decision was “a crime against humanity … Every scientist, every health worker, every citizen must resist and rebel against this appalling betrayal of global solidarity.” The move also drew a rebuke from the head of the United Nations, who said the WHO was “absolutely critical to the world’s efforts to win the war against Covid-19”.

Background: The WHO was founded as the UN global health body in 1948 in the aftermath of the Second World War with a mandate to promote global health, protect against infectious disease and to serve the vulnerable. It was inspired by the international sanitary conferences of the 19th century set up to combat communicable diseases such as cholera, yellow fever and plagues. Its current program envisages expanding universal healthcare to a billion more people, protecting another billion from health emergencies and providing a further billion people with better health and wellbeing. In practical terms, the badly underfunded WHO acts as a clearing house for investigation, data and technical recommendations on emerging disease threats such as the coronavirus and Ebola. It also supports eradication of existing diseases such as malaria and polio and promotes global public health.

While its role on emerging diseases is most familiar in the developed world with its more resilient healthcare systems, its practical involvement is far more intense in the global south, where it has been working to expand basic universal healthcare, support vaccination and sustain weak and often stressed health systems through its emergencies programs. Its 2018-9 budget was $4.8bn, which became $5.7bn when emergencies were included. Even before the Trump announcement, the organization was looking at potential cuts to already underfunded programming. Such impacts could be felt in programs already complicated by the coronavirus, such as vaccination for communicable diseases and in building up early warning systems and resilience to deal with diseases such as Ebola in African countries.

President Trump has presented the freezing of US funding to the WHO as a direct response to what he claims was its slow reaction in raising the alarm over the global threat from the coronavirus and being too “China-centric” in its response. But the organization’s funding was already in his sights on 7 February, when his administration was suggesting cutting the US contribution, about $400m annually, by half as part of $3bn cuts to US global health funding across the board. The WHO, to whom the US theoretically contributes roughly 10-15% of its budget as its largest contributor, has been appealing for an extra $1bn to help fight the coronavirus.

Trump’s pronouncement came amid sustained criticism of his failure to prepare for the epidemic, which has infected more than 600,000 people and killed more than 24,000 inside his country. The US is the worst affected country in the world in terms of infection numbers. On Wednesday it was reported that $1,200 relief cheques for as many as 70 million people could be delayed for several days because President Trump wanted his name printed on them.

According to Vox media, President Donald Trump’s failure to respond to the coronavirus pandemic didn’t begin with the administration’s inability to send out the millions of test kits and the protective medical gear for health care workers that experts say are needed to tackle the crisis. It didn’t start with President Trump’s bungled messaging downplaying the crisis even as it’s worsened, nor with his mid-March insistence that social distancing measures could be lifted by Easter (he later backpedaled).

President Tump’s failure to protect the US public began in April 2018 — more than a year and a half before the start of the Covid-19 pandemic. The Trump administration began dismantling the team in charge of pandemic response, firing its leadership and disbanding the team in spring 2018. The cuts, coupled with the administration’s repeated calls to cut the budget for the Centers for Disease Control and Prevention (CDC) and other public health agencies, made it clear that the Trump administration wasn’t prioritizing the response to disease outbreaks. That lack of attention to preparedness, experts say, helps explain why the Trump administration has consistently botched its response to the coronavirus pandemic (lack of preparedness is also a learning for us in Ontario).

 It appears President Trump is following his familiar playbook: finding others to blame amid his own handling of the coronavirus outbreak, which has included calling it the “Chinese virus”, the previous Obama administration and taking aim at state governors.

Take action – One million people have signed the petition: "We condemn President Trump’s decision to suspend funding to the World Health Organization, and urgently call on you to ensure the WHO, and all other international organizations leading the response to this pandemic, are properly funded, and any vaccine or treatment is developed and distributed in a fair and equitable manner. This virus affects us all and we’re in this fight together. We must meet this common threat with cooperation, and our common humanity must shine through in our response." To add your name, go 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! See a letter from the Ottawa Public Health Unit:

I am writing to convey our sincere appreciation for the exceptional support of RNAO during the COVID-19 response… During this challenging time with the COVID-19 pandemic, the RNAO was able to take prompt action to support OPH to accelerate our efforts to build nursing capacity in the early days of the response. Through the partnership of the RNAO’s VIANurse program, OPH was able to quickly enhance its capacity for triaging, test results, case management and contact tracing by an additional 100 nurses, so that service could be provided 7 days a week, without delay…

RNAO’s work with the OPH highlights the importance of collaboration during this crisis and has been very relevant across the province. Within 72 hours of contacting the RNAO, OPH was onboarding RNAO nurses...

…The strength of nurses during this response is remarkable while they put their health and the health of their families at risk to support others. The work of RNAO and nurses support the well-being of all Ontarians and represents the importance of health care in our province and exemplifies how nurses are vital to shaping the health system. You can read earlier responses here.   

MOH EOC Situational Report #82 here for Thursday, April 16 (no report was received on Friday, April 17)

 Situation:

• 514 new cases were reported today in Ontario, bringing the cumulative total to 8,961 (this includes 4,194 resolved cases and 423 deaths).
• In Ontario, a total of 128,093 people have been tested, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 4,323 tests under investigation.
• 807 patients are currently hospitalized with COVID-19; 248 are in ICU; and 200 are in ICU on a ventilator.

EOC report #82 for April 16 informs of the following actions taken: 

• The Government of Ontario announced significant expansions to hospital capacity in preparation for any COVID-19 outbreak scenario.
• The ministry has updated the Quick Reference Public Health Guidance on Testing and Clearance – see here.

RNAO’s ViaNurse Program

RNAO launched its COVID-19 ViaNurse program on March 13 and it has already registered 280 nurse practitioners (NPs), 1,007 critical care RNs (who have experience and continued competency in the provision of critical care) as well as 7,227 RNs for virtual/clinical care.

RNAO is actively staffing nursing homes and retirement homes requiring NPs, RN and PSWs; so far, 415 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:

16 April - A Home Based Model To Confront COVID-19 – The Case Of The Balearic Islands – go here.

15 April - COVID-19 and the Challenges in Homecare – go here.

14 April - Reprocessing Of N95 – An Update – go here.

14 April - A New COVID-19 Facility For Persons Experiencing Homelessness In Toronto – go here. 

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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