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Registered Nurses' Association of Ontario      

Dear Colleagues: Welcome to our Friday, January 15 report during this eleventh month of COVID-19 in Ontario. You can find earlier update reports here, including thematic pieces in Doris’ COVID-19 Blog. And, for the many resources RNAO offers on COVID-19, please visit the COVID-19 Portal where you will also find RNAO media hits and releases on the pandemic here. As always, feel free to share this report and links with anyone interested. Daily Situational Reports from Ontario's MOH EOC can be found here.

Once again, we would like to thank our many colleagues who have reached out to us expressing a desire to help during the pandemic, including providing vaccination support. This is a kind reminder that you can link with employers through RNCareers.ca, RNAO’s official career site since 2005. There is a section for jobseekers and one for employers. For more details, go here.

 

Virtual Queen’s Park Day is open to all RNAO members: Circle February 25 in your calendar

Members of RNAO’s assembly have long appreciated the opportunity to take part in the association’s Queen's Park Day. In February, all members will have a chance to join as well since the Feb. 25 event will be taking place virtually. The event, which will take place from 3:30 to 7:30 pm, will feature remarks by Premier Doug Ford, Minister of Health Christine Elliott, Official opposition and NDP leader Andrea Horwath, Liberal Party leader Steven Del Duca, and Green Party leader Mike Schreiner.

The agenda will also feature the release of Vision for Tomorrow: The Nurse Practitioner Task Force Report. Registration for Queen’s Park Day will open on January 25th. Please contact RNAO’s board affairs coordinator Ann-Marie Morris at amorris@RNAO.ca for details.  

 

The escalating catastrophe of the COVID-19 second wave in Ontario

RNAO has been a leading voice since the end of the first wave in summer 2020 calling on government to engage measures to pre-empt and prevent the unavoidable second wave in the fall.

On July 24, 2020, we asked in this blog: Preparing for the second wave of COVID-19: What is the plan? We proposed a detailed plan of how government must act to make sure the second wave is not a recurrent tragedy. I wrote: “Let me begin by repeating what I have begged government at all levels since January, and in particular from Ontario’s Chief Medical Officer of Health David Williams: We must prepare for the worst and hope for the best. During the first wave of COVID-19 in Ontario, we had it backwards – we hoped for the best, but engaged action late and at a slow pace, thus ending in the middle of the pack.”

Tragically – although entirely avoidable – today we find ourselves in a much worse situation than during the first wave, and for the same reason of “too little, too late.” This week, on January 12, RNAO issued a media release, urging Premier Doug Ford to deliver on his promise to do everything in his power to defeat COVID-19. RNAO re-issued its request to implement – effective immediately – the following measures:

  • A full province-wide lockdown as during the first wave of this pandemic, plus a curfew similar to the one in effect in Quebec. 
  • No reopening of schools (we welcomed the province’s decision made on Jan. 7 in regards to hot zones in Ontario).
  • Increased supports for vulnerable populations, including safe places to isolate, paid sick days and a moratorium on evictions.
  • Vaccinations 24-hours-a-day, seven-days-a-week for residents, their essential care partners and staff in long-term care homes.

With modelling predictions that suggest COVID-19 case counts will rise to more than 5,000 per day and as high as 10,000 within the coming weeks in Ontario (40,000 under the worst scenario), a failure to act with swift and immediate measures will lead to catastrophic – yet preventable consequences. We said in the media release that “The pattern of ‘too little, too late’ has led to increasing numbers of COVID-19-related deaths, delays for non-COVID-19 surgeries, procedures and treatments, and the inevitable premature and preventable deaths resulting from those delays. It has also led to increased staff burnout.” We implored Premier Ford to act swiftly today (Jan 12).

Later in January 12, Premier Doug Ford announced the latest set of measures to address the second wave. He declared a state of emergency in response to rapidly escalating cases of COVID-19. He had little choice since various measures this government has enacted to flatten the curve have proven futile. Both the number of new cases and the speed at which the virus is spreading throughout communities are alarming, to say the least. There is the major concern that the UK variant, much more easily transmitted, may take hold in Ontario within a few weeks.

The measures announced by the premier sound like tough talk and concrete action, however, they fall short of delivering what is needed to avoid an unthinkable death toll and the collapse of emergency departments and ICUs – which we are now witnessing. In numerous media interviews and on social media, we at RNAO described these measures as not enough, too little, too late and – since we are in an intensifying tragedy – calculated recklessness. In December, Premier Ford decided to keep stores open for five more days before starting the lockdown so they could complete their inventory. My reaction was that “the inventory of illness and death is never worth the inventory of business. The latter is reparable –  lost lives are not.” My tweet below, sent out of sheer desperation, tells you how fast our tragedy is evolving. I plea to all my readers to RT right away, as we MUST do all we can to help our Premier regain reason and do what is right for Ontarians.    

Next we address the areas that RNAO has identified as essential for success:

Lockdown and curfew: The reason RNAO has been advocating for movement restrictions, such as a stricter and enforceable lockdown or a curfew, is simple: one third of Ontarians are not abiding by health directives. Contact-tracing efforts are not working. Highways are jammed, in contrast to the empty streets and highways during the first wave. And, of course, critical care is becoming overwhelmed.

COVID-19 infections continue to rise and long-term care residents by and large, have been the casualties of this inaction. Ontario has surpassed 5,100 deaths and seniors’ deaths in nursing homes represent more than 3,000 of those. It’s a shameful statistic and we will live with the knowledge that they were entirely preventable. Hospital ICUs are filling up and are under tremendous pressure; this has drastic consequences for people diagnosed with COVID-19 and those in need of non COVID-19 procedures, treatments and/or surgeries. The result is delays in care for others leading to premature and unnecessary deaths and a health system that continues to collapse in front of our eyes. Racialized and marginalized groups in society bear the brunt of the pandemic, with higher burden of illness and mortality (and they also suffer the most with the measures put in place to respond to the pandemic – see below).

All this affects healthcare workers directly. Many of you have been working day in and day out, without taking vacations and enduring the stress and burnout of fighting the pandemic for months. We know this is having a profound effect on you and your families. Please know that we have your back and are fighting on your behalf.

We urged a curfew as a last resort to restrict movement given that earlier measures have not helped. Too many people do not heed the advice, stay at home and refrain from meeting with others outside their immediate households. Rather than making it clear what is needed, the measures announced this week have caused confusion. For example, they ask people not to go out unless it is essential – such as for groceries, medical appointments or the pharmacy –, and yet, they allow non-essential retailers to continue offering curbside pick-up. This is incoherent. There is also no rationale for the decision to keep big box stores open for non-essential products; it is unfair for small businesses that are suffering and raises the question whether lobbying power drives health directives. All this results in confusion, more uncertainty and is an open invitation for people to engage in unnecessary contacts, driving the transmission.

Not re-opening schools: We applaud the government’s decision to extend online learning in five of Ontario’s so-called hot zones until Feb. 10 (Hamilton, Peel, Toronto, York and Windsor-Essex). We were already in support of government’s decision to delay the start of in-class instruction to contain the spread of the virus and the troubling number of infections among school-age children. We do recognize that not all children have the proper conditions at home and some may not be in a safe situation. We ask that available teaching staff and school nurses, including the 625 public health nurses approved for schools last September, maintain contact with children and parents to make sure all children are safe. It is important that this period when the school buildings are empty should be used to ensure schools are safe when they reopen later. This includes addressing issues flagged for quite some time, such as class sizes and ventilation.   

Increased supports for vulnerable populations: The long-standing structural inequities in our society means that low income, marginalized and racialized populations have suffered the highest burden of COVID-19.  

Many essential workers lack the workplace supports to protect themselves and their families. They do not have the luxury of working from home, and they worry about how they will pay their bills. Their precarious employment means they lack access to paid sick days or do not live in housing that provides them with adequate space to self isolate safely from family members if they have been exposed to the virus, or worse, test positive for COVID-19.

They also represent a disproportionate number of those who have tested positive and unknowingly have helped accelerate transmission rates within their communities. They carry a disproportionate burden of illness and death as a result from infection with the virus. Supports that allow people to stay isolated safely are critical public health measures.

Government needs to step in to help. Most importantly at this time, essential workers need access to paid sick days and the federal benefit Premier Ford touts as an option is inadequate. People in PEI and Quebec have access to paid sick days. There is more that Ontario can and should do. RNAO has long advocated for paid sick days. That’s why we urge the government to provide 10 paid sick days for workers without the federal benefit.

Also needed are more places – across Ontario – where people can self–isolate, especially for those who live in crowded accommodation and are unable to isolate themselves from other family members.

For those tenants who are facing hardship and eviction, we thank the government for responding to our call for a moratorium with a temporary pause on enforcement of residential evictions. But the government needs to go much farther. The Landlord Tenant Board (LTB) must stop hearing eviction applications during the pandemic. They are not providing tenants with adequate access to counsel and representation and a fair hearing. Also, the moratorium needs to extend beyond the duration of the province’s emergency order because the economic impacts of this pandemic will have devastating effects on most tenants long after it is over.   

Finally, I want to address how hard it is to advise on health directives given the impact on racialized communities. RNAO has given advice to scale up the enforcement of health directives, such as a curfew or a stay-at-home order, with a heavy heart. On the one hand, they are essential to flatten the curve, which is hitting the worst among these communities. On the other hand, “enforcement” means potentially more encounters in the street of people who work in essential jobs with police (as could happen now with the stay-at-home order or could have happened with a curfew). We are aware of the terrible history of encounters between Indigenous, Black and other stigmatized communities with the police and other law-and-order officers. We appreciate that the government has clearly stated the lockdown order does not apply to persons experiencing homelessness.

RNAO is sending, in the most vocal way, a message to governments, police and other agencies at all levels, that the enforcement of health directives should not be an excuse to torment, once again, those who are just doing their jobs, so that others in more privileged positions can have the essential goods and services they require. We commit to watching very closely, and speak out should the ugly face of discrimination and racial profiling arise. We call on all our readers to be watchful that the pressures of the pandemic are not used as an excuse for stigmatization, harassment, hate and discrimination.   

Vaccination: See our discussion next.

 

Progress in vaccine distribution: Updates, issues and concerns

RNAO remains heavily involved in the COVID-19 vaccine rollout process in Ontario.

Major information resource on COVID vaccines

As mentioned earlier, RNAO is participating in a collective effort to develop a comprehensive information resource on COVID-19 vaccines led by the Centre for Effective Practice. To see this valuable resource, go here. This week, you will find the latest information on the availability, rollout and prioritization of vaccines in Ontario, as well as the vaccine ingredients in the Pfizer-BioNTech and Moderna vaccines. If you are a health provider who discusses hesitancy with your clients, check the section on addressing patient questions about vaccines. If you are engaged in the administration of either vaccine, check the section on point-of-care-guidance for each of the vaccines.

Webinar with Dr. Dirk Huyer

On January 11 RNAO held its latest Health System Transformation and COVID-19 Webinar Series with Dr. Dirk Huyer on COVID -19 vaccine distribution: Progress to date, with over 850 attendees via Zoom and several hundred more via Facebook live stream.  

Dr. Huyer is member of the Lead Clinical Guidance and Surveillance Work-Stream, COVID-19 Vaccine Distribution Task Force. You can watch a recording of the webinar here and see the slides here. The vaccine rollout plan in Canada can be found here. The Ontario vaccine rollout plan is here and the technical document is here.

We thank Dr. Huyer for providing us with a summary of his presentation, next:


The Ontario government has developed a three-phase implementation plan to receive, store and administer COVID-19 vaccines to Ontarians as soon as they are received.

Safe and reliable vaccines can help protect everyone from COVID-19. They will be an important tool to help stop the spread of the virus and allow individuals, families and workers to safely resume a normal life.

When a large percentage of the population becomes immune to COVID-19, the spread of the virus will slow down or stop.

As recommended by the COVID-19 Vaccine Distribution Task Force and aligned with the National Advisory Committee on Immunization, on January 13, 2021 the province announced that it has mapped out the next steps for transitioning into Phase Two of vaccination rollout and has adopted an approach for identifying the next groups to receive the vaccination as early as March 2021, following the vaccination of Phase One populations.

Phase One populations include:

  • Residents, staff, essential caregivers, and other employees of congregate living settings (e.g., long-term care homes and retirement homes) that provide care for seniors as they are at higher risk of infection and serious illness from COVID-19;
  • Health care workers, including hospital employees, other staff who work or study in hospitals, and other health care personnel;
  • Adults in Indigenous communities, including remote communities where risk of transmission is high; and
  • Adult recipients of chronic home health care.

Because demand for COVID-19 vaccines among Ontario’s health care workers and other care staff will initially exceed available supply, priorities for voluntary vaccination must be set among health care workers and will be phased. 

A stepwise approach to prioritization has been developed which considers multiple factors including the sectors and settings that people work in, local and community factors as well as individual factors. Each step should be performed in sequence to gradually refine from the broad sector/setting level down to the individual level.

Groups eligible to receive vaccines as part of Phase Two of the Ontario immunization program will include:

  • Older adults, beginning with those 80 years of age and older and decreasing in five-year increments over the course of the vaccine rollout;
  • Individuals living and working in high-risk congregate settings;
  • Frontline essential workers (e.g., first responders, education workers, food processing industry);
  • Individuals with high-risk chronic conditions and their caregivers; and
  • Other populations and communities facing barriers related to the determinants of health across Ontario who are at greater COVID-19 risk.

Steps are underway to identify the subpopulations within each Phase Two category, including essential workers, followed by a plan for sequencing vaccination within the categories.

Phase Two is expected to be completed by end of July 2021 and Phase Three for the general population could begin as early as August 2021, pending availability of vaccines. Vaccination of populations in Phase One will continue until all vaccinations are complete.

As the COVID-19 vaccination rollout continues, it remains critically important that all Ontarians continue following public health advice to protect our communities and most vulnerable populations, and to stop the spread of COVID-19.


Once again, our thanks to Dr. Huyer for his contribution.

RNAO’s concerns about the vaccine rollout

Since the start of the vaccination, RNAO has been pushing the government to ramp up the initial slow pace of vaccinations, and not keep large stocks in the freezers. If the supply is there, vaccinations should be carried out 24-hours-a-day, seven-days-a-week, starting with those at highest risk of severe disease or death – residents of long-term care homes –, as well as their essential care partners and staff in those homes. Other health-care workers must also get the vaccine, but in the view of RNAO – long-term care must be the top priority sector. We have also been steadfast in urging that only health providers who are facing patients get the vaccine. We are troubled by revelations that staff not facing patients have received the vaccine in hospitals, and have raised those concerns with the minister of health and the premier’s office.   

Getting the vaccine rollout into the hands of community providers

On January 14 RNAO issued a media release jointly with three home care providers  – SE Health, VON, Bayshore HealthCare – entitled Distribute COVID-19 Vaccines Through Community Providers NOW. Here is the text:


The priority for government right now is to get vaccinations out as effectively and efficiently as possible. The Registered Nurses’ Association of Ontario (RNAO) and three of the largest home care providers in the province – SE Health, VON, Bayshore HealthCare – are calling on the government to get the COVID-19 vaccinations into the hands of community providers including nurses, physicians and pharmacists, immediately. By making immediate use of existing community care providers and their existing infrastructure, we can rapidly accelerate the rate of vaccination across the province. There is no need to reinvent the wheel.

Every year, thousands of nurses, physicians and pharmacists provide routine vaccinations through public health and established networks including primary care, pharmacies and home care. For example, home care nurses vaccinate vulnerable populations who are homebound or in congregate settings, such as shelters, as part of their regular job. These community-based infrastructures and their health-care professionals using practiced and perfected distribution systems for vaccination – must be put to work immediately to deliver what is urgently needed – COVID-19 vaccinations.

“The current approach to vaccine roll-out has been painfully slow and is delaying a life-saving shot for those who need it most, including long-term care residents and homebound frail seniors who cannot or ought not travel to access care,” says Dr. Doris Grinspun, CEO of RNAO. Going forward, Grinspun adds, “RNAO wants to see existing community resources such as primary care physicians, nurse practitioners, registered nurses, registered practical nurses, and pharmacists being fully utilized to get the broader population inoculated by end of July, without drawing away the already overwhelmed hospital resources. For example, nurses working in home care could be vaccinating the patients they visit, as well as vulnerable populations they serve every year during the flu season.”

“We can do this. With our competent nurses and a distribution network already set up, we are ready to go,” says Shirlee Sharkey, CEO of SE Health. “If we were given access to the vaccine today, our nurses would be vaccinating seniors in their homes tomorrow. It’s that simple.”

The COVID-19 vaccination roll-out cannot overlook the opportunity for vaccine distribution in community care sectors that already serve vulnerable populations. In home care alone, hundreds of thousands of homebound clients and frontline health-care professionals could be vaccinated rapidly using existing systems and practices. Vaccinating family caregivers at the same time would allow for an efficient roll out of vaccines for a very significant portion of the population using existing visits and infrastructure.

The COVID-19 vaccine, in concert with public health measures, represents our best opportunity to defeat COVID-19 and end its devastating impact. We urge the government to leverage opportunities already existing in community care for rapid vaccine roll-out to those at greatest risk, 24x7.

 

 

Upcoming webinar: Building a mentorship movement for Black nurses

The upcoming webinar in the Let’s Talk about Anti-Black Racism and Discrimination in Nursing series will be on Monday, January 18, 2021, 6:30 to 8:00 pm.

Topic: Building a mentorship movement for Black nurses

Objectives:

  • explore definitions of mentorship and the attributes of an effective mentor/mentee;
  • increase participants' understanding of Black nurses access to and experiences of mentorship;
  • discuss what constitutes a successful mentor/mentee relationship;
  • describe the value, benefits and outcomes of mentorship for mentors, mentees and for health-care organizations; and
  • generate dialogue to help shape RNAO's mentorship initiative for Black nurses.

Panelists:

  1. Michele James, Vice-President, People and Transformation, Scarborough Health Network 
  2. Ryan Hinds, Community Engagement Lead, Toronto Central LHIN
  3. Sandra Robinson, NP, CNO Council President, Manager at Toronto Western Hospital
  4. Sharon Nwamadi, RN, Nurse Manager, Bayview Family Practice

To register, please go here. To see information about earlier webinars in the series, as well as background information on RNAO’s Black Nurses Task Force, please go here.

 

MOH EOC Situational Report

We are posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you can access the Ministry’s guidance at any time.

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

Here is a segment from the Situation Report #346 for January 15:

Case count as of January 15, 2021 / Nombre de cas le 15 janvier 2021

Area / Région

Case count / Nombre de cas

Change from yesterday / Changement par rapport à hier

Deaths / Décès

Change from yesterday / Changement par rapport à hier

Canada*

688 891

+ 7 563

17 538

+  155

Ontario**

231 308

+ 2 998

5 289

+  100

No updates for today.

 

Staying in touch          

Please continue to keep in touch and share questions, comments, and challenges. Feel free to also recommend ideas for future webinars. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten email: pgbatten@rnao.ca. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you all for being there for our communities – everywhere and in all roles! Together, in solidarity, we are stronger and more resilient. These continue to be tough times and we have to keep strong and focused! While the vaccine is hugely important, the immediate target is fighting the spread of the virus to preserve lives. To everyone and most especially our colleagues working in the front lines here at home and in countries around the world hit hard by evil COVID-19 – THANK YOU, and please know we stand by you!

As we have said before, the silver lining of COVID-19:  Coming together and working as one people – for the good of all!

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer, RNAO

 

RECENT BLOG ITEMS:

8 Jan - RNAO raises its voice in the media: Media coverage in December 2020go here.

8 Jan - A practicum experience at RNAOgo here.

8 Jan - RNCareers: Help during the holidays and help for next phases of this pandemicgo here.

29 Dec - Public health nurses in schoolsgo here.

29 Dec - Government failing Ontarians as virus runs rampant and endangers livesgo here.

29 Dec - We need your help in addressing urgent staffing needs in health facilitiesgo here.

29 Dec - Best wishes for the holidaygo here.

18 Dec - Providing compassionate nursing care in an age of artificial intelligencego here.

18 Dec - RNAO continues to express grave concern regarding the second wavego here.

18 Dec - Long-term care staffing plan lacks urgency and legislated actiongo here.

11 Dec - RNAO gravely concerned about the second pandemic wavego here.

11 Dec - Health organizations plead for Ontarians to celebrate holiday season safelygo here.

4 Dec - Continuing the conversation: Mobilizing collective action for LTC reformgo here.

4 Dec - Nurses urge dedicated funding for infection prevention and control in LTCgo here.

27 Nov - RNAO, once again, plays major role in the media during Novembergo here.

27 Nov - COVID-19 in long-term care: A nurse’s witness statementgo here.

20 Nov - Government’s measures too late and insufficient; calling for a COVID-Zero strategygo here.

13 Nov - Mobilizing collective action for long-term care reform in Canadago here.

13 Nov - RNAO’s media conference to address the crisis in long-term care go here.

6 Nov - Fall 2020 provincial budget once again leaves vulnerable populations to fend for themselvesgo here.

6 Nov - Elections in the US: A path to healing and respect for sciencego here.

30 Oct - 2S-LGBTQ+ Seniors: Our Existence is Our Resistance!go here.

23 Oct - Responding to the second wave of COVID-19: RNAO continues to speak outgo here.

16 Oct - RNAO advocates for national long-term care standards in Canadago here.

16 Oct - Reta’s Story  (a contribution of Judy Smith, Reta’s daughter-in-law)go here.

9 Oct - RNAO relieved that Premier Ford engages late, but essential, actiongo here.

9 Oct - Patient-centred-care – the dream and the realitygo here.

2 Oct - RNAO urges stricter measures to combat rapidly rising number of COVID-19 infectionsgo here.

25 Sept - Nurses say throne speech advances A Just Recovery for Allgo here.

18 Sept - Is Your Hospital Using Blood Wisely?go here.

18 Sept - RNAO calls to Delay Action on CNO Council Decision to Expand RPN Scopego here.

11 Sept - International Overdose Awareness Day: Statement from RNAOgo here.

11 Sept - RNAO joins global movement: A Just Recovery for Allgo here.

We have posted earlier ones in my blog here. I invite you to 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.

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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