"Public health officers can only work with what governments give them", Chris Selley

April 28, 2020, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

The COVID-19 crisis in nursing homes was predictable. Despite the recommendations made as a result of the 2004 SARS crisis we face a scramble for resources at the time we need them most. We as a province are watching the result of the failure to implement the recommendations. Our most vulnerable and elderly citizens are bearing the brunt of our failure to be prepared. We as a province and society are responsible to for what has happened and for what we need to change.

This editorial from the Ottawa Citizen sums up our situation perfectly.

Chris Selley: The COVID-19 nursing home crisis wasn't 'unimaginable.' It was predicted, then ignored

Author of the article: Chris Selley

When it comes time for the official post-COVID-19 inquiries, and I think several are called for, it’s fair to predict the situation in nursing and long-term care homes will leave the starkest impression. The Pinecrest Nursing Home in Bobcaygeon, Ont. was the first to come to widespread public attention thanks to a harrowing report in The Globe and Mail. “Equipment everywhere. An eerie silence broken only by the sound of TVs, the coughing of residents and the shuffling of workers in protective masks, gowns and gloves. Patients with dementia had slipped into a kind of ‘fugue state,’” a nurse there reported. COVID-19-positive residents shared rooms with healthy ones, she said, because there was nowhere else to put them. Later we learned of far more horrifying conditions at Résidence Herron in Dorval, Que., after police and public health officials arrived in search of a resident who had tested positive and found staff had abandoned their posts. “There were (two) patients who were dead in their beds,” a source told the Montreal Gazette. “There were patients who had fallen on the floor. There were patients who hadn’t had any basic care for a number of days, diapers that hadn’t been changed for three or four days, excrement that was covering their skin and patients who hadn’t been fed.”

The death tolls certainly aren’t unique to this country. And we have heard of similarly gruesome scenes in other countries — though mostly countries with much higher infection rates than ours, like Spain and the United States. On Thursday, Hans Henri Kluge, the World Health Organization’s European director, said “up to half” of cases on that continent were residents of long-term care facilities. He called it “an unimaginable human tragedy.”

In Ontario the figure is 70 per cent. In Quebec, it’s 80 per cent.

Not all will have passed away in a state of neglect. And while it’s certainly tragic, it’s not “unimaginable.” For all kinds of reasons, including higher rates of lung disease and diabetes, the elderly are simply far less able to fight off something like COVID-19. Housed in close quarters, they are far more likely to catch it.

Clearly, though, not all Canadian jurisdictions put their best foot forward. On April 8, having been caught off guard by the explosion of cases in long-term care homes, Quebec redirected resources from hospitals — who were seeing far fewer patients than anticipated — and announced all care-home residents and staff would be tested for COVID-19. At that point, 85 residents had died of COVID-19.

For two more weeks, despite Premier Doug Ford demanding a similar policy, Ontario’s public health officials continued to recommend against testing asymptomatic people. “You may be wasting a lot of tests that should be done on other people who are in an outbreak situation, or in the other groups that are very high priority,” Barbara Yaffe, the province’s associate chief medical officer of health, told reporters on April 13.

On Wednesday, public health officials inevitably shifted gears: Now, like Quebec, all nursing home residents and staff would be tested. Five hundred residents had already perished.

Asked about this remarkable volte-face, chief medical officer of health David Williams cited advice from Public Health Canada, via the WHO, about the low risk of asymptomatic transmission. That advice was discredited weeks ago.

More compellingly, he cited a shortage of swabs, reagents and personal protective equipment. Public health officers can only work with what governments give them, and it’s clear that in Ontario, especially, the most basic anti-pandemic tools were not available in nearly sufficient quantity. That being the case, resources needed to be rationed as public health officials best saw fit. Their reasoning should and will be subject to inquiry. But ultimately, as Ford said Thursday, his voice choking up, “the system needs to be better.”

He was referring to nursing homes specifically. (We learned Thursday that Ford’s 95-year-old mother-in-law, a resident in a long-term care home, has tested positive for COVID-19.) But it’s true across the board, and on the most basic levels. The SARS Commission report into the 2003 coronavirus outbreak in Toronto makes maddeningly familiar reading, from a lack of lab and testing capacity to shortages of personal protective equipment to debates over the efficacy of masks and methods of transmission — all of which could be avoided, the authors stressed, simply by employing the precautionary principle. All these lessons had been learned, we were assured.

In a section titled “Improvements since SARS,” the commission reported that “a two-month stockpile of personal protective equipment, including masks, gloves, gowns, eye protection and other clinical supplies, for a community the size of Toronto is available and could be distributed quickly through a central distribution system.” Seventeen years later, it was a mad scramble all over again. It’s not surprising, sadly, that the most elderly and vulnerable Canadians are bearing the brunt of that colossal failure. Ideally the shame of it might finally get it through our thick skulls never to let complacency set in again.

 

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