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Dear Colleagues: Welcome to our Sunday, August 8 report during this eighteenth 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 policy updates for all to act on & must join events. In this update we share: (1) RNAO’s statement on the government’s plan for reopening of schools; (2) RNAO’s call on the Ontario and federal governments to implement vaccine passports; (3) an article considering a third (booster) dose of COVID-19 vaccine.
We also ask that you please urgently retweet this tweet, announcing this Monday’s launch of RNAO’s 3 Mandatory Asks from Ontario’s Premier Doug Ford. Given that this applies to readers of this blog in any country, please RT and feel free to adapt for your own context.
Ontario nurses welcome government’s school reopening plan; say additional measures needed to stave off worst effects of fourth wave RNAO issued the following media release upon announcement of the Ontario government’s plan for reopening of schools on August 3, 2021. See RNAO’s earlier, July 25, call for government action. With only one month left until schools reopen in Ontario, the Registered Nurses’ Association of Ontario (RNAO) is pleased the provincial government’s plan includes mandatory indoor masking for students in grades one through 12 and improving ventilation systems. These measures meet some of RNAO’s long-standing recommendations to Premier Ford, including those in the association’s July 28 open letter. “The measures are essential to minimize the impact of a fourth wave of COVID-19 as Ontario opens school doors to students and staff,” says RNAO CEO Dr. Doris Grinspun. “Although RNAO is pleased to see a paragraph dedicated to vaccination in the government’s plan, it’s just that – a paragraph,” says Grinspun, adding that “given how effective vaccines are in the face of the highly transmissible Delta variant and the emerging Lambda variant, nurses will continue to insist on mandatory vaccination for all educational staff (and health-care workers), unless they have a medical exemption.” RNAO joins Ontario’s Chief Medical Officer of Health Dr. Kieran Moore in urging school boards to work with public health units to promote vaccination uptake, and “we will support the move if school boards (and health-care organizations) make it mandatory,” emphasizes Grinspun. “The association also stresses the importance of requiring masks for kindergarten kids, and hopes the government will modify its strategy to reflect this,” says RNAO president Morgan Hoffarth. “The plan also fails to specify physical distancing requirements in schools other than among separate cohorts,” adds Hoffarth. “While we are delighted music classes are back, we caution against the resumption of indoor choir practices given what we know about aerosol transmission of the virus.” The government plan does outline ongoing mental health support for students but provides no concrete plan for this to be achieved. We call on Dr. Moore to permanently employ the 625 public health nurse positions across Ontario schools, as well as the additional 50 community wellness nurses to serve First Nations communities. Nurses join students and parents in celebrating a back-to-the-classroom September, but additional measures are necessary to ensure a safe return for staff, students and their families to keep the learning experience positive amid an ongoing pandemic.
RNAO calls on Ontario and federal governments to implement vaccine passports to help reopen Canada RNAO issued the following media release on August 5, 2021. See our earlier articles on vaccine passports here and here. The Registered Nurses’ Association of Ontario (RNAO) says a new temporary tool is needed in the fight against COVID-19: Vaccine passports. “During this transition to reopening we should facilitate the resumption of certain non-essential activities such as indoor dining in restaurants, going to the gym, attending concerts and sporting events, and travelling – while keeping people safe. Having a secure passport will allow people who have received both doses of the vaccine to enjoy the things they have been missing out on for the past 17 months. We are facing dangerous variants and a fourth wave driven by those who aren’t vaccinated; a vaccine passport helps address that,” says RNAO President Morgan Hoffarth. RNAO’s board of directors passed the following motion:
“Extraordinary times call for extraordinary measures and our motion is an example of this. If the vaccine passport is implemented in the right way, we can address the equity and privacy concerns. I am so proud to work for a board that is calling for this bold and courageous action. Thousands of people have died from COVID-19 and people’s lives have been changed forever. We must address the fourth wave without lockdown measures. We must take this temporary step so people can resume their lives and the things they enjoy, while at the same time remain vigilant. In the meantime, nurses and other health-care providers will continue our fight against COVID-19 and its stubborn variants,” says RNAO CEO Dr. Doris Grinspun. As part of its call, RNAO says vaccine passports will encourage individuals and organizations to do all they can to remain safe and healthy.
COVID-19 vaccine boosters: is a third dose really needed? RNAO is considering the question of a third dose of COVID-19 vaccine. The following article reflects our current thinking on the matter. Although it is focused on the UK, it is relevant to the Canadian context. Basically, we believe it is too early to launch a vaccine booster program in Canada, except for immunodeficient persons and adults 80 years and older. Instead, it is urgent to channel billions of vaccine doses to less developed countries to mitigate the spread of COVID-19 in those countries, as called by the WHO. This article is republished from The Conversation under a Creative Commons license. Read the original article published July 9, 2021, by Sheena Cruickshank, Professor in Biomedical Sciences, University of Manchester. The UK is enjoying real success with its COVID-19 vaccine coverage. Around 85% of adults (44.8 million people) have received one vaccine dose and 63% (33 million people) both doses, with around 160,000 doses a day still being administered. Vaccination with two doses helps prevent infection, and in those that do still get infected, lessens the impact of the virus by reducing disease severity, transmission of infection and death. Even so, plans to give people a third shot have been unveiled by the UK’s Joint Committee on Vaccination and Immunisation (JCVI). The two main arguments to support giving a third dose are that the effectiveness of the first two jabs falls over time, and that there’s a need to take new vaccines to deal with viral variants, such as the delta variant. But what does the evidence say? Several studies have investigated the durability of immunity to COVID-19, and their results are encouraging. Researchers have focused on specialised white blood cells called lymphocytes. Lymphocytes come in two main varieties: B cells, which make antibodies, and T cells, which can help the B-cell response or directly kill the COVID-19 virus. Antibodies play a critical role in stopping viruses entering the body’s cells, which is what the virus needs to do to replicate. You can readily measure someone’s antibody levels in a blood sample, but the data on what a typical person’s antibody levels are following vaccination or infection with COVID-19 has been variable. Most people have good persistent levels of antibodies that can be detected for at least seven months. However, some other people have quite low levels of antibodies or their levels rapidly fall after infection or vaccination. Such variability makes it difficult to know how useful antibody data alone is for measuring lasting immunity to infection. A clearer picture can emerge if other indicators of immunity are considered: our B and T cells. A recent preprint (a piece of research still awaiting review by other scientists) suggests that looking at both antibodies and T cells gives a clearer picture of whether immunity has lasted. And reassuringly, functional T-cell responses against COVID-19 have been detected six months after infection. Similarly, memory B cells – long-lasting cells kept on hand in case the immune system encounters COVID-19 in the future – have been detected in people even when their antibody levels have fallen so low as to be undetectable (though this research is also still waiting review). This suggests that even after their antibodies have waned over time, these people have the means to quickly produce new ones should they face the coronavirus again. Older people (>80years) often have less effective immune responses when infected or vaccinated, meaning their overall immunity may be lower and may fade more quickly. In any booster campaign they would be likely to be prioritised. However, so far the data for older people has been encouraging. Another recent preprint has shown that older people produce a strong immune response following vaccination. All these studies are immensely reassuring. Added to what we know about immune responses to viruses more widely, there’s growing confidence that immunity to COVID-19 is durable – although longer-term studies will still be needed. Nevertheless, right now there isn’t strong evidence that people’s immunity needs topping up with a booster. Can current vaccines handle variants?There are now several variants of the coronavirus in circulation, with four to date – alpha, beta, gamma and delta – being deemed variants of concern (VOCs). These are variants that spread more easily, cause worse disease or are less well managed by vaccines. Initial studies on the effectiveness of vaccines against the alpha variant – one of the first discovered – have been encouraging. And while early data on the gamma variant suggested it may be somewhat able to evade immunity, a subsequent preprint suggests that vaccines still protect against it. There have been concerns too about the delta variant, however data from Public Health England (also still in preprint) suggests vaccines offer robust protection against it. Even when vaccines give reduced protection – as seen with the beta variant – more early research (again awaiting review) suggests they still protect against the worst impacts of disease. The evidence is showing vaccination is working: immunity is lasting and is protecting us against the worst effects of COVID-19. So why is the UK planning on third booster shots when there isn’t clear evidence that there’s a need? A huge concern should be that the majority of people in the world still remain unvaccinated. In many low-income countries as little as 1% of eligible adults have received one vaccine dose. Poor vaccine coverage enables the virus to thrive. When it infects and reproduces in many thousands of people, this gives the virus an opportunity to mutate, which can lead to new variants emerging. It’s no coincidence that the VOCs all emerged from areas with high levels of viral transmission. There are also at least seven variants of interest that have also emerged from areas with high levels of viral transmission. These are viruses with the potential to be VOCs, and so are being monitored to see what threats they could pose. To prevent more VOCs appearing, we urgently need to get ahead of the virus – not just in the UK, but everywhere. The evidence to date doesn’t suggest there’s an urgent need to give people a third COVID-19 vaccine dose in rich countries like the UK. It would be better to give those doses to countries with low coverage, rather than launching a booster programme. Because until we have high vaccine coverage around the world, we can never truly hope to escape this pandemic.
POLICY UPDATES FOR ALL TO ACT ON & MUST JOIN EVENTS – OPEN TO ALL
RNAO Action Alerts Take action on global vaccine access: Sign an Action Alert calling on Prime Minister Trudeau to ensure global vaccine access. Let’s also make sure we urge Prime Minister Trudeau to match President Biden’s commitments to Covax. Take action on a safe reopening of schools: Add your voice to 1,800 calling for #MandatoryVaccination of educators, unless medical exemption. Sign our Action Alert Take action on #MandatoryVaccination of all healthcare workers, unless medical exemption: Add your voice to over 2,500 calling for urgent action. Take action on Bill 124 and sign the Action Alert. Add your voice to the 5,162 others calling on Premier Ford to exempt health-care workers from Bill 124. We join the call to #RepealBill124. This is urgent given the deterioration of nursing human resources as colleagues leave the profession or move to the United States. President Biden is eager to welcome our awesome RNs. Call on elected leaders to step up and end the opioid crisis: Sign an Action Alert calling on politicians at all orders of government to work together to save lives and bring this crisis to an end. Enshrine a nursing home basic care guarantee in legislation, premier, set the path forward! Sign an Action Alert! Call on the premier to enshrine in legislation RNAO’s Nursing Home Basic Care Guarantee. RNAO’s #FullyVaccinated social media campaign and calls for #MandatoryVaccination for health-care workers – For social media, graphics, updates and other information go to our COVID-19 vaccine information and resources page here.
Continuing the Conversation: An Open Forum for Nurses Aug 18, 2021, 2:30pm - 4:00pm Topic: Nursing student transitions into the workplace: Experiences and supports COVID-19 has disrupted nursing education. Hands-on clinical placements have been replaced by simulation, in-class learning has gone virtual and students are completing their education at a time when all energy is focused on the global pandemic. Thousands of Ontario nursing students will be entering the nursing workforce at a critical time in history for health care: one where structural inequities and system failures have been brought to the spotlight, and where nurses, exhausted from relentless waves of the pandemic, are facing burnout and considering leaving the profession in larger numbers than usual. However, the pandemic has also raised the centrality of our profession and reinforced that without nurses the health-care system will collapse. RNAO is issuing a call to ensure the next generation of nurses thrive in the profession. During this heart-to-heart nursing forum, you will hear from nursing students, new grads and educators who will discuss the following questions:
Visit our COVID-19 Portal for additional resources and information on psychosocial support. Information about prior webinars can be found here.
Webinar: COVID-19 Webinar Series September 13, 2021, 2:00pm - 4:00pm When: Every second Monday of the month (except for August) RNAO's CEO Dr. Doris Grinspun will be hosting COVID-19 webinars for health providers. Topics include:
Health providers from Ontario, Canada, and anywhere in the world are welcome to join at no cost. We are here with you in solidarity. Together, we will continue to tackle COVID-19 with the best tools at hand, including accurate information, calmness, determination and swift actions! Upcoming webinar: September 13, 2021, 2 - 4 p.m. ET Details and registration link coming soon. Watch and read about earlier webinars 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 last Situation Report #487 for August 6:
No updates for today.
Staying in touch Keeping in touch remains important as we face the pandemic and other challenges in Ontario, in Canada and elsewhere – in particular, in Africa and Latin America – two of the continents most affected by COVID-19 and its variants – delta and lambda. Feeling that we are part of a community and that we have each other’s backs helps us get through these challenges, becoming better people in the process. We are eager to hear how we, at RNAO, can best support you. Send us your questions, comments, and challenges. Recommend ideas for articles and webinars. Write to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten at pgbatten@rnao.ca. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU! Thank you for being there for your community – everywhere and in all roles! Together, in solidarity, we are strong and resilient. In Canada we see hope at the end of this long pandemic tunnel. Please keep encouraging your colleagues, their loved ones and your communities to be fully vaccinated. We must not forget, however, about our privilege. Canada has purchased more vaccines than what it needs, while 9 out 10 countries have almost nothing. Like in other challenges we face, such as racism, Islamophobia, and other forms of discrimination, we are not safe until everyone is safe. Vaccines for all – literally for all, across the world – must guide policy in the upcoming 12 months. Let’s learn from the 17-month pandemic and take real action to build a better world. To everyone – THANK YOU! Please take care of yourself and know that RNAO always stands by you! Here’s one constant throughout the pandemic. The silver lining of COVID-19 has been to come together and work as one people for the good of all. Let’s join efforts to demand political leaders bring about #Vaccines4All! Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, FCAN, O.ONT
RECENT BLOG ITEMS: 1 Aug - RNAO’s continuing media profile: The July 2021 report – go here. 1 Aug - Preparing for the fourth wave – go here. 25 July - Action Alert: Mandate COVID-19 vaccination for all health-care workers, premier! – go here. 25 July - Are we preparing for a safe school reopening? – RNAO asks once again – go here. 17 July - Mandatory vaccination for healthcare workers – Exploring issues, challenges and supports – go here. 17 July - #FullyVaccinated campaign and mandatory vaccination for health-care workers – go here. 10 July - A Detailed Study of Patients with Long-Haul COVID – go here. 10 July - Prolonged brain dysfunction in COVID-19 survivors – go here. 3 July - RNAO’s continuing media profile: The June report – go here. 3 July - RNAO celebrates virtual 96th Annual General Meeting – go here. 26 June - Global herd immunity out of reach because of inequitable vaccine distribution – go here. 26 June - Canada is virtue signalling while waffling on global access to COVID-19 vaccines – go here. 20 June - Building your Twitter presence: Here are tips from RNAO – go here. 20 June - Let’s flatten the infodemic curve – go here. 12 June - RNAO statement on the terrorist attack in London, Ontario – go here. 12 June - Reducing the time interval for second dose after first AstraZeneca dose – go here. 12 June - AstraZeneca second dose: Should I get the same vaccine or Mrna? – go here. 5 June - RNAO’s continuing media profile: The May report – go here. 5 June - RNAO supports Premier Ford's announcement on schools as risk is too high – go here. 29 May - Vaccination passport apps could help society reopen – go here. 29 May - Email updates highlight best new evidence about COVID-19 – go here. 23 May – NPs speak about LTC during the COVID-19 Pandemic – go here. 23 May – Three surveys on the impact of COVID-19 on Canadian nurses – go here. 23 May – Exemption of nurses and other health-care workers from Bill 124 – go here. 23 May – RNAO’s statement on the government’s phased-in re-opening plan – go here. 23 May – Remembering Charlotte Noesgaard (1948-2021) – go here. 15 May - Nursing Now Ontario Awards Ceremony – go here. 15 May - Vaccine passports – reason for hope or cause for concern? – go here. 15 May - Government responds to RNAO’s call for increased enrollment in nursing education – go here. 15 May - Second dose vaccination for high-risk healthcare workers in response to RNAO’s call – go here. 8 May - Nurses must be fully vaccinated immediately, RNAO demands – go here. 8 May - A bill to support individuals with assistive devices for mental health – go here. 8 May - Action alert: Ensure global vaccine access, prime minister! – go here. 1 May - RNAO statement on the passing of RN Lorraine Gouveia – go here. 1 May - RNAO’s continuing media profile: The April report – go here. 1 May – RNAO response to Long-Term Care COVID-19 Commission report – go here. We have posted earlier ones in my blog here. I invite you to look.
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