Dear Colleagues: Welcome to our Friday, July 31 report – now in the sixth month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. You can refer to earlier update reports here, including thematic pieces in my blog. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. As always, feel free to share this report or these links with anyone interested – they are public.

Our continuing response to the crisis in long-term care

RNAO has raised the public profile of the Ontario government’s tabling of a staffing study in long-term care (LTC) due at the end of July under the recommendations of the 2019 Justice Eileen Gillese inquiry. The government tabled yesterday its report and RNAO responded with the  press release below. Please add your voice by re-tweeting this tweet. Also, please continue to sign our action alert here. Nursing home residents, their families and staff can’t wait – we must now begin hiring RN, RPNs, NPs and PSWs. THANKS!

LTC staffing study highlights what RNAO has been saying for two decades: Government must immediately mandate hiring to avert second tragedy

RNAO says the long-term care (LTC) staffing study released by the government today highlights deficiencies known for decades, and underlines an LTC sector that has been neglected by government after government, resulting in severe underfunding and understaffing. 

The government’s Long-Term Care Staffing Study Report provides recommendations within five priority areas to improve staffing across the sector:

1. The number of staff working in long-term care needs to increase and more funding will be required to achieve that goal
2. The culture of long-term care needs to change – at both the system and individual home level
3. Workload and working conditions must get better, to retain staff and improve the conditions for care
4. Excellence in long-term care requires effective leadership and access to specialized expertise
5. Attract and prepare the right people for employment in long-term care, and provide opportunities for learning and growth

“While these are, for the most part, sound recommendations within a comprehensive report, there is nothing here that we have not discussed before. Also not new is the government statement that ‘This study will inform the development of a comprehensive staffing strategy to be released later this year.’ What we needed to hear today was that Premier Doug Ford is ready to move swiftly to hire staff. This is foundational to the care residents in nursing homes will receive,” says Dr. Doris Grinspun, RNAO’s CEO. 

“We urge the minister of long-term care, Merrilee Fullerton, to immediately direct nursing homes to hire personal support workers, registered nurses, registered practical nurses and nurse practitioners ahead of the second wave of COVID-19, which will coincide with the coming Influenza season,” says Grinspun. “There is not a minute to wait if we are to prevent a second massive tragedy in Ontario’s nursing homes come the fall.” 

The need for immediate action is outlined in RNAO’s Nursing Home Basic Care Guarantee  submission to the government’s Long-Term Care Staffing Study Advisory Group, which was struck by minister Fullerton in response to the public inquiry on LTC homes, which issued its recommendations on July 31, 2019. Justice Eileen Gillese led that inquiry and gave the government a deadline of July 31, 2020 to table in the legislature a staffing plan for regulated staffing in LTC.  

The government’s report, released this afternoon, highlights a minimum staffing complement to provide four (4) direct hours of nursing and personal care per resident, per day. However, the report fails to specify the skill-mix composition of those four hours, leaving residents, families and staff to the will of operators. 

RNAO will continue to call for the Nursing Home Basic Care Guarantee as the only way forward. It will also continue to urge that no nursing home – whether for-profit or not-for-profit – go below four hours of direct nursing and personal care per resident, per 24 hours. All homes must guarantee a proper skill mix as follows:

• 0.8 hours (48 minutes) of RN care per resident, per 24 hours
• 1 hour (60 minutes) of RPN care per resident, per 24 hours
• 2.2 hours (132 minutes) of PSW care per resident, per 24 hours

RNAO is also calling on government to fund each LTC home for one NP per 120 residents, in the role of attending NP or director of clinical care; as well as one additional nursing full‐time equivalent (FTE) staff (preferably an RN) to support the functions of infection prevention and control and quality improvement.

RNAO and others have repeatedly sounded the alarm about inadequate staffing levels in the sector. In June, RNAO released a list of 35 reports that have been published over the last 21 years, each with recommendations on how to address ongoing systemic failings. That list included the Gillese inquiry report. A common theme in those reports was the need for more staff in nursing homes, as well as a proper mix of regulated staff, in particular RNs, RPNs and NPs, which are scarce in this sector and are central to improving the safety and quality of care needed to meet the complex care needs and rising acuity levels among residents. The government's own report states today that: "The Long-Term Care Staffing Study Advisory Group concludes that if barriers to optimal staffing are addressed, as recommended in this report, the sector could more consistently deliver safe, quality and resident-centred care, to better meet the needs of long-term care residents." Yet, once again, the government has failed to move into action.

RNAO says rising acuity levels demand urgent attention. Currently, 55 per cent of seniors in LTC homes are 85 years or older, and 90 per cent of all residents have some form of cognitive decline, including dementia and Alzheimer’s disease. Add to that, many residents have chronic health ailments, such as heart disease, diabetes or arthritis. These health conditions require the knowledge and expertise of nurse practitioners, clinical nurse specialists and registered nurses. PSWs cannot manage these complex areas of care without the support, direction and oversight of registered staff.   

“Improving the staffing and skill mix in nursing homes is the first and most fundamental change that is needed,” says RNAO President Morgan Hoffarth. “In addition, we need human resource policies that encourage staff to only work in one home by providing full-time work and offering compensation that is on par with compensation for those who work in other settings, such as hospitals. All of these measures are necessary to ensure continuity of care for residents, and to keep infection rates down and provide people with a satisfying work environment,” urges Hoffarth.  

It is also essential that nurses and personal support workers are not left scrambling to deal with the devastating consequences of outbreaks in nursing homes, which is why RNAO says each of Ontario’s 626 LTC homes must be equipped with a six-month supply of personal protective equipment (PPE). “One of the consequences of a lack of PPE during the first wave of COVID-19 was that it effectively let the virus spread freely amongst staff and residents, taking a toll on a sector already grappling with a shortage of workers trying desperately to care for residents. It was a tragedy of major proportions for residents, their loved ones and staff,” adds Hoffarth.

Hoffarth says residents and their families, as well as staff who work in nursing homes, have paid a heavy price during COVID-19. There have been too many preventable deaths and unbearable suffering. That’s why RNAO is steadfast in urging that the government allow family visits with residents, in all nursing homes – including those experiencing an outbreak. “Residents and staff don’t need the army and they also don’t need hospitals to come to their rescue. What they need is adequate staffing, PPE, and the help and love only family members can provide. Families are essential care partners who keep residents’ spirits up, and help them maintain their will to live. They also support residents with toileting, hydration and eating,” says Hoffarth.

Close to 2,000 nursing home residents died during the first wave of the COVID-19 pandemic in Ontario. “The government’s announcement demonstrates it is willing to learn from its past and recent mistakes, and make the necessary improvements that we desperately need to see in long-term care,” says Grinspun. That political will is extremely important, she adds: “However, to save residents’ lives and boost their well-being, we must immediately move from more reports to decisive actions.” 

Important announcement regarding the VIANurse program

RNAO played a central role during the first wave of the pandemic, in many ways, including by running the VIANurse program to recruit and channel thousands of NPs, RNs, RPNs, and PSWs to health organizations in need. Until May 26 it had served more than 313 organizations in different sectors, including 238 long-term care homes, 29 hospitals, 11 public health units, 7 indigenous health facilities, 3 hospices, 3 correctional centres and other sectors. Many of these organizations accessed VIANurse multiple times. RNAO’s initiative and capabilities helped address many of the worst outbreaks, aggravated by staff shortages, and thus saved many lives.

RNAO has now decided it will not re-open the VIANurse program if another wave of COVID hits the province. VIANurse addressed an emergency in a province that was slow in responding to the pandemic, and thus played a vital role. The next waves of COVID should not be an emergency as we can prepare now. In the hard-hit long-term care sector, RNAO has insisted to government and to health organizations – see our press release above – the time to hire staff is NOW, in August, with immediate on-boarding and training of staff to be ready for the second wave of COVID-19 + Influenza season.

RNAO’s RNCareers program – a service open to employers and employees since 2005 – is ready to help you find the resources you need. The career site has served thousands of employers to hire NPs, RNs, RPNs, PSWs, and other health professionals. Individuals seeking work can register for free in the website.

Preparing for the second wave of COVID-19: Discussion

Last week I posted RNAO’s thoughts on preparing for upcoming waves of COVID-19. It is impossible to know for certain if and when these waves may come, or if and when an effective vaccine and access to therapeutics will be available. RNAO has argued since January that we must prepare for the worst and hope for the best. We raised 15 lines of action, many of them interrelated, as part of that required preparation. Keep sending us your feedback, as it is very important and much appreciated! Please write to dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten , subject line to read: “Feedback on preparing for the next waves of COVID-19.” 

The Ontario government acted on one of RNAO’s recommendations today by requiring bars and restaurants to keep client logs for a period of 30 days so as to facilitate case and contact tracing in case of need.

The federal and provincial governments released today the new Ontario COVID Alert app that will serve as an additional tool in case and contact tracing. This app has been developed taking account of privacy concerns (it does not collect location, contact, health or other personal data) and RNAO is strongly recommending downloading and activating it. Please encourage co-workers, family and friends to do so as well. I already did + RT this tweet!

Our provincial government has not yet acted on the recommendation to implement universal masking requirements across Ontario rather than rely on a hodge-podge of different regulations across various municipalities and regions. We call, once again, on the Ontario government to act – now is the time to keep moving in the right direction.

Thoughtful feedback received from two readers:

RNAO member Erin McPherson writes:

Flu vaccine schedule:

Normally, we don't have access to the flu shot until early November, much later than the schedule in the US where the flu shot is available in September. Normally, I would say that doesn't matter as flu season doesn't really start until late November or early December, but given the real risk of competing viruses, is there any possibility of moving the distribution of flu shots earlier? I imagine that the schedule from development to distribution is already quite tight and thus, altering the timeline may not be feasible, but thought it might help with compliance. 

RNAO response: We agree, Erin, that this year the timetable should be advanced as much as practically possible. I have asked the question from our medical officer of health and will get back to you.    

Masks in schools:

What is RNAO's stance on masks in school? I understand that Sick Kids put out guidance in June stating the masks weren't necessary in schools but I'm concerned that their guidance is already 1 month old in a pandemic that is 6 months old. 

While I appreciate that the recommendations are mixed on the use of masks in kids, there is evidence that the use of masks indoors reduces transmission of the virus without much downside, especially in older kids (references below)

• The National Academies of Sciences, Engineering and Medicine states to "Provide surgical masks for all teachers and staff. All students and staff should wear face masks. Younger children may have difficulty using face masks, but schools should encourage compliance." 
• The AAP recommends that "Children should wear face coverings when harms (eg, increasing hand-mouth/nose contact) do not outweigh benefits (potential COVID-19 risk reduction)" while acknowledging that "Face coverings(cloth) for children in the Pre-K setting may be difficult to implement." 
• Children's Hospital of Philadelphia (CHOP) states "Children are less likely to transmit the virus than adults. Student masking should be prioritized for periods of limited distancing, including: buses, public transit and carpools; hallways or other high-traffic areas; bathrooms; and classroom environments where 6 feet of distance between desks cannot be achieved. More frequent masking may be considered, particularly, in periods of increasing or elevated community spread.” "For young children and youth who are unable to comply with masking, distancing and hygiene measures should be prioritized."

I appreciate the fact that the data is mixed and can only assume that as we learn more, the guidance will continue to evolve. 

RNAO response: As you may know, RNAO has advocated for the use of masks in children three years and older and we run the #Maskhaton campaign to promote their use. We are sensitive to the challenges of having younger children use masks for a full day, so the advice of Children’s Hospital of Philadelphia seems wise. Their advice is similar to a prominent Harvard study that recommends “students wear face masks as much as possible, especially when in hallways or bathrooms.” The revised Sick Kids guidelines recommend masks for high school children but the authors could not agree on recommendations for younger children. The Ontario government’s plan for reopening schools indicates that students from Grade 4-12 and school staff will be required to wear masks.

Batch/pool testing:

Where is Ontario on batch / pool testing? I am reading about approval and use of this technique in other areas and feel like we should be talking about it more. This could be particularly relevant in schools, long-term care, etc., where screening full floors, classrooms and so on – instead of each person separately –, might help prevent outbreaks. Thanks so much for all you are doing to keep us connected.

RNAO response: An explanation on batch/pool testing can be found here. This technique only works in scenarios where the case count is low, so you are right – it fits the current context. I am not aware of consideration and use of batch/pool testing in Canada so thanks for raising it.

RNAO member Timea Andersen writes (we shortened the long message):

I have read this week's letter and, as usual, I applaud the work that you are attempting to do.  There is one part, however, that concerns me. 

With regards to asking government to control the "false health information" being posted on social media, I have intense concerns. What I interpret you to be suggesting sounds like censorship, which is a slippery slope indeed, even with the best intentions.

I was born in communist Eastern Europe and my family immigrated to Canada when I was a child to escape a regime that did exactly that. All other opinions, good and bad were replaced with their own propaganda… Yes, some people do have very misinformed and possibly harmful opinions on any and all possible subjects, but it is not up to the government to decide that. It is up to the reader… 

As a perfect example, it was anti-establishment and absurd to suggest at one point in healthcare history for doctors to wash their hands between patient examinations… There may be some controversial opinions now and in the future which sound incorrect or far-fetched, but at least a few of those may turn out to be cutting edge, ahead of their time, out of the box thinking… We must strive to educate people with the best current knowledge available and hope, not only that the general public chooses wisely but also that the information we now think is the best, turns out to be the best in hindsight…

RNAO response: Thanks, Timea, for raising a crucial issue and helping us clarify our ideas; you are right our writing could be misinterpreted as inviting censorship. You are referring to our item on Fighting misinformation as a public health threat where we say “One of the sad lessons from the debacle south of the border is that misinformation can cause death and suffering on an unimaginable scale. Science and evidence-based information is not a luxury but an absolute necessity if we want to minimize death and disruption to the economy… Government should engage measures to diminish these negative impacts, including demanding that social media venues remove fake and false information on health matters. Governments have sway over Facebook, Twitter, Instagram, WhatsApp, and other platforms that have an enormous influence on health outcomes, and they should use it.”

To clarify our position, we are not calling for government censorship or for government to dictate which views are acceptable or not. The suggestion is that legislators should enact laws that require social media giants to have public accountability and enforce posting standards and ethical frameworks similar to what mainstream media has. This doesn’t silence anyone, but assures there are checks and balances as well as recourse mechanisms when there is evidence of sustained harm. RNAO takes the position that health professionals hold substantive power and should inform that public accountability. That means they must speak with the best available scientific evidence, and caution about damaging health information.

We support freedom of speech, recognizing also that there are limits and constraints to that right. Everyone would agree that free speech does not convey the right to scream “fire” in a packed theatre, when there is no evidence of fire. Does it convey the right to access mass social media platforms indiscriminately to propagate information that science tells us can kill people in the thousands? That’s a thorny question. A nuanced understanding of freedom of speech that reflects our thinking can be found here.

Let’s Talk about Anti-Black Racism and Discrimination in Nursing

As updated earlier, RNAO launched a task force to tackle anti-Black racism within the nursing profession. A powerful webinar on July 20 offered an update on the work of the task force and an open consultation with participants (the presentation slides are available here). The consultations of the task force will continue in the form of a webinar series, to be held the third Monday of each month. Mark your calendar for the upcoming dates: Aug. 17, Sept. 21, Oct. 19 and Nov. 16, 2020. The plans for the webinar series are presented here.

Update on webinars

RNAO held weekly COVID-19 webinars every Monday evening between March 30 and early July, with decreased frequency after that. Attendance is always anywhere between 200 and 350! The COVID-19 Webinars: Together We Can Do It! are free and open to all.

The next webinar will be on Monday, August 10, 6:45-8:00 pm, focusing on nurses’ mental health and wellbeing. The global pandemic has exacerbated health and mental health concerns amongst nurses. Shortages of PPE, fear of infecting family members, isolation from family members, increased emotional and physical exhaustion, and inability to take time off – all exacerbated mental health concerns among nurses which predated the pandemic. Come hear about the healthy professional worker partnership that aims to identify interventions to better support nurses’ mental health and facilitate healthy return to work. Share your experiences and find out how to support this research. You can register here. An article presenting the issues is here. The guest speakers are: 

• Abby Ayoub (University of Ottawa)
• Melanie Lavoie-Tremblay (McGill University)
• Ivy Bourgeault (University of Ottawa)

If you have not had a chance to watch previous webinars, here are a couple of them:

• On July 1, we hosted Dr. Jennifer Kwan, a family physician and one of the organizers of #Masks4Canada. She spoke about what we need to do to have a successful re-opening of the economy, and the role that COVID-19 surveillance, good data and masking have in achieving that. You can watch it here.
• On June 22 we discussed the Impacts of COVID-19 on Indigenous Communities with three guest speakers: Ontario Regional Chief RoseAnne Archibald; Mae Katt, Nurse Practitioner with Temagami First Nation; and Marilee A. Nowgesic, CEO of the Canadian Indigenous Nurses Association. You can watch it here.

#Togetherwecandoit

MOH EOC Situational Report

As announced above, we will be posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you will be able access the Ministry’s guidance without having to wait for my COVID-19 report. Again, the link is here and you can check it every day.

Since this report will come out once weekly, that will provide a more timely access to Ministry guidance.

For a more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here.

Here is a segment from the latest Situation Report #188 for 31 July: 

Actions taken:

• The Ontario government, in consultation with the Associate Chief Medical Officer of Health, has amended orders O. Reg 364/20: Rules for Areas in Stage 3 and O. Reg. 263/20: Rules for Areas in Stage 2, under the Reopening Ontario (A Flexible Response to COVID-19) Act, 2020, implementing additional measures for restaurants, bars, and other food or drink establishments, as the province carefully and gradually reopens.
• As Ontarians continue to do their part to help stop the spread of COVID-19, the Ontario government is encouraging everyone to download the new COVID Alert app on their smart phone from the Apple and Google Play app stores. This app, which is available beginning today, lets users know if they may have been exposed to the virus. It is free, easy and safe to use. The more people who download the app, the more effective it will be in stopping the spread of COVID-19.

Staying in touch          

Please continue to keep in touch and share questions, comments and challenges. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten <pgbatten@rnao.ca>. Due to the volume of comments and questions, we are responding as fast as we can. 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. We want to send huge love and support to our colleagues and BPSOs in Latin America – they are still hit hard, striking the poorest communities. 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

PAST BLOG ITEMS:

24 July - Preparing for the second wave of COVID-19: What is the plan? – go here.

17 July - RNAO launches new social media campaign #Maskathon – go here.

17 July - RNAO calls on government to reunite families in LTC homes in Ontario – go here.

10 July - Nurses’ mental health, leave of absence and return to work experiences – go here.

10 July - RNAO continues to pursue family reunification in LTC – go here.

10 July - Support Zimbabwean nurses arrested and fired for protesting deteriorating pay and working conditions during pandemic – go here.

3 July -   RNAO launches task force to tackle anti-Black racism within the nursing profession – go here.

3 July -   Rather than praise, let’s protect our nurses – go here.

3 July -   Nurses celebrated diversity during Pride month – go here.

26 June - Nursing Home Basic Care Guarantee – go here.

26 June - Masks for all – the policy imperative in Canada – go here.

18 June - Annual General Meeting – an exhilarating week! – go here.

12 June - Petition on masks for Canada – go here.

12 June - LTC: RNAO releases list of 35 reports and recommendations dating back 20 years – go here.

6 June   - Statement – RNAO stands together with our Black sisters and brothers – go here.

3 June   - Adapting harm reduction during a pandemic – go here.

29 May - Foot care nurses – go here.

29 May - Update on pandemic pay; pandemic pay in consumption and treatment sites – go here.

28 May - RNAO Calls for Immediate Action in Response to the Canadian Armed Forces’ LTC report – go here.

26 May - Update on VIANurse – go here.

26 May - Ending homelessness: Will you join us to build a COVID-19 recovery for all? – go here.

24 May - Technology as a solution: Opportunities and pitfalls of COVID contact-tracing apps – go here.

21 May - Debunking PPE myths with Dr. Jeff Powis: Which masks should health care workers wear during COVID-19? – go here.

20 May - RNAO response to announcement of an independent commission into Ontario's long-term care system – go here.

19 May - With the pandemic curve flattening, VIANurse program will focus its effort on outbreaks – go here.

14 May - Nursing Week update – go here.

14 May - Pandemic puts health system to the test: Nurses have answers for shortfalls – go here.

14 May - Disappointment for not being included in pandemic pay – go here.

13 May - RNAO saddened by the loss RN Brian Beattie to COVID-19 – go here.

13 May - End racism and prejudice – go here.

12 May – Enhancing Community Care for Ontarians (ECCO 3.0) – go here

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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