A woman opens the door to a person in a wheelchair at Pinecrest Nursing Home after several residents died and dozens of staff were sickened due to coronavirus disease (COVID-19), in Bobcaygeon, Ontario, Canada March 30, 2020.
Healthcare workers put on protective equipment before entering the Vigi Mount Royal CHSLD senior’s residence in Montreal, Friday, May 15, 2020.
In the spring wave, Dr. Amit Arya was part of a long-term care rapid action response team sent into homes hit by horrifying COVID outbreaks. A palliative care doctor, Arya saw residents who were gasping for air, whose oxygen levels had plummeted and who clearly had COVID-19 and were dying “and no one was there to provide the proper care, or look after them.”
“I’ll just be very open with you. It’s still something I think about every day. It haunts me. I wish I could have done more,” he said in an interview.
As a rash of new infections seeps back into long-term care homes, Arya fears more similarly horrendous scenes. Despite promises to protect the vulnerable this time around, COVID-19 is shifting, from the highest case numbers in the 20 to 39 age group over the summer, to increasing cases in older people. Canada’s chief public health officer warned this weekend about a growing number of outbreaks in long-term care.
“While these outbreaks involve a smaller number of cases than in April and May, we know that spread in these facilities often leads to death,” Dr. Theresa Tam said, with considerable understatement. The spring wave claimed more than 9,100 lives, with outbreaks in long-term care and retirement homes accounting for 75 per cent of all COVID-19 deaths in the country.
As of Monday, there were active outbreaks in 58 long-term care homes in Ontario; there have been 40 COVID-19 deaths in the homes in the past month. On Sunday, federal Public Safety Minister Bill Blair tweeted that the Red Cross was being sent into seven Ottawa-area homes to help “asses and stabilize the situation.” Eleven homes in the Ottawa area are battling active outbreaks. In Edmonton, 53 residents and 27 staff have tested positive for the pandemic virus at the Millwoods Shepherd’s Care Centre; seven residents have died. Outbreaks have been reported in Quebec, B.C. and Alberta long-term care homes. Last week, an interim report from Ontario’s patient ombudsman told of reports of COVID-19 positive staff forced to come to work, and staffing shortages that were making it difficult to provide even the most basic care.
It haunts me. I wish I could have done more
We blundered, appallingly, on the long-term care front in Ontario and Quebec in the first wave, experts say. It was the Achilles heel that drove up Canada’s case fatality rate. We crushed the curve and contained community spread, but forced the infection into under-staffed, ill-equipped long-term care homes, many of them older homes with three or more beds per room. There were more than 840 outbreaks. Military sent into Ontario and Quebec nursing homes found residents unwashed, dehydrated and, in some cases, dead. The “once-in-a-century” pandemic laid bare the deadly deficiencies dozens of studies and advocates had warned of for decades while so many governments averted their eyes. Now some worry, will the scenarios of the spring be repeated?
“If we think back to those early days in February and March, what we were all worried about was a scenario like Italy and New York,” said Arya, who has appointments at the University of Toronto and McMaster University in Hamilton. “A lot of the focus was on protecting acute care — acute care hospitals, making sure we had enough ventilators. Some of those fears are coming back, and rightfully so. We have to be careful. But we also have to do all we can to protect long-term care.”
When outbreaks hit long-term care, residents were left doubly vulnerable, Arya said — not only was there not enough staff, families were restricted from visiting. “There was no family there, not just to look after seniors, but also to recognize how bad the situation was.”
It’s not surprising outbreaks in care homes are increasing. “These homes are not on separate islands,” Arya said. The more transmission in the community, the greater the risk of COVID-19 being carried into a home.
Other provinces acted quickly. In June, Quebec, which had a similar catastrophe in the first wave, promised an additional 10,000 “orderlies,” or personal support workers, by September. According to CTV News, just over 7,100 are in place. In B.C., where Canada’s first reported COVID-19 related death involved a man in his 80s, a resident at the Lynn Valley Care Centre in North Vancouver, the province moved quickly. Health workers were limited to a single home. The province promoted a system of full-time work, standardized wages and sick leave, so that workers didn’t have to move from one home to the next to string together a living wage. “We know from the first wave it was health workers who unknowingly spread the virus,” Arya said. Long-term residents were also nearly three times more likely to live in shared rooms in Ontario than in B.C., according to a recent study.
As of Sept. 10, Ontario had reported 1,817 resident deaths from COVID-19 in long-term-care homes, compared with 156 deaths in B.C. homes.
Ontario recently announced a $3 per hour wage boost for personal support workers, one dollar less than the old $4 per hour pandemic subsidy. The province has also announced half a billion in additional support, including a greater supply of personal protective equipment, testing workers, improved infection control and repairs and renovations. But most of the financial commitment over the summer was focused on building new homes or refurbishing older ones. “It wasn’t until the last couple of weeks that money started being committed for things like personal support workers and accelerated training programs to train up enough of a work force — things Quebec and B.C. had been doing since June,” said Dr. Nathan Stall, a geriatrician at Toronto’s Mount Sinai Hospital.
Homes have also been directed to stop admitting people to rooms of three or four. But it didn’t address the people already living in multiple-bed rooms.
“It’s unsurprising to me, sadly, that we’re having outbreaks in long-term care homes,” said Stall, who believes, despite the messaging from government, that the second wave started somewhere around the beginning of September.
“And since that time we’ve continued to accumulate two to three long-term care homes a day that are going into outbreak. Because who works in long-term care homes? They’re people who don’t live in long-term care homes. They come from the community where the transmission is high, and they are going to become infected themselves by living in the community and unknowingly import the virus” into care homes.
Personal support workers are overwhelmingly racialized women who are poorly paid, without benefits, and who tend to live more in COVID hotspots — multi-generational households or crowded buildings in zones where there are higher rates of community transmission, Stall said. “You have to consider the socioeconomic factors of these workers as well. We shouldn’t be blaming them. It’s just a reality of the system.”
But the staffing crisis is still largely unaddressed and it worries Stall when he sees homes going from two cases of COVID-19 one day, to 50 or 60 the next.
“It’s sort of a perfect storm, unfortunately, of surging community transmission and the ongoing issues with the long-term care sector that make it such a fragile place to be.” Seventy percent of residents have dementia, 90 percent some cognitive impairment, making it difficult for them to understand the need for distancing or hygiene, “or even recognize they’re ill themselves,” Stall said.
We need to think about creating additional space, like field hospitals, he said. Viruses rip through crowded homes, because there’s no empty space to isolate residents.
“What happened in the spring was truly a humanitarian crisis,” Stall said. “If we do not create emergency response plans that include things like this, the same level of catastrophe will happen again.”
Copyright Postmedia Network Inc., 2020