Dear Colleagues: Welcome to our Saturday, April 10 report during this fourteenth 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. Scroll down for information on several webinars in the next few weeks.

In today’s report we first discuss the situation in Ontario, followed by an article about the global context of vaccination and what it means for all of us.

On April 1 the Ontario government enacted a “shutdown” that RNAO and other experts deemed weak and insufficient. RNAO issued a press release denouncing the measures and calling on the premier to enact stronger public health measures to control the runaway third wave of the pandemic. This release followed earlier calls from RNAO cautioning of the impending third wave driven by new variants (see here, here, here and here). RNAO also issued an Action Alert and within 24 hours over 4,000 nurses, other health professionals and persons from the public responded demanding robust public health measures. On April 7 the government finally heeded the calls and announced a provincial emergency and stay-at-home order. RNAO responded with a media release on April 8 that you can read next.

RNAO continues to monitor the expansion of variants of concern, in particular B.1.1.7 (originally identified in the UK), B.1.351 (originally identified in South Africa), and P.1 (originally identified in Brazil). B.1.1.7 is already dominant in Ontario and P.1 is expanding in BC, Alberta and Ontario. RNAO is watchful for public health measures that target people’s crowding and movement from region to region, as well as the speed and effectiveness of the vaccine rollout to vulnerable persons and regional/workplace hotspots.  Please take a moment to listen and RT an important and sobering interview.

Last minute addition (April 8, 9 pm): New government directive to maximize capacity and preserve resources needed to care for patients. See here.

RNAO says latest public health measures will help curb COVID-19 variants, urges greater utilization of nurses in vaccination rollout

April 8, 2021

The Registered Nurses’ Association of Ontario (RNAO) says the government’s new public health measures announced yesterday will help stop the spread of the virus’s variants. The announcement came on a day when officials reported another 3,215 cases of COVID-19 and more than 500 patients in hospital intensive care unit (ICU) beds.

The government’s province-wide emergency stay-at-home order is in effect for four weeks. Big box stores are restricted to selling groceries and pharmaceutical items only. While non-essential retail stores can remain open, they will be limited to curbside pick-up.

“The measures announced by the government are welcome, and we are glad our voices were heard,” says RNAO CEO Dr. Doris Grinspun referring to the Action Alert issued by the association immediately preceding Tuesday’s cabinet meeting. In that call, RNAO asked for:

• a lockdown of all non-essential services
• the need to vaccinate all essential service workers
• 10 paid sick days for all workers
• re-instituting a moratorium on all residential and encampment evictions
• restricting travel within Ontario and between Ontario and other provinces and countries to only essential travel

“We thank the 4,000 respondents who signed the Action Alert, and say to them your voices were heard,” says Grinspun. She adds that “the only measure the government didn’t respond to is the need for sick days for people in precarious employment. We heard Premier Ford’s explanation regarding the Canada Recovery Sickness Benefit (CRSB) provided by the federal government, but as nurses we know that accessing those funds is not easy for the many people who lack this benefit and who may experience language and/or technology barriers.”

“This is not about politics. Expert after expert has said providing paid sick days is an important public health measure that would offer protection to thousands of workers who fear losing their jobs or have no choice but to show up for work because they have to provide for their families,” says Grinspun, adding that “many of these workers are the ones who have ended up in hospital ICUs and have succumbed to the virus.”

RNAO urges the province and local public health units to move swiftly to on-site vaccination of workers in warehouses, food processing plants and other large workplaces that will be allowed to operate under the stay-at-home order. Bringing vaccines on site to such workplaces and also to high-risk neighbourhoods is essential to protect workers, their families and entire communities

To succeed in stepping up the vaccination program, RNAO says the government and public health units must make use of untapped infrastructures and human resources. RNAO President Morgan Hoffarth says the government should fully utilize the more than 20,000 nurses who work in primary care and home care. “These are nurses who work in organizations such as community health centres, nurse-practitioner led clinics, family health teams, aboriginal health centres and home care agencies that have highly efficient and effective vaccine distributions networks – and while used every year are yet to be fully utilized during this pandemic. We have written to Premier Ford and Minister Elliott – imploring them to get all hands on deck to beat this virus. Nurses and their employers are eager and ready to rollout vaccines.”

RNAO agrees with the government’s decision to support public health units to make their own decisions regarding school closures. “We were pleased to hear the premier say that teachers – starting with those in special education, and then all education workers – are being prioritized for vaccination, says Hoffarth adding that “we urge the province to also utilize nurses to rollout vaccines 24-hours a day, seven-days-a-week to get the job done.”

As the virus continues to play havoc with the economy and the livelihoods of thousands of people, RNAO is also pleased that the government heard its plea to re-institute a moratorium on tenant evictions.

“This pandemic is testing all of us and affecting people of all ages. During the next four weeks, RNAO will watch and continue its strong advocacy on behalf of nurses across this province. We need to remember this as we go about our lives. Think about your family, your friends, your neighbours and your work colleagues. We all need to watch out for each other and rely on one another to stay strong,” says Hoffarth.

3 ways to vaccinate the world and make sure everyone benefits, rich and poor

I remain extremely concerned about the slow pace of vaccination in the less privileged regions of the world. I am re-posting a still-relevant February 28 article from Michael Toole, Professor of International Health at the Burnet Institute in Australia. This article is republished from The Conversation under a Creative Commons license. The suggestions of how Australia could contribute to improve the global landscape are relevant for Canada as well. Read the original article. 

As of February 25, a total of 221.7 million doses of COVID-19 vaccine had been administered around the world. Well over one-third of these doses were in just two countries — the United States and the United Kingdom.

A study in mid-November analysed commitments to buy 7.48 billion doses of COVID-19 vaccines. Just over half will go to the 14% of the world’s population who live in high-income countries.

It’s estimated most high-income countries will achieve widespread vaccination coverage by the end of 2021. Most middle-income countries will not achieve this until mid- to late 2022, while the world’s poorest countries, including almost every country in Africa and some in our own Asia-Pacific region, will have to wait until 2023.

This inequality is clearly a moral outrage. But it is also a surefire way to perpetuate the pandemic’s devastating health, social and economic impacts on the whole world.

Why everyone benefits from vaccine equity

There are many reasons why rich countries should do all they can to ensure global vaccine equity — in which COVID-19 vaccines are distributed fairly to different populations, including people of different means and backgrounds.

First, there is the moral argument. Given the vaccines already exist, every day that goes on results in deaths we could have prevented.

Second, the longer it takes to eradicate the virus globally, the more it will mutate, possibly reducing the effectiveness of the vaccines. That would affect us all.

Third, as long as the virus is here, trade flows and global supply chains will be severely disrupted. Avoiding this is also in our own interests if we want to see foreign tourists and students return to our shores.

A recent study found high-income countries may bear 13-49% of global losses — which could be up to US$9 trillion — arising from an inequitable distribution of vaccines in 2021.

Finally, a prolonged pandemic might result in even more poverty, destabilising the already fragile livelihoods of millions of poor people in low- and middle-income countries. This, in turn, could result in conflict, undermining global political stability, which would affect us all.

Here are three ways to ensure global vaccine equity.

1. The COVAX facility — but there are issues

A number of large middle-income countries have begun to roll out their vaccination programs, including India, Brazil, Mexico, Chile, Egypt, South Africa and Indonesia. Only a few African countries have begun their vaccination programs, of which just one, Zimbabwe, is a low-income country.

Some middle-income countries and most low-income countries will be relying on the World Health Organization (WHO)-led COVAX facility, to which Australia contributes funding. This aims to administer two billion doses of vaccine, starting with health-care workers, in poorer countries by the end of 2021.

However, COVAX doses will cover only up to 20% of the population of each country. And COVAX supplies may be slow to arrive, especially if delays in the production and delivery to richer countries push back delivery dates for poorer ones.

For instance, Ghana, the first of 92 countries to receive vaccines through this initiative, only received its 600,000 doses last week.

Tedros Adhanom Ghebreyesus, director-general of the WHO, has said that rich countries’ approaches to manufacturers to secure more vaccine doses are undermining COVAX’s effort to achieve its goal of purchasing two billion doses of vaccines to administer during 2021.

2. Countries can produce their own vaccines

Low- and middle-income countries can also produce COVID-19 vaccines themselves, an option taken by nations including India, Thailand, Vietnam and Cuba.

The Serum Institute of India is one of the world’s largest manufacturers of vaccines and has a licence to produce the AstraZeneca vaccine, which the WHO has approved for emergency use.

The company recently announced it would manufacture vaccines for India before doses earmarked for the rest of the world, a move that may delay vaccine shipments to dozens of countries and hamper the firm’s plans to share its vaccine supply. India is also developing its own vaccine, from Bharat Biotech, which has been approved in India.

Cuba has four vaccines under development. The most promising in early trials is Soberana 2, which will start phase three clinical trials shortly. If successful, Cuba’s Finlay Institute plans to produce up to 100 million doses by the end of 2021.

In Thailand, two vaccines are under development by Chulalongkorn and Mahidol universities. Both are about to start human trials.

In Vietnam, Nanogen Pharmaceutical has received government go-ahead to start clinical trials of its vaccine Nanocovax. The company can produce two million doses a year but plans to increase that to 30 million doses in the next six months.

3. Rich countries can donate spare vaccines

Rich countries can donate vaccines to poorer countries. France’s President Emmanuel Macron said richer countries should send up to 5% of their current vaccine supplies to poorer nations. There is little evidence other countries have followed France’s lead.

However, Russia and China have provided their own vaccines – Sputnik V and Sinopharm, respectively – to a number of low-income countries in Africa, the Middle East and Latin America.

What could Australia do?

Australia has agreements to purchase enough vaccines (Pfizer, AstraZeneca and Novavax) to inoculate its population many times over.

In addition to its pledge to COVAX, Australia could contribute to vaccine equity in our region in two ways.

First, once CSL ramps up domestic production of the AstraZeneca vaccine, we could provide a portion of doses to our close neighbours, including Pacific nations and Indonesia.

Once the Therapeutic Goods Administration approves the Novavax vaccine, which is likely to occur by the middle of the year, we could share our order of 51 million doses with poor countries in the Asia-Pacific region.

These doses could be provided either free or at heavily discounted prices. Deliveries should be made directly from the manufacturer rather than sending “leftovers” from Australia, which could lead to expired vaccines ending up in neighbouring countries.

In a nutshell

This is no time for short-sighted vaccine nationalism. Encouragingly, Australia has signalled its intention to support the region.

But the projected two-year delay between vaccinating the world’s rich and the poor is both morally unacceptable and the biggest impediment to the world’s health and economic recovery.

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

COVID-19 webinar: Wave three: Update, advocacy and what's next?

April 12, 2021, 2 - 4 p.m. ET

Ontario is now in the third wave of the COVID-19 pandemic. During this webinar, Dr. Doris Grinspun, RNAO's CEO, and colleagues will provide an update on how the third wave is affecting nurses and Ontarians. Hear how RNAO, together with members and allies, are advocating for immediate actions to save lives, and long-term actions to right wrongs and establish justice for all. Learn about the next steps and how you can help shape the trajectory of this devastating virus and its variants.

To learn more about the COVID-19 Webinar Series, go here.

Register here for the April 12 webinar.

Continuing the conversation – An open forum for nurses to share how they're feeling during COVID-19

Wednesday, April 14, 2021, 2:30pm - 4:00pm

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

RNAO hosts a biweekly virtual open forum series for nurses to share how they're feeling during COVID-19. During these forums, RNAO holds breakout sessions for participants to discuss themes identified in the previous forums, such as dealing with multiple losses, taking care of yourself and more.

All Ontario RNs, NPs, RPNs and nursing students – in all roles and sectors – are invited to take part and share or simply join in to listen to your nursing colleagues.

The next session is on April 14, 2021, 2:30pm - 4:00pm. Register here.

Learn more about the open forums here.

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

Apr 19, 2021, 6:30pm - 8:00pm

This is a monthly webinar series designed for nurses interested in receiving updates on RNAO’s Black Nurses Task Force and to engage them in meaningful conversations that will inform the work of the Task Force. The Black Nurses Task Force has a mandate to tackle anti-Black racism and discrimination within the nursing profession. Read more here.

The April 19, 2021 webinar will be on:

Topic: Recruiting, retaining and advancing Black nurses

Objectives:

• generate awareness on the underrepresentation of Black nurses in leadership and executive roles in health care;
• describe strategies to incorporate equity, diversity and inclusion in hiring processes;
• explore best practices and effective strategies for recruitment, retention and advancement of Black nurses; and
• identify the meaning of sponsorship and its value in the progression of Black nurses.

Presenters:

• Ingrid Wilson, CHRL, CMS, GridFern Strategic HR
• Josephine Etowa, PhD, RN, RM, FWACN, FAAN, Professor, OHTN Chair in Black Women’s HIV Prevention and Care in Health Sciences, University of Ottawa

Register here.

Connecting Culture, Land and Wellness to Indigenous Youth Webinar

Apr 20, 2021, 4:00pm - 6:00pm

This webinar is in partnership with the Registered Nurses’ Association of Ontario (RNAO), Nishnawbe Aski Nation (NAN), Chiefs of Ontario (COO), the Centre for Addiction and Mental Health (CAMH) Shkaabe Makwa, the Canadian Indigenous Nurses Association (CINA) and Ontario First Nation Young Peoples Council (OFNYPC).

The overall purpose of this webinar is to increase health care providers' awareness of the importance of Indigenous language, community, culture and the wise practices and teachings of Elders to support well being amongst Indigenous youth. The objectives of this webinar are to facilitate knowledge exchange between Indigenous youth and health-care providers in regard to:

• the importance of language and what language says about wellbeing;
• how culture helps maintain wellbeing;
• the vision of healthy Indigenous youth; and
• the role of the health-care provider in supporting Indigenous youth

Presenter: Joseph Pitawanakwat (biography)

Moderated by: Quinn Meawasige, Indigenous Youth and Rachel Radyk, RPN, RN Student.

Target audience: Registered nurses, nurse practitioners, registered practical nurses and nursing students across care settings, primary care providers, public health and health promotion professionals, allied health-care providers and policy makers.

Note: Webinar will focus on nurses and health-care providers supporting First Nations communities and organizations; however all are welcome to attend.

NP Virtual Institute on April 21 with LTC Commissioner Frank Marrocco and other notable speakers

April 21, 2021, 9 am - 4:30 p. (ET)

Nurse practitioners from all sectors and settings across the province are welcome to RNAO’s Second-Annual Nurse Practitioner Institute – Nurse practitioners shaping the health system of the future.

The one-day virtual event provides NPs with an opportunity to network, engage and explore topics related to policy, clinical practice, quality improvement and patient safety, leadership and research. Top speakers this year include Matt Anderson, President & CEO, Ontario Health; Frank Marrocco, Associate Chief Justice and LTC Chief Commissioner; Dr. Jennifer Zelmer, President & CEO Canadian Foundation for Healthcare Improvement; Donna Duncan, CEO, OLTC; Shirlee Sharkey, President & CEO SE HeathCare and Greg Tofner, President & CEO from the Ontario Association of Medical Radiation Sciences delivering a clinical session of CT Scans & MRIs, and much more!

Participants will also discuss and debate key lessons and learnings from COVID-19 relevant to their practice and health system performance as well as build leadership and advocacy skills to drive meaningful policy and practice changes.

The NP Institute will close with an update about RNAO’s NP Task Force report Vision for Tomorrow, including the advisory role task force members will take on to ensure progress is made on each of the eight recommendations. 

These awesome speakers and much more are at NO cost for RNAO’s 1,800+ NPs. Register online today. If you are an NP and not yet a member of RNAO, you can join for a short time for ONLY $100 with PLP and all taxes included! And, then join the NP Institute for free! Join here  

To learn more, please see the agenda. Register online today.

RNAO and NAN sign Relationship Accord to improve health across NAN Territory

To advance health equity and effective health care and in support of Nishnawbe Aski Nation’s (NAN) aspirations for self-determination over matters of health, RNAO signed a new partnership with NAN on March 24.

During the NAN virtual Chiefs Assembly on Health Transformation & Governance on March 23 and 24, RNAO along with other health-care associations signed Relationship Accords with NAN Grand Chief Alvin Fiddler and First Nations leaders.

Through this accord, RNAO commits to support NAN as they engage in nation-to-nation negotiations with the provincial and federal government for a NAN-run health system on its territory.

In response to the new partnership, RNAO President Morgan Hoffarth said: "RNAO is delighted to be formalizing our support for the aspirations of NAN for self-determination on all matters, including its peoples health needs and services. We look forward to working with NAN and in concert with other health system partners, bringing to life a health system that will improve the health outcomes for NAN's communities.”

To learn more about the signing ceremony, please see the press release. 

Mark your calendar: 96th Annual General Meeting (AGM)

Jun 24, 2021, 2:00pm - Jun 26, 2021, 1:00pm

RNAO’s 96th AGM will be held virtually on June 24 - 26, 2021. Details on how to join the live streamed events will be posted in early June.

View the schedule of events and register now!

For a recap on last year's virtual AGM, please visit our AGM portal.

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 #405 for April 9 (no report on April 10):

No updates today.

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 health professionals – must keep focused. There is hope at the end of this long tunnel. Vaccines are being delivered in large quantities and now we need to fasten the rollout! Hugely important is to continue 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 stands 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:

3 April - Government’s “shutdown” announcement doesn’t go far enough – go here.

3 April - RNAO’s continuing media profile: The March report – go here.

27 Mar - Provincial budget fails to deliver urgent nursing investments to care for Ontarians – go here.

27 Mar - Government's reopening plan threatens the health of Ontarians – go here.

20 Mar - Preliminary results of RNAO‘s Work and Wellbeing Survey – go here.

13 Mar - Getting it right – go here.

13 Mar - RNAO leads dozens of organizations in candlelight vigil – go here.

6 Mar - RNAO’s continuing media profile: The February report – go here.

6 Mar - Communication during a Pandemic: How we can endure the pandemic together – go here.

6 Mar - Webinar: Understanding wellness in Indigenous wisdom traditions for caregivers – go here.

27 Feb - RNAO celebrates Black History Month 2021 – go here.

27 Feb - RNAO’s 21st annual Queen’s Park Day goes virtual – go here.

27 Feb - RNAO’s NP Task Force releases groundbreaking report – Vision for Tomorrow – go here.

20 Feb - Are you struggling with substance use and/or mental illness? – go here.

20 Feb - RNAO hears about COVID-19: A heart-to-heart dialogue for nurses – go here.

20 Feb - With new variants growing, concerns mount about the premature lifting of restrictions – go here.

18 Feb - Anti-Black racism and discrimination in nursing: The power of mentorship in nursing education – go here.

13 Feb - RNAO’s letter to the premier on the vaccine rollout and the current context – go here.

6 Feb - Use community care providers to ramp up vaccinations! – go here.

6 Feb - RNAO’s continuing media profile: The January report – go here.

30 Jan - The PrOTCT plan for nurses: Counseling vaccine hesitant patients & colleagues – go 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 settings – go here.

23 Jan - Home care nurses are #ReadyToVaccinate – go here.

23 Jan - Hurtful comments about law enforcement – go here.

15 Jan - The escalating catastrophe of the COVID-19 second wave in Ontario – go here.

15 Jan - Progress in vaccine distribution: Updates, issues and concerns – go here.

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

8 Jan - A practicum experience at RNAO – go here.

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

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

Information Resources

Public Health Ontario maintains an excellent resource site on COVID-19 materials. 

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.

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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