Dear Colleagues:  Welcome to my Monday, April 20, COVID-19 report -- now in the fourth month of COVID-19 in Ontario. Last week, I gave each and all of you a standing ovation and virtual BRAVO for being there, day in and day out, for patients and for one another, with knowledge, compassion and courage! Today, I begin the week sharing an inspiring message from one of RNAO’s board members who lives in Thunder Bay:

Dear Doris - I wanted to share how proud I am of my nursing colleagues at Thunder Bay Regional Health Sciences Centre (RNAO Region 12), including Registered Nurses, Nurse Practitioners, Registered Practical Nurses, and nursing students. I would like to recognize, in particular, the efforts of all bedside Registered Nurses and their unit managers (Terri Gurney and Wayne Taylor) in the Cardiac Catheterization Department and 2C In-Patient Cardiology. Well done! So very proud to be a Registered Nurse at Thunder Bay Regional Health Sciences Centre and to work with such intelligent Registered Nurses in cardiology!

Dr. Michael Scarcello, DNP, CNS, RN

The reality is that at RNAO we receive so many awesome messages that I thought – why not share some of these and energize you in the same way they invigorate us. We are adding to our COVID-19 Portal a “Thank a Health Professional” page where we will post all the wonderful messages we receive. If you would like to recognize a health provider, a colleague, a unit, an organization – please email: Sandra Cheverie, scheverie@RNAO.ca

I’ve just mentioned the COVID-19 Portal. At RNAO we have been so active during the COVID crisis that we found ourselves with precious and large amounts of material in our website. Now we have organized it all and put it at your fingertips – please visit us at the COVID-19 Portal. For those of you who are new to my blog, or others who wish to see RNAO’s analysis and recommendations throughout the this pandemic, 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 UK 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/

Can loss of smell and taste help screen for COVID-19? 

The Government of Ontario has announced a $20-million investment for COVID-19 research. While it is important to develop vaccines and treatment, I would like to advocate for potentially an equally important process to protect the vulnerable population – namely, prevention and screening.

COVID-19 is a mysterious disease with high rate of transmission even among individuals with virtually no symptoms. While we are using a myriad of symptoms to screen for those who need to be tested, we still do not have good population data on which symptoms can be specific for COVID-19. Recent news articles and studies from around the world have suggested that loss of smell and taste may be specific and early symptoms for COVID-19. In fact, sometimes rapid onset loss of smell is the only symptom in these individuals. A recent US study has suggested that COVID-19 patients may be at 10 times the risk of having loss of smell. However, these studies are based on small numbers and are not population-based data. 

In Ontario, a research group led by Dr. John Lee from the University of Toronto based out of St. Michael’s Hospital is working on this very project. They are currently using surveys to study both smell and taste in patients who have been tested for COVID-19. While the study is currently focused on the COVID-19 assessment site at St. Michaels’ Hospital, they are hoping to expand this study to partner hospitals and in fact to all Ontario residents who have been tested.  I have high hopes for this study as by using such a simple survey, they can quickly obtain meaningful data to help identify whether we can use smell and taste as cardinal symptoms of COVID-19. This may lead to more effective screening in a very inexpensive manner. I sincerely hope that our government can support research such as this led by Dr. Lee as it may greatly improve our ability to screen for COVID-19 both here and around the world. Contact john.lee@unityhealth.to If you are interested in learning more about this study or if your organization, in Ontario, other parts of Canada or other countries wants to participate.

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. The COVID-19 Portal is here.

One of the reasons I like to write this blog is that it serves to inform, collaborate and share. As you can see we have moved away from only RNAO’s analysis and RNAO’s “asks” to invited pieces and profiling important work that serve to build collective solutions and a #togetherwecandoit approach. We have had important pieces by Dr. David Fisman on testing, surveillance and case definition and Minister of Health Patricia Gomez from Balearic Islands on primary care and homecare as approaches for tackling COVID-19. We received tips for effective use of masks from Dr. Jeff Powis, an infection prevention and control specialist. We profiled Shirley Sharkey on the challenges of homecare during COVID-19, Dr. Aaron Orkin on surveillance and the work of Inner City Health Associates (ICHA) with persons experiencing homelessness (also here), and the lessons from Médecins Sans Frontières from their work overseas. We look forward to continue to profile key work and expand the collaborative network that RNAO believes is at the core of substantive progress on COVID-19 (and anything else). Please send us your ideas for new items and significant questions.

Together we can do it

MOH EOC Situational Report #85 here for Sunday, April 19

 Situation:

568 new cases were reported today in Ontario, bringing the cumulative total to 10,578 (this includes 5,209 resolved cases and 553 deaths).

In Ontario, a total of 156,097 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 5,736 tests under investigation.

809 patients are currently hospitalized with COVID-19; 247 are in ICU; and 196 are in ICU on a ventilator.

EOC report #85 for April 19 informs of the following actions taken: 

The Ministry of Health, Ministry of Long-Term Care, Public Health Ontario, and Ontario Health continue to partner with the health and long term care sector to implement the COVID-19 Action Plan for Long-Term Care. Over the weekend, homes were supported with urgent staffing needs, and pools of workers are being matched to meet the ongoing needs of homes across the province to combat COVID-19. This work is based on risk assessments informed by regional tables, local public health units, the Ministry of Long-Term Care and long-term care homes.

EOC report #84 for April 18 informs of the following actions taken:

The Government of Ontario is investing $20 million to advance medical research and develop tools and resources to combat COVID-19 and other infectious diseases through the Ontario COVID-19 Rapid Research Fund.

RNAO’s ViaNurse Program

RNAO launched its COVID-19 ViaNurse program on March 13 and it has already registered 280 nurse practitioners (NPs), 1,012 critical care RNs (who have experience and continued competency in the provision of critical care) as well as 7,239 RNs for virtual/clinical care.

RNAO is actively staffing nursing homes and retirement homes requiring NPs, RN and PSWs; so far, 418 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 around the world. 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:

18 April - COVID, Trump and the World Health Organization– go here.

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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