Dear Colleagues:  Welcome to my Thursday, May 14, 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. 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.

RNAO joins its nursing colleagues and the entire health-care community in mourning the death of RN Brian Beattie. Brian, who was 55-years-old, was an expert mental health nurse who worked at Kensington Village. On May 12, 2020, International Nurses Day and the 200th birthday of Florence Nightingale, Brian lost his battle with COVID-19. He is the first Ontario RN to die from the virus. RNAO joins all RNs, NPs and RPNs across the province in a heartfelt thank you to Brian for selflessly caring for our most vulnerable seniors, and ultimately giving his life to ensure the safety of theirs. RNAO sends its deepest condolences to Brian’s personal and work families. Please know that Brian’s legacy of outstanding service will inspire us all to continue fighting COVID-19. Thank you CBC National for honouring RN Brian Beattie in your news.

Nursing Week update

Our Nursing Week activities have been in full swing! All events this year emphasized the critical role of nurses and health professions during COVID-19. Here is a recap of our virtual activities so far:

Monday –  Christine Elliott, Deputy Premier and Minister of Health launched with us Nursing Week (video here). Minister Elliott also visited with us Michael Garron Hospital and heard the accounts of amazing nurses (video here) ● Ian Arthur, MPP Kingston and the Islands, visited KFLA Public Health where we learned of their splendid role on testing and case/contact tracing, as well as the lived experience of clients ●  We ended the day with a COVID-19 Webinar where we heard from five formidable nursing leaders.             

Tuesday – We released RNAO's ECCO 3.0 Report with much media coverage, nursing and health partners (video here) ● Celebrated with ONA and WeRPN the Nursing Now Ontario Awards Ceremony with three awesome winners NP Michael Borja, RN Patric Campeau, and RPN Kelly Karges - and with special guests Minister Christine Elliott and Lord Nigel Crisp, Co-Chair of Nursing Now (video here).

Wednesday – Premier Doug Ford, Minister of Health Christine Elliott, and Minister of Long-term Care Merrilee Fullerton visited West Park Health Care Centre were we heard several outstanding nurses share their expertise ● MPP Mike Schreiner, Ontario Green Party Leader, visited Guelph Community Health Centre (video here) ● Natalia Kusendova, MPP Mississauga Centre, visited Trillium Health Partners (video here).

Today, Thursday – We had the tremendous privilege of taking Prime Minister Justin Trudeau to visit with nurses at Ottawa Public Health where we thanked him for his tremendous leadership working in strong partnership with all the provinces and territories. The Prime Minister also visited with VIANurses to thank them and hear directly from them about their experiences during COVID-19. Chief Nurse Esther Moghadam was as, always, a super star! ● Terence Kernaghan, MPP London North Centre, visited St. Joseph's Health Care London ● Sol Mamakwa, MPP Kiiwetinoong, visited Sandy Lake Nursing Station and Health Centre.     

Tomorrow, Friday, more important events –  Release of the second edition of Oral Health: Supporting Adults Who Require Assistance BPG (register here) ● Three Take Your MPP To Work LIVE events are planned with: Hon. Caroline Mulroney, Minister of Transportation and Minister of Francophone Affairs; Andrea Horwath, Leader, Official Opposition; and Mitzie Hunter, MPP Scarborough – Guildwood. For details go here.

This will end what has been an intense week of events and a roller coaster of emotions. Check RNAO’s Nursing Week portal to watch all past events and register for tomorrow. All events were open for colleagues anywhere in the world, free-of-charge, through Zoom.

Pandemic puts health system to the test: Nurses have answers for shortfalls

On Tuesday RNAO released its major report ECCO 3.0 – Enhancing Community Care for Ontario. It provides the path forward through a comprehensive assessment of the current health system and its fractured response to COVID-19. 

Enhancing Community Care for Ontarians (ECCO) 3.0 was first intended as a call, in the context of Ontario’s health-system transformation, to both government and health-system partners to strengthen community care and anchor the health system in primary care to better meet the needs of all residents. Over the period of its development, ECCO 3.0 has become an urgent response to the need for an integrated health system that can effectively serve Ontarians at all times, even when confronted with a deadly pandemic – COVID-19 – that has ravaged the lives of Ontarians and their communities.

Ontario’s health-system transformation, including the launch of Ontario Health and its now existing 24 Ontario Health Teams (OHT), has been put to the test ahead of schedule. Our response to COVID-19 highlights the work needed ahead to make a marked difference for the people of Ontario, through an integrated system of care. Evidence shows that for the first four months of the COVID-19 pandemic, Ontario’s response was focused mainly on the role of hospitals. All other sectors were an afterthought. This reality must change if we are to fully realize the power of OHTs.

As health officials have pointed out, COVID-19 in Ontario is a tale of two pandemics. One is the management of the spread of the disease in the general population, and its containment though physical distancing, self-isolation and hospitalization, when necessary. Public health officials cautiously shared on April 20, 2020, that community spread had peaked and we were heading down the curve. The second tale of COVID-19 in Ontario is the growing spread in congregate settings – all related to vulnerable populations. RNAO has decried on numerous occasions throughout this pandemic the lack of timely public health action in congregate settings overall, and specifically the devastating effect of COVID-19 on residents of long-term care and retirement homes. On March 22, 2020, we called for the protection of residents with universal masking and pre-outbreak testing. Our call was not heeded until April 8, 2020.

As we write this report, 84 per cent of all lives lost to COVID-19 are residents of Ontario’s long-term care facilities. This is a shocking and tragic reality.

RNAO remains gravely concerned about all other vulnerable populations, including persons experiencing homelessness and living in shelters, persons living in supportive housing, persons housed in correctional facilities, and our Indigenous sisters and brothers. Authorities have been slow to protect these communities, extending histories and reconfirming past neglects.

Ontario Health, the province’s lead health agency, states that its singular focus is to “enable the delivery of better quality health care to every Ontarian while offering the best possible experience at every step along your journey.” RNAO shares this lofty goal, and to achieve it, Ontario must recalibrate its heavy focus on hospital care with much-needed and strengthened community care. This is where ECCO 3.0 is a clarion call for urgent change.

ECCO 1.0 was first released in 2012.6 That first version was discussed with then Minister of Health and Long-Term Care Deb Matthews, and was lauded by then Health Critic for the official opposition, Christine Elliott, and supported by the Leader of the Ontario New Democratic Party, Andrea Horwath. Despite initial praise, there was a lack of movement towards our vision, and RNAO issued ECCO 2.0 in 2014 with an updated human resources transition plan. ECCO 1.0 and 2.0 called on both the government and health-system partners to strengthen community care and anchor the health system in primary care as a means to better meet the health needs of all Ontario residents. Eric Hoskins, Minister of Health in 2014, recognized ECCO 2.0 as a key document that influenced his thinking and his delivery of Putting Patients First, his action plan for better health care, released in 2015.

ECCO 3.0 was first conceived in early 2019, when the Ontario government announced plans to reshape the health system. That announcement renewed RNAO’s hope that reform would focus on enhancing community care in the province as a means of providing services and improving health outcomes for everyone. The idea of OHTs, in particular, had many of the elements included in ECCO.

Now, after almost five months of the COVID-19 pandemic, we urge government – more than ever before and in the strongest possible terms – to incorporate the recommendations of ECCO 3.0 as we all engage in a retrospective analysis of the pandemic. This look into our rearview mirror should help address our health-system performance as well as sector-by-sector successes, failures, experiences and outcomes. We’ve lost too many lives to COVID-19. Let’s make sure those lives were not lost for naught. We owe it to them, to their loved ones, and to so many who sacrificed along the way – starting with our health-care workers – to draw from these lessons that will make for a better health-care system. We need to speed up our health-system transformation – in a revised direction – so we can better respond to people’s needs both in normal times and also during emergencies.

In many respects, RNAO’s call on government and stakeholders remains unchanged in this third version of ECCO. If anything, the current emergency context confirms the need for enhanced community care. Our vision of an accessible, equitable, person-centred, integrated and publicly funded health system will only be realized when we have a fully integrated health system anchored in primary care with enhanced community care capacity. This is a reachable goal with the current health-system reform approach based on OHTs.

In ECCO 3.0, we adapt our model to align with the creation of a single health-system administrator (Ontario Health) and multiple integrated care delivery organizations – OHTs.

The report is divided into three sections. The first sets out the context for the ECCO model, including RNAO’s vision for a healthy Ontario, the current state of our health system, drivers for change, including social and environmental determinants, and ongoing health-system reforms. The second section discusses the ECCO model and its alignment with health-system restructuring. The third section sets out RNAO’s recommendations and actions required to realize health-system reform built around enhanced community care.

The report contains nine system change recommendations and four transition recommendations necessary to move from the current state to the transformed health system. You can read them here.

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.

We have received a number of communications expressing concern regarding the restrictions on pandemic pay to certain groups. Here is a letter from RNAO member Leslie Wight expressing disappointment for not being included in pandemic pay:

As an RN in the role of Health Care Manager at the Algoma Treatment and Remand Centre, I provide guidance and leadership to nursing staff within the health care unit. My office is located within the Health Care unit, and I work side by side with the nurses on a regular basis. With 32 years of nursing experience, I am called upon to provide consultation on complex patients, to investigate concerns brought forward by the Ombudsman, to demonstrate and teach procedures, and to ensure that quality patient care is delivered. This work is not unique to Algoma Treatment and Remand Centre and is common to all Health Care Managers across the province.

With many of our physicians choosing to work from home during the pandemic and preferring to provide care via OTN, I have remained on the front line and have been instrumental in ensuring that nursing staff are adequately trained to support this new technology. It is not unusual for the physician to call upon my expertise when seeing patients via OTN to ensure required assessments are performed when the MD cannot be present to provide hands on care.

Planning for the pandemic has doubled the workload of the Health Care Manager in a currently understaffed and under resourced setting. Contingency planning generally relies on the Health Care Manager’s providing front line care when nursing staff are not available. On regular basis I am called upon to assist with a variety of front-line duties in addition to my leadership duties. This involves spending time in the intake unit and isolation unit providing support and guidance to both officers and nurses on best practices with infection control and the use of Personal Protective Equipment. It is not unusual for me to be in an isolation cell with a patient that is being monitored for the COVID virus and working with the nurses to provide optimal care during this very difficult time. 

I am an extremely dedicated, caring, knowledgeable professional who is working very diligently to prevent and treat illness with our most vulnerable citizens; however, have been grossly overlooked in the pandemic pay initiative.

Sincerely, Leslie Wight, RN

RNAO response: Thanks for writing, Leslie. There is no question that clinical nurse managers, working on the frontlines of care anywhere, should be included in pandemic pay. RNAO has expressed this clearly and forcefully to government, and we will continue to do so.

Together we can do it

MOH EOC Situational Report #110 here for Wednesday, May 14

Situation:    

• 258 new cases were reported today in Ontario, bringing the cumulative total to 21,494 (this includes 16,204 resolved cases and 1,798 deaths).
• In Ontario, a total of 492,487 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 17,578 tests under investigation.
• 1,026 patients are currently hospitalized with COVID-19; 184 are in ICU; and 141 are in ICU on a ventilator.

EOC report #110 for May 14 informs of the following actions taken:

• Updated guidance for Acute Care settings has been posted on the ministry’s website.
• Today, the Ontario government announced the retailers, seasonal businesses and health and community service providers who will be permitted to open or expand their services on Tuesday, May 19, 2020 at 12:01 a.m., provided that the general trend on health indicators continues to improve as part of the first stage of the government's reopening framework. The workplaces opening as part this stage are well-positioned to put workplace safety measures in place and get more people back to work, while not overburdening public transit and other services.
• The testing guidance was updated to expand access to testing for Ontarians who are experiencing symptoms compatible with COVID-19. The symptoms list has also been slightly modified to include myalgia (muscle aches) as an atypical symptom. Both documents are here.

EOC report #109 for May 13 informs of the following actions taken:

• The Ontario government is working together with the province's education sector to voluntarily place available employees in staffing roles needed at congregate care settings during the COVID-19 outbreak. This initiative is part of the government's ongoing efforts to redeploy broader public sector workers to areas where they are needed most, such as hospitals, long-term care homes, retirement homes, women's shelters, and homes serving those with developmental disabilities.
• The Minister of Health issued a statement about multisystem inflammatory vasculitis, indicating Ontario is taking immediate action to better monitor this emerging issue to effectively respond to the illness and protect Ontario's children.
• The Command Table met on Monday; a summary of the discussion is here.

EOC report #108 for May 12 informs of the following actions taken:

• An updated case definition and reference document for symptoms have been posted on the Ministry’s website in English and French. The updated case definition includes consideration for travel within Canada (as well as international travel), and includes updates to the ‘probable’ case definition to include people who were living/working in a facility known to be experiencing an outbreak. The updated symptoms list now includes multisystem inflammatory vasculitis in children. Other guidance documents are currently being updated to align with these changes.
• The Ontario government extended the Declaration of Emergency under the Emergency Management and Civil Protection Act until June 2, 2020. Further information can be found here.
• A memo was sent today (here) to Public Health Units communicating an emergency order authorizing coroners and Public Health Units to access to the provincial Electronic Health Record (EHR) to help in the response to COVID-19.

RNAO’s ViaNurse Program               

RNAO’s VIANurse program, launched on March 13, has already registered 7,404 RNs for virtual and clinical care, 1,027 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 308 organizations, of which 234 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 14, we deployed RNs, NPs and/or PSWs to 134 organizations, including 121 nursing homes, with some of these organizations having been served multiple times. On May 14, on a matter of hours from request we responded to the staffing needs of 3 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.   

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.

So far we have got 387 responses: 284 RNs and 40 NPs and 52 nursing students – ready to go to nursing homes in an active outbreak - plus, 11 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:

11 May - Nurses share their successes and challenges during National Nursing Week – go here.

10 May - A story of hope, ingenuity, support and genuine care for an LTC resident – go here.

7 May    - Counting the missing deaths: Tracking the toll of the coronavirus outbreak – go here.

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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