Dear Colleagues:  Welcome to my Tuesday, April 28, COVID-19 report – now in the fourth month of COVID-19 in Ontario. For the many resources RNAO offers on COVID-19, visit the COVID-19 Portal. In particular, VIANurse is your go-to page if you need to augment your nursing and personal support worker human resources. You can refer to earlier update reports here, including thematic pieces in my blog. Feel free to share this report or these links with anyone interested – they are public.

Nursing Now – Webinar in Spanish, Thursday, April 30, 3:00 pm (Toronto time)

Nursing Now 2020 has recognized once again 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 – this time in Spanish. The RNAO Nursing Now webinar will take place this coming Thursday, April 30, at 3:00pm, Toronto time (8:00pm, London time and 9:00pm Spain). Here is the link for any of you to register.

Please RT this Nursing Now Tweet.

RNAO’s ongoing call to serve vulnerable populations

Our focus on vulnerable populations continues, since COVID-19 always discriminates, targeting the frail, the weak, the poor and the vulnerable. In particular, we should worry about the threat to underserved communities that are more susceptible to COVID-19 impacts on population health and well-being. This is why, today, we spotlight the valuable work of the Chiefs of Ontario in supporting the needs of First Nations persons and communities during this pandemic to prevent and/or delay the spread of COVID-19.

On behalf of RNAO, we tremendously appreciate the work of Ontario Regional Chief RoseAnne Archibald, Carmen Jones (Director of Health) and their teams for contributing to the article that follows. RNAO joins in partnership with Ontario Chiefs in urging governments and others to immediately heed their call!

Supporting First Nation Communities during COVID-19

In 2019, the Chiefs of Ontario (Health Sector) signed a partnership agreement with RNAO. Given RNAO’s expertise and resources in evidence-based practice and political advocacy at the provincial and federal government levels during this pandemic, Ontario Regional Chief Archibald reached out to RNAO to seek guidance to prevent the worst case scenario in First Nations communities. RNAO has been honoured to heed the Chief’s call.

The Chiefs of Ontario Secretariat under the guidance of the Ontario Regional Chief is supporting local First Nations communities to ensure their safety and well-being during the COVID-19 pandemic.  The Chiefs of Ontario wishes to support and/or enhance and learn more about on-going local efforts in First Nations communities related to their pandemic planning preparation  including: prevention, protection, surveillance and care for their community and peoples. The goal of this support is to prevent the COVID-19 virus from entering communities and to mitigate the spread of the virus, through supporting social distancing and other measures, as well as enhanced testing and surveillance. 

The tragedy that has unfolded in clusters of under-serviced communities in Ontario, such as in the Long-Term Care sector, demonstrates that we must be prepared to manage this pandemic.  The Long-Term Care sector has faced challenges due to the nature of the environment with groups of residents in close proximity, lack of adequate preparation in advance of outbreaks, lack of staffing, lack of protective personal equipment and ineffective and limited on-going resources and support. This in turn has led to a high number of residents contracting and succumbing to this virus. Learning from what has transpired in Long-Term Care, we can work together to prevent the worst-case scenario from unfolding in First Nations communities.

Over the last few weeks, COO and RNAO have been collaborating on the creation of a comprehensive COVID-19 pandemic action plan template, based on current and emerging evidence-based research that can be integrated, adopted or used to enhance current pandemic planning by local communities. The action plan outlines five critical processes to be enacted, which include: (1) Pre-outbreak testing and surveillance; (2) Physical distancing for community, self-isolation and cohorting of cases; (3) Robust case and contact tracing; (4) Universal masking and personal protective equipment (PPE) and; (5) Health-human resource surge capacity. COO and RNAO are seeking First Nations community feedback with both those who have created their own pandemic plans, and others who may have not reached this goal yet. 

COO and RNAO are also liaising with organizations such as First Nation, Inuit Health Branch, and the Ministry of Health-Public Health Division amongst others to provide supports to First Nations communities. At this time, COO and RNAO are actively working towards increasing local community education, creating a streamlined process to maximize access to PPE and test kits, advocating for novel technologies to support universal testing in communities and increasing health human resources, in particular deploying and supporting the long term retention of additional Nurse Practitioners and Registered Nurses to local communities through RNAOs VIANurse. RNAO is about to launch a First Nations community section on the RNAO portal, where you can access documents such as the COVID-19 Action plan template for communities as well as other informative and advocacy resources. We at COO and RNAO are here to support First Nations communities, during this pandemic, to get ahead of the curve. Together we can do it!

RNAO: Once again, I can’t express strongly enough the privilege for me and our team of working closely with Regional Chief RoseAnne Archibald, Carmen Jones and everyone else who is laboring so hard to protect First Nation communities against the ravages of COVID-19. The Chiefs of Ontario updates on COVID-19 are here. Here is an article where Chief Archibald raises concerns about the risks for First Nations. Here is another (and another) informing that Six Nations of the Grand River has lost one of its members to COVID-19. In an earlier article, communities expressed concern that lack of priority to their needs opens the door for outbreaks. Indigenous communities, systemic racism and COVID-19 is discussed here. The impact on urban Indigenous population is presented here. The Government of Canada’s page on COVID-19 for Indigenous Communities is here. Steps taken by the Ontario government are described here.

To the federal and provincial governments, our message is simple: Act now – immediately. Don’t tell us any longer, as I’ve heard so many times, that “we are working together and plans are in place.” RNAO demands that our sisters and brothers be given -- immediately --ample PPE supplies, ample testing kits, and sufficient funding to cover for additional RN and NPs. These supports are essential so that we prevent additional outbreaks and tragedy can be averted. Let’s for once, have Canada provide justice to our sisters and brothers, where justice has been forever denied.  

RNAO’s ViaNurse Program               

RNAO’s VIANurse program, launched on March 13, has already registered 284 NPs, 1,020 critical care RNs (who have experience and continued competency in the provision of critical care) as well as 7,300 RNs for virtual and clinical care. RNAO is continuously responding to requests from health organizations. So far, we have served 255 organizations, of which over 190 are nursing homes and retirement. RNAO has also offered the government to identify NPs and RNs who can help manage LTC organizations that are in crisis, and assist with urgent interventions where severe outbreaks are ongoing. For any nursing HR needs go to RNAO’s VIANurse program

** Seeking RNs, NPs and nursing graduates ready to work in nursing homes in active outbreak

RNAO launched on Friday, April 24^th a fourth survey for RNs, NPs and nursing graduates urging them to register for work in nursing homes that are on an active outbreak. This will fasten even more the matching of nursing staff to homes in dire need. Yesterday we responded, within hours, to the staffing needs of 11 additional organizations. Please retweet the following urgent tweet to have many more RN, NP and new graduates enrolled.  

For those of you ready to work in a nursing home with an outbreak – we need you – please CLICK HERE and complete our survey ASAP. We need your response as soon as possible given the rapidly evolving situation, and the urgent need in nursing homes across the province. The government has now improved the compensation, recognizing your critical role – see Ontario’s press release here.

So far we have got 207 responses: 23 NPs, 176 RNs – ready to go to nursing homes in an active outbreak - plus, 8 RNs who can do non-clinical work such as management. These colleagues are being deployed as we speak, including over the weekend. 

Your messages: Voices and responses

Each day we welcome new readers to this daily report: thank you deeply for the work you do always and especially 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.

• Abby Yuill, BScN RN, writes: “I have a concern regarding washroom access for community health nurses. I am a community health RN working full-time in-home care and have in the past relied on fast food restaurants to use as a public washroom. With the closure of bathrooms due to COVID-19, this has left many of us without access. Some homes we go to are not hygienic, as well as clients are anxious about letting nurses use their washrooms because we are “contaminated” which leads us to quite extreme discomfort during the shift, and/or wasted time to travel home to use our own washroom. Is it possible for fast food restaurants to allow access to public washrooms for nurses/healthcare providers?”
• Wellness Together Canada: Resources for mental health and substance use support. We recognize the significant strain that COVID-19 has placed on individuals and families across the country. Many people are concerned about their physical and mental well being. Canadians are being challenged in a number of ways because of isolation, financial and employment uncertainty and disruptions to daily life. Wellness Together Canada provides tools and resources to help Canadians get back on track. These include modules for addressing low mood, worry, substance use, social isolation and relationship issues.

Together we can do it

MOH EOC Situational Report #94 here for Tuesday, April 28

Situation:  

• 525 new cases were reported today in Ontario, bringing the cumulative total to 15,381 (this includes 8,964 resolved cases and 951 deaths).
• In Ontario, a total of 253,040 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 6,282 tests under investigation.
• 957 patients are currently hospitalized with COVID-19; 239 are in ICU; and 187 are in ICU on a ventilator.

EOC report #94 for April 28 informs of the following actions taken:

• A memo regarding regional COVID-19 staffing response in support of Long-Term Care Homes is here.
• The latest version of the Primary Care Guidance is now available on the ministry’s website.

EOC report #93 for April 27 informs of the following actions taken:

• Friday’s Command Table memo is here.
• Today, the Ontario government released A Framework for Reopening our Province, which outlines the criteria Ontario's Chief Medical Officer of Health and health experts will use to advise the government on the loosening of emergency measures, as well as guiding principles for the safe, gradual reopening of businesses, services and public spaces.
• An amended Primary Care Provider Guidance document is here.  The amended document makes reference to the ‘COVID-19 Patient Screening Guidance Document’ under active screening, and clarifies that the case definition is primarily meant for public health surveillance purposes.
• An updated screening tool for Long-Term Care Homes and Retirement Homes has been uploaded to the website.

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 must redouble our efforts to tackle COVID-19 with the best tools at hand: full, accurate and transparent 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:

27 April - Responses to COVID-19 for persons experiencing homelessness in Toronto: An update – go here.

25 April - Lessons learned through a COVID-19 nursing home outbreak – go here.

25 April - Letter from a retired RN to Premier Ford: The problems with LTC were evident long before COVID – go here.

23 April - Working with seniors in long-term care requires specialized knowledge – go here.

22 April - Shaking the stigma: We need a proactive COVID-19 response for mental health and addiction – go here.

21 April - We Require Expanded and Accessible COVID-19 Data in Ontario – go here.

20 April - Can Loss of Smell and Taste Help Screen for COVID-19? – go here.

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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