The Globe and Mail - 03.04.2020

A4 | NEWS O THE GLOBE AND MAIL| FRIDAY,APRIL3,

‘I

f my mom was in long-term
care, I would pull her out.
Now.”
Dr. Samir Sinha, Canada’s fore-
most geriatrics expert, is blunt.
The rapid spread of coronavirus
in seniors’ residences is “very, ve-
ry bad news” and, unless the re-
sponse changes dramatically,
families should seriously consid-
er bringing their loved ones to
relative safety.
One cannot overstate how
grim the news is that at least 600
seniors’ residences have been hit
by COVID-19.
This is a wildfire that could
soon grow far worse.
More than 75 residents of
long-term care facilities, nursing

homes and retirement homes

have already died (at least half of

all coronavirus deaths). These fa-

cilities are living up to their ma-

cabre nickname: God’s waiting

room.

One can scarcely imagine a

more nightmarish scenario than

a novel virus spreading among a

high-risk group such as seniors.

Making matters worse is that

the structure of the long-term

care system in much of Canada

facilitates the spread of infec-

tious diseases such as coronavi-

rus.

Many facilities suffer from

chronic understaffing. They de-

pend largely on part-time work-

ers who juggle jobs at a variety of

institutions and are rewarded

with abysmal pay and no bene-

fits.

If that were not bad enough,

these essential care providers are

treated as second class, with little

access to the personal protective

equipment available to hospital

workers, and no paid sick leave if

they fall ill.

Ontario’s Premier has spoken

of creating an “iron ring” around

seniors’ facilities; Quebec’s Pre-

mier has warned that keeping

outsiders away is “a matter of life

and death.”

But sealing them off from the

outside world is a lot easier said

than done, again because of

what bureaucrats call “systemic

vulnerabilities.” A typical 200-

bed home, for example, will have

about 40 staff, and then another

40 care workers coming from the

outside, all of them deemed es-

sential. Then there is the struc-

ture of homes themselves. Shar-

ing rooms is common. Commu-

nal dining is the norm. Activities

are often done in groups. In

short, seniors’ homes are much

like cruise ships, except without

the luxury. They are petri dishes.

There can be lockdowns –

with no group gatherings, meals

brought to rooms, aggressive so-

cial distancing and so on. But can

understaffed, underequipped fa-

cilities maintain these rigorous

standards?

The outbreak of at long-term

care facility in Washington State

shows just how quickly things

can go bad in this environment.

At the Life Care Center in Kir-

kland, Wash., one worker unwit-

tingly infected one resident. In a

little more than two weeks, there

were 167 infections, including 101

residents, 50 staff and 16 visitors.

Half the residents were hospital-

ized and 33 died.

Just as importantly, the direc-

tor of the Centers for Disease

Control and Prevention said this

week that as many as 25 per cent

of people infected with the new

coronavirus may not show

symptoms, meaning they can

transmit the illness without feel-

ing ill.

Practically, that means current

protocols, which involve isolat-

ing people once they are sick, are

not good enough.

Neither is the policy of testing

only the symptomatic sufficient.

Even a single case in a seniors’

home has to be considered an

outbreak, with everyone tested,

masked and isolated.

As the number of patients ad-

mitted to hospitals, and to inten-

sive-care units in particular, con-

tinues to climb in Canada, we

have to consider the affect that

will have on seniors in institu-

tional care.

Once hospitals became over-

whelmed, as they did in in Italy

and Spain – which have health

systems as good as Canada’s –

they ran out of ventilators. Then,

they simply stopped accepting

patients from other facilities.

Older people were left to die

alone in their nursing homes. So

many workers fell ill or aban-

doned their jobs that some facil-

ities were left with no care pro-

viders.

These deaths were not even

included in the already mind-

numbing mortality statistics.

More than 400,000 Canadians

are in some kind of communal

or institutional care.

It is estimated that 30 per cent

to 70 per cent of people in the

world will be infected with coro-

navirus, with the more vulnera-

ble in the upper range. In Cana-

da, about 7 per cent of those who

test positive are ending up in

hospital, but that figure jumps to

as high as 50 per cent among

nursing-home patients. Half of

the hospitalized end up in ICU,

but that figure is higher for the

elderly. The overall death rate is 1

per cent but, again, it is as high

as one-third in the frail elderly.

A disaster is not inevitable,

but it is quite possible. The

ghoulish math can be done eas-

ily enough.

But if you have a loved one in

long-term care and you realize

that, if they fall ill with COVID-19,

they may have a one in three

chance in dying, it’s pretty clear

what you should do.

If you can, get them out while

you still have a chance.

COVID-19inseniors’homesisanightmare

Atleast600facilities

havebeenaffectedby

coronavirus,andthe

structureofCanada’s

caresystemexpedites

thespreadofdiseases

ANDRÉ
PICARD

OPINION

A spokeswoman for Health Minis-
ter Christine Elliott said a total of
274 health-care workers in various
institutions, including hospitals
and long-term-care homes, had
tested positive as of Thursday.
While this represents one in 10
cases in the province, the spokes-
woman said, it does not necessar-
ily mean the workers all got the
disease on the job. They could
have taken ill by coming in close
contact with someone else with
the disease.
Ms. Elliott told reporters on
Thursday that thegovernment
has put a human-resources strate-
gy in place to provide replace-
ments while hospital workers are
away, self-isolating at home for 14
days.
“We know they’re doing really,
really difficult work right now,”
Ms. Elliott said. “And we want
them to stay both mentally and
physically healthy.”
Hospitals in Ontario run the ga-
mut from prestigious teaching in-
stitutions to community ones in
smaller cities and towns. Few
have been spared from the coro-
navirus, based on a random sam-
ple of hospitals pro-actively dis-
closing the number of patients
who have tested positive for CO-
VID-19.
Hospitals under the University

Health Network umbrella in To-

ronto, the largest in Canada, had

18 in-patients, including nine in

intensive care, as of Thursday. Mi-

chael Garron Hospital in the city’s

east end had eight and Windsor

Regional Hospital had 15, up from

10 the previous day.

In all, 405 patients with CO-

VID-19 are currently in hospital in

Ontario, said Dr. Barbara Yaffe,

the province’s Associate Chief

Medical Officer of Health. Of

those, 167 are in intensive care.

The Globe and Mail asked sev-

eral hospitals for the number of

workers sick with the disease but

they either declined to provide

the information or did not re-

spond by deadline.

In the Wellington-Dufferin-

Guelph region, Dr. Mercer said the

majority of COVID-19 cases are

with staff rather than patients.

Guelph General Hospital has two

patients with the disease, com-

pared with the 21 workers. Head-

waters Health Care Centre in Or-

angeville has nine workers and

one patient, and Homewood

Health Centre in Guelph, one of

the province’s largest mental-

health and addictions hospitals,

has two workers. St. Joseph’s

Health Centre in Guelph, a com-

plex-care hospital, has one infect-

ed worker.

“What this means is the health-

care providers are not giving it to

the patients,” Dr. Mercer said.

Like everywhere else in Onta-

rio, hospitals in Dr. Mercer’s re-

gion are struggling with a short-

age of crucial protective equip-

ment, including face masks, to

keep workers and patients safe.

The shortage comes just as hospi-

tals prepare for a significant in-

crease in the number of patients

expected over the next two

weeks, she said.

Doctors and nurses in the re-

gion are coping with the shortage

of face masks by sterilizing and re-

using them instead of discarding

the protective coverings after one

wearing, as is normally done.

“The shortages are so significant

that we are having to reuse some

pieces of equipment in a safe

manner,” she said.

With a report from Laura Stone

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Durham

Ottawa

Peel

B.C. firefighters have been or-
dered to stop responding to all
but the most dire medical emer-
gency calls during the COVID-
pandemic, a directive that means
they will no longer attend most
overdoses.
The order, a copy of which was
obtained by The Globe and Mail,
was issued by B.C. Provincial
Health Officer Bonnie Henry and
is aimed at limiting first respon-
ders’ exposure to the new corona-
virus and the amount of personal
protective equipment needed.
The directive states firefighters
must go only to the most immedi-
ately life-threatening calls, such
as cardiac arrest, events that are
colour-coded as purple.
But in Vancouver, which re-
corded eight overdose deaths last
week, most overdose calls are
classified as red – life-threatening
or time-critical, but less urgent
than purple. Data provided by the
fire service show firefighters usu-
ally arrive at such calls first.
That is in part because one fire
hall is in the heart of the city’s
Downtown Eastside, which has a
large population of drug users.
A computer-automated dis-
patch system usually sends both
paramedics and firefighters to
purple and red calls. Under the
order, effective immediately, only
paramedics will be dispatched to
most medical calls.
Firefighters can be considered
for select red events only if para-
medics expect to be delayed by
more than 20 minutes, or if tech-
nical assistance is required, such
as in car accidents.
The classification is deter-
mined by what callers report –
whether a patient is breathing,

for example. However, the infor-

mation can be unreliable and the

person’s condition can change

quickly.

In a statement provided by

spokeswoman Sarah Morris, BC

Emergency Health Services

(BCEHS) said the order will pro-

tect firefighters from potential

exposure to COVID-19 and limit

the spread of the disease within

communities.

As well, “the changes are being

made to maintain a reliable sup-

ply of personal protective equip-

ment for health-care workers,

which includes paramedics,” the

statement says.

During the pandemic, first re-

sponders have attended calls

wearing protective equipment

such as N95 face masks.

“To be clear, this order does

not change the way BCEHS oper-

ates or responds to medical emer-

gencies. Our aim, as always, is to

send the closest ambulance to pa-

tients as quickly as possible.”

From March 26 to April 1, a pe-

riod that captures the week when

income assistance cheques are

distributed and when overdose

calls are historically higher, Van-

couver Fire Rescue Services

(VFRS) responded to 89 overdose

calls, according to the fire services

data. Of those, 31 were classified

as purple and 58 red or lower.

From Feb. 14 to Feb 20, VFRS re-

sponded to 138 overdose calls; 31

were purple, and 107 red.

In March, of all medical calls,

VFRS were first on scene 63.4 per

cent of the time.

Jonathan Gormick, spokes-

man for Vancouver Fire Rescue

Services, said he believes the

change “of course” has the poten-

tial to delay the response to over-

dose calls.

“Even if the person making the

call is right, and they assess that

breathing is present, maybe the

person is unconscious, the very

nature of opiates is to suppress

the respiratory system,” he said.

“So if that person is breathing

now, chances are, if it’s an opiate

overdose, they’re not going to be

breathing in a few more minutes.”

If an ambulance is diverted, it

could be additional 15 or 20 min-

utes before fire is dispatched,

Capt. Gormick said – adding min-

utes to a call with few to spare.

“With a call where it can esca-

late from not super high priority

to very high priority very quickly,

by the nature of the poisoning, I

think it’s hard to imagine there

wouldn’t be an impact on patient

care,” he said.

In an e-mail, Ms. Morris said

paramedic specialists monitor all

calls and can upgrade events and

recommend sending additional

resources, such as firefighters.

“However, we have an ambu-

lance station in the Downtown

Eastside, which is fully staffed

and regularly responding to over-

doses,” she wrote.

The eight overdose deaths in

Vancouver, which occurred be-

tween March 23 and 29, were the

most in a single week since last

August and are in contrast with

the decline in overdose deaths in

the past year.

The COVID-19 pandemic has

forced community spaces and so-

cial service providers to close,

while some overdose prevention

services are shuttered, and others

are operating at half-capacity.

B.C.firefighterstoldtheyshouldnolongerattendmostoverdosecalls

ANDREAWOOVANCOUVER

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paramedicisseen

outsidetheLionsGate

HospitalinNorth

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firstrespondershave

attendedcallswearing

protectiveequipment

suchasN95facemasks.

JONATHANHAYWARD/

THECANADIANPRESS