Dear Colleagues:  Welcome to my Thursday, May 7, 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.

Counting the missing deaths: Tracking the true toll of the coronavirus outbreak

The official counting of deaths is just a fraction of the real toll of COVID-19 in about every country affected by the pandemic. The New York Times, doing important work, found at that least 60,000 more people have died during the coronavirus pandemic than the official Covid-19 death counts report, a review of mortality data in 15 countries shows — providing a clearer, if still incomplete, picture of the toll of the crisis. Over the last two months, far more people have died in most of these countries than in previous years.

These numbers undermine the notion that many people who have died from the virus may soon have died anyway. In Paris, more than twice the usual number of people have died each day, far more than in the peak of a bad flu season. In New York City, the number has spiked to six times the normal figure. The city has become the epicenter of the outbreak in the United States. More than 30,700 people have died since mid-March — 23,000 more than normal, and 4,300 more than have been captured by official death statistics.

They estimated the excess mortality for each country by comparing the number of people who died from all causes this year with the historical average during the same period. It is unusual for mortality data to be released so quickly, demographers say, but many countries are working to provide more comprehensive and timely information because of the urgency of the coronavirus outbreak. The data is limited and, if anything, excess deaths are underestimated because not all deaths have been reported. The data reflects that most acute side of the situation, primarily through the hospital-based system.

Despite the early data, many European countries have reported clear deviations from normal patterns of deaths, according to data released by the European Mortality Monitoring Project, a research group that collects weekly mortality data from 24 European countries. In Italy, almost 50 percent more people died in March than the average for that month in the last five years, about 25,000 deaths more than normal in a single month. In some countries, like Belgium and France, authorities are working to include Covid-19 deaths outside of hospitals in their daily reports, or adjusting the overall Covid-19 death totals once a death is confirmed in a place like a nursing or retirement home. Others, like Britain’s Office for National Statistics, have started to release mortality data after death certificates have been processed, confirming those that mention Covid-19. This provides a more accurate, if delayed, account of mortality than the hospital figures released each day by Public Health England.

In a handful of countries, including Norway and Denmark, there has been no clear sign of increased mortality this year. Demographers say this is due in part to a less severe flu season this winter — and because these countries implemented early, severe restrictions to slow the spread of the virus when their outbreaks were smaller and easier to contain. Denmark announced a nationwide lockdown on March 11, before it had registered a single confirmed death. Norway announced a lockdown the next day, with just one confirmed death. In comparison to neighboring Sweden, which never implemented a national lockdown, Norway and Denmark have each recorded fewer than 500 Covid-19 deaths. Sweden has tallied over 2,500.

The totals include deaths from Covid-19 as well as those from other causes, likely including people who could not be treated as hospitals became overwhelmed. The article profiles the death of a cancer patient who could not obtain proper attention, describing the situation in the United States. Beds, blood, doctors, nurses and ventilators are in short supply; operating rooms are being turned into intensive care units; and surgeons have been redeployed to treat people who cannot breathe. Even if there is room for other patients, medical centers hesitate to bring them in unless it is absolutely necessary, for fear of infecting them — or of health workers being infected by them. Patients themselves are afraid to set foot in the hospital even if they are really sick. Early on, as the epidemic loomed, many hospitals took the common-sense step of halting elective surgery. Knee replacements, face lifts and most hernias could wait. So could checkups and routine mammograms.

But some conditions fall into a gray zone of medical risk. While they may not be emergencies, many of these illnesses could become life threatening, or if not quickly treated, leave the patient with permanent disability. Doctors and patients alike are confronted with a worrisome future: How long is too long to postpone medical care or treatment?

RNAO’s view: Although the New York Times does not include Canada among the countries studied, the issues and concerns hold as well for our country. Canada doesn’t provide up-to-date death data, so this kind of study may have to wait, but it’s importance does not diminish. It is essential to know the real death toll, including those who are not counted in official statistics. As the pandemic moves to a “new normal,” we need to place focus on the non-COVID patients, the delayed surgeries, and those falling through the cracks of a healthcare system entirely captured by COVID.

Your messages: Voices and responses

Each we receive numerous emails and phone calls. Each day we also 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.

A reader alerts us to Insurance companies discriminate against health care providers

Insurance companies discriminate against health care providers - Insurance companies are screening for professional exposure to COVID-19. I applied earlier this year to The Cooperators Insurance for life insurance. They sent me a questionnaire asking whether I come in contact with COVID patients. Have I been tested or asked to stay home for quarantine? It is wrong and unfair to penalize front line healthcare practitioners and potentially have insurance companies raising premiums at our expense. Can the RNAO take a stand against this? Carol Chagnon, NP. RNAO’s response: Thanks, Carol. RNAO will review this matter with various insurance companies and will update you.

Together we can do it

MOH EOC Situational Report #102 here for Wednesday, May 6

Situation:  

• 412 new cases were reported today in Ontario bringing the cumulative total to 18,722 (this includes 13,222 resolved cases and 1,429 deaths).
• In Ontario, a total of 365,675 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 8,790 tests under investigation.
• 1,032 patients are currently hospitalized with COVID-19; 219 are in ICU; and 174 are in ICU on a ventilator.

EOC report #102 for May 6 informs of the following actions taken:

• The Ontario government announced easing restrictions on retail stores and essential construction during COVID-19. The Ontario government is allowing all retail stores with a street entrance to provide curbside pickup and delivery, as well as in-store payment and purchases at garden centres, nurseries, hardware stores and safety supply stores. The business owners should review the health and safety guidelines developed by the province and its health and safety association partners.
• The Ontario government launched a new website today on pandemic pay. It can be accessed here.

RNAO’s ViaNurse Program               

RNAO’s VIANurse program, launched on March 13, has already registered 7,366 RNs for virtual and clinical care, 1,024 critical care RNs (who have experience and continued competency in the provision of critical care), and 287 NPs. RNAO is continuously responding to requests from health organizations. So far, we have served 283 organizations, of which 215 are nursing homes and retirement residences. 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 HHR 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. The availability of these colleagues is already fastening even more the matching of nursing staff to homes in dire need. For example, between April 20^th and May 4, we deployed RNs, NPs and/or PSWs to 109 organizations, including 102 nursing homes, with some of these organizations having been served multiple times. On Saturday, on a matter of hours from request we responded to the staffing needs of 11 additional organizations. Also important to know is that VIANurse has no backlog requests, and we also respond after hours and on weekends – as we understand the urgency of each request. 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 362 responses: 270 RNs and 39 NPs and 43 nursing students – ready to go to nursing homes in an active outbreak - plus, 10 RNs who can do non-clinical work. These colleagues are being deployed as we speak, including over the weekend.

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:

5 May    - Life on the front lines of the pandemic: Profile of RNAO member NP Daria Gefrerer – go here.

5 May    - Addressing differential access to virtual care due to technology inequities – go here.

3 May    - Being person-and-family-centred during COVID-19 – go here.

1 May    - Migrant agricultural workers and the COVID-19 crisis – go here.

30 April - COVID-19 pandemic in provincial institutions and correctional centres – go here.

28 April - Supporting First Nation Communities during COVID-19 – go here.

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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