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Registered Nurses' Association of Ontario      

Dear Colleagues: Welcome to our Saturday, February 13 report during this twelfth 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. Daily Situational Reports from Ontario's MOH EOC can be found here. As always, feel free to share this report and links with anyone interested.

RNAO wishes a Happy Lunar New Year to our colleagues, as well as a meaningful and safe Family Day. We are grateful to our health professionals who will be working during the holidays. No one can fully comprehend what this COVID-19 pandemic has been for you and your loved ones. The length of this pandemic, its intensity and the many unknowns has demanded extraordinary commitment and strength from you. It has also demanded deep understanding from your family, who have undoubtedly feared for your health and theirs. THANK YOU!!!!!!!!!!

Two important webinars this week (scroll down for details):

 

The power of mentorship in nursing education – Tuesday, Feb. 16, 2021, 6:30-8:00 pm ET upcoming webinar in the Let’s Talk about Anti-Black Racism and Discrimination in Nursing

Continuing the conversation – an open webinar for nurses to share how they are feeling during COVID-19 – Wednesday, Feb. 17, 2:30-4:00 pm ET

 

RNAO’s letter to the premier on the vaccine rollout and the current context

RNAO sent the following letter on February 10 to Premier Doug Ford and Minister of Health Christine Elliott to convey our thoughts and priorities regarding the rollout. We also expressed our concerns regarding the premature lifting of the lockdown.


Dear Premier Ford and Minister Elliott,  

As Ontario prepares to receive sizable supplies of the COVID‐19 vaccine, we are writing to convey our thoughts and priorities regarding the rollout. As you know, RNAO has been actively engaged in discussions with members of the nursing community and the public at large regarding this critical and hopeful moment in the pandemic.  

We are focusing on key aspects of the vaccine rollout that are essential to its success. These include: the need for transparent and detailed plans for the massive immunization campaign commencing in March; the need to engage public health and community providers as pillars of the rollout; the importance of giving priority to elderly Ontarians who are most likely to die from COVID‐19; and targeted efforts to vaccinate vulnerable populations that otherwise may be inoculated last, or not at all. We also urge you to ensure the vaccine rollout does not distract us from the life‐and‐death public health measures that must continue if we are to preempt a catastrophic third wave driven by new variants.  

Prepare for large‐scale immunization starting in March: This task, starting in about three weeks, will be significant. As of Feb. 9, Ontario
had administered about 400,000 doses. According to Prime Minister Trudeau, Canada will receive six million doses by the end of March. For Ontario, this translates into about 600,000 doses in February and 1.2 million in March. These numbers suggest that during March, Ontario should be administering about 40,000 doses per day, or about four times the current daily rate. The rate of immunization will scale up even more in April and beyond, when five million doses are expected in Ontario each month, or about 160,000 doses per day, until 
the campaign is over.  

The Ontario government has not provided transparent access to detailed plans on how it will tackle this challenging rollout. To be successful, our government should lay out those plans and actively seek feedback and participation from diverse experts and communities.  

Engage public health and community providers: As RNAO has indicated on various occasions (media releases on Jan. 12 and Jan 14), and as recently as last week, the successful rollout of Phase 2 should rely on thousands of nurses, physicians and pharmacists working in community care across this province. Every year, these skilled professionals provide routine vaccinations through public health and established networks, including primary care, pharmacies and home care. These community‐based infrastructures, and the health‐care professionals who make them work, use tried and true distribution systems for vaccination. They must be utilized fully to deliver what is urgently needed – COVID‐19 vaccinations – 24‐hours‐a‐day, seven‐days‐a‐week. 

Prioritize right: Focus on the elderly. The initial purpose of the vaccine rollout should be clear: Reduce – as much as possible – hospitalizations, ICU utilization and deaths from COVID‐19. This is both an ethical mandate and a practical necessity due to the state of critical care in this province.  

The key insight from science is clear: Age is a dominant variable. Patients who are 80 or older are at least 20 times more likely to die from COVID‐19 than those in their fifties. They are also hundreds of times more likely to die than those who are 40 or younger. Canadian data supports these findings. Ninety‐six per cent of those who died from COVID‐19 by Feb. 9 were 60 years or older, and 71.2 per cent of hospitalizations had been in that age range.  

It is questionable that “older adults, beginning with those 80 and older and decreasing in five‐year increments over the course of the vaccine rollout” were included in Phase 2 of the Ontario rollout plans rather than in Phase 1. According to Statistics Canada, there are about 655,000 Ontarians 80 and older, and if this number was too high to incorporate into Phase 1, at least the 336,000 who are 85 or older should have been included (these numbers include those in the age bracket who are residents in long‐term care and high‐risk retirement homes, who are part of the Phase 1 rollout). Given the decisions made, it is crucial that elderly Ontarians who were not inoculated in Phase 1 be at the top of the list in Phase 2.  

Despite the enormous risk for deadly outbreaks in long‐term care and high‐risk retirement homes, the government was late in prioritizing these congregate settings, although they are part of Phase 1. Fortunately, the long‐term care sector is now scheduled to receive its first dose of vaccine by Feb. 10.  

RNAO remains extremely concerned that elderly persons outside long‐term care settings do not appear to be at the front of the queue in Phase 2. They appear to be further back than health‐care workers who do not work on the frontlines, or even other essential workers who must be supported, but who are, on average, much less likely to die from COVID‐19. This must be corrected urgently and ahead of launching Phase 2.  

RNAO’s message to the provincial government is simple: Elderly Ontarians are most likely to be hospitalized, admitted to ICU and/or to die from COVID‐19. Rollout should start immediately with those 80 or older, with a continuous reduction in the eligible age down to 60 as the Phase 2 rollout progresses. Not only is this the right thing to do, but it will also contribute to diminishing the pressure on critical care in our province.  

Prioritize right: Target vulnerable populations. The experience of COVID‐19 immunization in the United States suggests that young, white and wealthy, more tech‐savvy people often end up snagging online appointments, even though they are least impacted by COVID‐19. Racialized, marginalized, low‐income and elderly populations, in contrast, face challenges accessing appointments.  

Studies identify older people, men, racial and ethnic minorities, and those with underlying health conditions among the most vulnerable populations that are more likely to die of COVID‐19. These groups have higher levels of co‐morbidities and face higher rates of hospitalization and death due to the virus.  

There are many reasons people may face difficulty or hesitancy getting the vaccine. Persons in disadvantaged social groups may encounter language barriers, misinformation, lack of access to technology, difficulties using online appointment software, historical injustices, mistrust of government and medical institutions, mobility restrictions, financial constraints, employment concerns (i.e. missing a day of work to get vaccinated), and so on. These multiple barriers are not mutually exclusive, and are often exacerbated by one another.  

All of these barriers must be squarely addressed early in Phase 2. Targeted plans for each community need to fit the needs of that community. This is the only way vulnerable populations will get the priority they require in vaccine rollout. The plans should be developed with leading involvement and the participation of members of the communities affected, as that’s the only way to succeed.   

Do not allow vaccines to distract us from a potentially devastating third wave. Israel has been a learning ground for the successful deployment of mass vaccination. But it has also shown us that vaccines are not a silver bullet. With more than 50 per cent of the population inoculated, the country is still in lockdown. Its hospitals and ICUs are still at capacity. A leading Israeli health officer has noted that the introduction of the British strain has been a negative game changer for Israel. The vaccines have been a big success, but they are not enough to curb the rise in contagion brought by the mutation. Hospital beds left free by the inoculated over‐60 population are being filled by the under‐50 crowd. “The danger confronts any country that chooses a primarily vaccine‐reliant policy before COVID‐19 is finally vanquished.” 

This is a crucial lesson for Ontario as the B117 variant, first identified in the United Kingdom and the one creating havoc in Israel, will likely become the dominant strain in Ontario within four to six weeks. There is the distinct risk of an explosive rise in the number of cases and hospitalizations. The public is not prepared for the worrisome characteristics of some of these variants, which appear to challenge our assumptions about transmissibility (such as two‐metre distancing, 15 minutes of exposure, and use of regular cloth masks).  

RNAO has pleaded with the government not to open up parts of the province before ensuring the necessary public health measures are in place to safeguard the lives and livelihoods of Ontarians and to control the spread of COVID‐19.  

What do we do now? It is essential to wait before loosening restrictions. We need at least three weeks after schools re‐open in a specific region to make sure epidemiological data is moving in the right direction. It is also important to restrict travel between regions with different levels of measures. Contact tracing and isolation must continue to be strengthened across the province to handle the existing number of infections. And there must be stronger plans to upgrade public health measures and make sure they are strictly enforced in workplaces.  

RNAO also urges the government to immediately act to protect vulnerable communities. We have repeatedly called on you, Premier Ford, to cover paid sick days to protect workers who do not have access to them as part of their employment, and for whom the federal benefit does not suffice. RNAO has also demanded that the government enact a full moratorium on evictions and provide places for people to self‐isolate safely while awaiting test results. 

While we understand that businesses are hurting, opening up too soon carries an inherent risk that affects everyone in this province, especially those most vulnerable, and who have assumed the greatest burden of this relentless virus. It is the responsibility of governments to provide proper economic supports for businesses closed or suffering due to public health measures. 

All of these factors must be considered in the Ontario government’s plan to begin re‐opening the economy. The focus for the government should be to ensure a successful rollout of vaccines, as detailed above, while maintaining public health measures and engaging the public so we can all get through this together.  

With warm regards, and best wishes for health and safety, 

Doris Grinspun (RNAO Chief Executive Officer) and Morgan Hoffarth (RNAO President)

 

POLICY UPDATES FOR ALL TO ACT ON & MUST JOIN EVENTS OPEN TO ALL

 

Upcoming webinar: The power of mentorship in nursing education

Tuesday, Feb. 16, 2021, 6:30-8:00 pm ET (note: Tuesday due to Family Day holiday)

The upcoming webinar in the Let’s Talk about Anti-Black Racism and Discrimination in Nursing series will be on Tuesday, February 16, 6:30 to 8:00 pm ET.

Topic: The power of mentorship in nursing education

Objectives:

  • explore the value, benefits and outcomes of mentorship opportunities for Black nursing students in academic settings;
  • review strategies for establishing goals, expectations and boundaries in a mentor/mentee relationship;
  • identify enablers and barriers to Black nursing students’ access to mentors;
  • examine how mentorship experiences for Black nursing students are impacted by the diversity of the faculty and student population; and
  • promote dialogue to help shape RNAO's mentorship initiative for Black nurses and nursing students.

Presenters:

  • Dr. Bukola Salami, RN, MN, PhD, Associate Professor at the Faculty of Nursing, University of Alberta
  • Ola Thomas Obewu, 3rd year BScN Student at York University, RNAO Black Nurses Task Force Panelist

REGISTER NOW

 

View information about earlier webinars here.

 

RNAO work and well-being survey closes February 16

In an effort to understand the impact of COVID-19 on your work and well-being and the best ways we can continue to support you and Ontario’s nursing community, RNAO has created a short survey. If you are an RN, NP or nursing student in Ontario, please complete this 15-minute survey. Your participation will allow RNAO to better understand how this pandemic has changed your work, your attitude to work and your future in nursing, and inform our policy and advocacy now and into the future. It will also allow us to capture trends and themes across health-care sectors and settings that may inform our "Join the Conversation" open forum series for nurses to share how they are feeling and coping during COVID-19. 

All responses will remain anonymous and your privacy protected. 

We thank you in advance for sharing your experiences and views with us at your earliest convenience. The survey will close at 4 p.m. on Tuesday, Feb. 16, 2021.

Go to the survey here.

 

Continuing the conversation – an open virtual forum for nurses to share how they are feeling during COVID-19

Webinar: Wednesday, Feb. 17, 2:30-4:00 pm ET

RNAO is aware nurses across this province – especially those working on the frontlines of COVID-19 – are experiencing tremendous levels of physical and emotional stress and burnout. We know this can affect your mental health and well-being at this challenging time and that you may have less time to devote to your own self-care. 

To further understand the impact of COVID-19 on our nursing community and on our colleagues, and the best ways we can continue to provide support, RNAO initiated an open forum webinar series.

On Wednesday, Feb. 3, RNAO hosted the first open forum with 130 participants and heard firsthand how nurses are feeling during COVID-19. Feedback on the first forum was very positive; participants felt supported, more connected and heard about new resources and strategies for coping.

We are continuing the conversation on Wednesday, Feb. 17 from 2:30-4 pm (ET). This time, we will host breakout sessions to provide more opportunities to discuss the following themes identified in the first forum:

  • dealing with multiple losses and grief
  • time out from COVID  – learning to let go
  • taking care of yourself
  • organizational support for well-being

All RNs, NPs, RPNs and nursing students in Ontario – in all roles and sectors – are invited to participate in this heart-to-heart sharing with colleagues. You may wish to share how things are going for you or you can simply join and listen in. We are holding our open forum every two weeks.

Sign up online.

For help and support, see links here. If you are in a crisis call 911 or visit the emergency department of your local hospital.

 

Watch a webinar on vaccine hesitancy and effective vaccine communication

RNAO holds its Health System Transformation and COVID-19 Webinar series every month to support health providers from Ontario, Canada and anywhere around the world. They are free and open to any health provider. For information on the series and on earlier webinars, go here.

The COVID-19 vaccine will change the course of this pandemic. As millions of people are getting immunized, how can we as health-care workers become champions for this vaccine, and feel empowered to communicate about it with our patients, colleagues, family and friends? To this end we organized on Feb. 8, a webinar on COVID-19 vaccine hesitancy and effective communication.

We had an absolutely outstanding speaker and over 550 participants. I share here the sentiment of many who wrote in the webinar chat: “I could listen for hours to Dr. Cora Constantinescu, pediatric infectious disease specialist.” The session on COVID-19 vaccine hesitancy and effective communication lasted two hours. I strongly encourage you to watch here.

The webinar objectives were:

  • appreciate the extent of vaccine hesitancy around the COVID-19 vaccine and some of the reasons for this phenomenon,
  • understand how Canada measures up globally and at home; and
  • apply a communication framework to hold a vaccine hesitancy conversation around COVID-19 vaccine.

You can watch the webinar here.

 

Watch a webinar on vaccines rollout

The January 11 webinar was on COVID-19 vaccine distribution: Progress to date with Dr. Dirk Huyer, Chief Coroner, member, Lead Clinical Guidance and Surveillance Work-Stream, COVID-19 Vaccine Distribution Task Force. About 850 health providers participated online. You can watch the webinar here and see the slides here. Dr. Huyer’s written summary and RNAO’s perspective on vaccines can be found here.

 

 

Register for February 25, virtual Queen’s Park Day – open only to RNAO members

Registration is open for Queen's Park Day on Thursday, February 25, 3:30 to 7:30 pm. The virtual event will feature remarks by Premier Doug Ford, Minister of Health Christine Elliott, Minister of Long-Term Care Merrilee Fullerton, 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. You can register for the event 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 #366 for February 12 (no report on February 13):

Case count as of February 12, 2021 / Nombre de cas le 12 fevrier 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*

817 163

+ 3 181

21 088

+  84

Ontario**

283 587

+ 1 076

6 632

+  18

Update

  • Ontario Deploys Rapid Tests to More Essential Workplaces and Settings. Based on the successful use of rapid tests in select settings across the province the Ontario government is deploying test kits to more essential workplaces and sectors in order to quickly identify and help stop the spread of COVID-19. Rapid tests are now being used in long-term care homes, retirement homes, congregate care settings, First Nations communities and many essential workplaces.
  • Ontario Returning 27 Public Health Regions to Strengthened COVID-19 Response Framework. In consultation with the Chief Medical Officer of Health, the Ontario government is transitioning twenty-seven public health regions out of the shutdown and into a revised and strengthened COVID-19 Response Framework: Keeping Ontario Safe and Open (the "Framework"). The four remaining public health regions, Toronto Public Health, Peel Public Health, York Region Public Health and North Bay Parry Sound District, will remain in the shutdown, and the Stay-at-Home order and all existing public health and workplace safety measures will continue to apply to these four public health regions.   

 

Staying in touch          

Keeping in touch is now more important than ever. Feeling that you are part of a community and that we have your back will help you get through this challenging time. We are also eager to hear from you how we can best support you. Send to us your 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 reach out to one another in solidarity! Our government, the public and indeed all of us as health professionals – must also keep 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 take care of yourselves and know that RNAO always 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, FCAN, O.ONT
Chief Executive Officer, RNAO

 

RECENT BLOG ITEMS:

6 Feb - RNAO’s continuing media profile: The January reportgo here.

30 Jan - The PrOTCT plan for nurses: Counseling vaccine hesitant patients & colleaguesgo here.

30 Jan - Please sign action alert urging Premier Ford to suffocate COVID-19, NOW!go here.

23 Jan - Mitigating the spread in Toronto shelter settingsgo here.

23 Jan - Home care nurses are #ReadyToVaccinatego here.

23 Jan - Hurtful comments about law enforcementgo here.

15 Jan - The escalating catastrophe of the COVID-19 second wave in Ontariogo here.

15 Jan - Progress in vaccine distribution: Updates, issues and concernsgo here.

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 on 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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