A8 FOLIO O THE GLOBE AND MAIL | FRIDAY, APRIL 3, 2020
The B.C.government will take
over to guarantee equal pay to
workers and ensure they don’t
split their time between multiple
facilities.
There was a severe shortage of
personal support workers – the
aides who bathe, change and feed
elderly residents – even before
the coronavirus hit nursing
homes, with some employers of-
fering benefits for part-time staff
or $1,000 retention bonuses to
help attract workers to care for
the country’s aging population.
Now the pandemic has intensi-
fied the staffing crisis, said Heath-
er Maxwell, chief executive offi-
cer of Maxwell Management
Group, a health-care recruitment
firm trying to fill hundreds of
openings in seniors’ facilities
across the country.
“It’s been a challenge for a
while, to be honest with you. [CO-
VID-19] certainly has put an extra
stresser on the system,” she said.
In Ontario, five groups repre-
senting long-term-care and resi-
dent organizations released a
joint letter this week warning the
sector is facing the potential loss
of half of its front-line work force
during the pandemic.
“Despite the heroic efforts of
dedicated staff, a severely short-
staffed home simply cannot pro-
vide the level of care that resi-
dents need during this pandem-
ic,” the letter said.
Donna Duncan, CEO of the On-
tario Long-Term Care Associ-
ation, one of the letter’s signato-
ries, said that the sector is strug-
gling against fear.
“We’re getting suppliers who
are dropping supplies off on the
road,” said Ms. Duncan, whose
group represents 70 per cent ofOntario’s 630 long-term-care
homes. “They won’t even come
up the steps.”
Some homes can’t get plum-
bers or elevator repair people to
complete work, she added.
The novel coronavirus has
caused more devastation in nurs-
ing and retirement homes than
in any other setting in Canada,
with at least 75 deaths among res-
idents as of Wednesday, accord-
ing to a tally done by The Globe
and Mail after contacting local
and provincial public-health au-
thorities across the country. The
new coronavirus has invaded at
least 600 nursing and retirement
homes.
The toll continues to rise. Two
more residents died of COVID-
overnight on Wednesday at the
Pinecrest Nursing Home in Bob-
caygeon, Ont., the site of the
deadliest outbreak in the coun-
try.
Sixteen Pinecrest residents
have succumbed to the coronavi-
rus, according to Michelle Snarr,
the home’s medical director.
Ms. Duncan of the Ontario
Long-Term Care Association said
she supports the Ontario govern-
ment’s recent emergency order
that relaxes requirements
around completing paperwork,
and allows homes to hire and de-
ploy staff where needed.
She said there is a labour force
looking for work that could help
in homes with general care – any-
one from dental hygienists to
housekeepers to food handlers.
Candace Rennick, secretary-
treasurer of CUPE Ontario, said
she understands the need to
boost staffing in long-term-care
homes, but bringing in untrained
workers or volunteers puts both
staff and residents at risk.
“These people aren’t necessar-Carehomes:Pandemichas
intensifiedanalreadytroubling
lackofpersonalsupportworkers,
healthindustryexecutivesays
FROM AOntario is instructing hospitals on who should
and should not receive life-saving care if med-
ical facilities become overstretched by the nov-
el coronavirus pandemic.
In the most severe phase – if hospitals are at
double their capacity for a sustained period –
anyone with less than a 70-per-cent chance at
surviving would not qualify for the medica-
tions and machines that keep them alive. This
group includes those who have metastatic can-
cer, those in cardiac arrest and those with se-
vere and moderate cognitive impairment
caused by a progressive illness.
The guidelines apply to life-saving treat-
ment of all kinds, not just to COVID-19. People
who are already receiving life-saving treatment
could be removed from supports
in favour of individuals with bet-
ter odds of surviving.
While the protocol does not
apply directly to children, they
could be denied life-saving treat-
ment out of what the protocol
describes as fairness. When adult
hospitals are at their most severe
triage level, it says, hospitals may
consider triage for children “in
order to respect the principles of
utility and fairness population-
wide.” It says doctors should first
consider “the moral distress in-
herent in removing a child from
life support, or denying its appli-
cation.”
An ethicist involved in the development of a
similar protocol, yet to be finalized, in New
Brunswick, called Ontario’s guideline a bold
model for other provinces as they move to
“pandemic ethics.”
“When you change from normal clinical eth-
ics to pandemic ethics, the goals have to
change, to save as many lives as possible,” said
Timothy Christie, regional director of ethics
services for Horizon Health Network in New
Brunswick. (The Globe and Mail sent him a
copy of the document.)
The result, he acknowledged, is that people
will die who otherwise would live.
“It means there are going to be a lot of peo-
ple we would be able to save under normal cir-
cumstances that we’re not going to be able to
right now. That is the unfortunate reality of the
situation we’re in.”
The Clinical Triage Protocol for Major Surge
in COVID Pandemic, dated March 28 and carry-
ing the insignia of Ontario Health, agovern-
ment agency, has not been made public. James
Downar, an Ottawa bioethicist, led the drafting
of the protocol, overseen by an ethics commit-
tee of Ontario’s centralized COVID-19 supervi-
sory group.
The document offers doctors a script for
how to talk to patients and their families about
the new rules on who receives life-saving care.
“Normally, when somebody develops criti-
cal illness, the medical team would offer them
intensive care (a combination of medications
and machines to support their vital organs),
provided that the medical team felt that they
had a reasonable chance of survival,” the docu-
ment says. “However, because of the COVID
outbreak, we are currently unable to offer in-
tensive care to everyone who is critically ill ... ”
The decision to start triage is to be made by
regional authorities, not individual hospitals.
When an individual hospital reaches capacity,
regional authorities must try to transfer pa-
tients to other sites for life-saving care. The
protocol takes effect only when all hospitals
are past capacity.
Currently, many Ontario jurisdictions are at
70-per-cent capacity in surgery, because of ag-
gressive attempts to postpone elective surger-
ies and other procedures, said Alan Drum-
mond, a spokesman for the Canadian Associ-
ation of Emergency Physicians.
Decisions on whether an individual receives
care will involve the physician responsible for
the patient’s care, a triage doctor and a hospital
triage committee, which should include a doc-
tor, an ethicist and an administrator responsib-
le for bed allocation, the protocol says.
The guiding principles are utility (those who
derive maximum benefit receive the care);
proportionality (the number harmed by the
protocol should not exceed the
number harmed under a first-
come, first-served approach);
and fairness (“priority should not
be given to anyone on the basis of
socio-economic privilege or polit-
ical rank”).
The triage contains three lev-
els. The first, when the system
reaches 200-per-cent capacity,
would deny life-saving treatment
to those with more than an 80-
per-cent chance of death from
trauma, and those who are un-
able to perform daily tasks be-
cause of a severe cognitive im-
pairment from a progressive ill-
ness. The wording suggests that
some individuals with dementia would be de-
nied life-saving care, but that individuals with
developmental delays not caused by progres-
sive illness would still qualify for such care.
The second level denies life-saving treat-
ment to those with more than a 50-per-cent
chance of death. The third level applies to
those with more than a 30-per-cent chance of
death.
Michael Bryant, head of the Canadian Civil
Liberties Association, said he is concerned
about the protocol not being made public. He
said his biggest concern is that in practice, un-
conscious biases against individuals with men-
tal illness or addictions might be expressed, or
errors in assessing these individuals could be
made, when doctors exclude people who ap-
pear to have cognitive impairments.
In British Columbia, a provincial coronavi-
rus task force released three documents on Sat-
urday for health-care workers that offer guid-
ance on their duty to help patients during this
pandemic, how the use of personal protective
equipment needs to be prioritized and a high-
er-level framework for making ethical deci-
sions if the virus brings a potential crisis of hos-
pital resources.
Unlike Ontario, B.C. has left the five regional
health authorities in charge of releasing more
granular details.Ontarioissues
health-careguidelines
ineventhospitals
becomeovercrowded
Inworst-casescenario,
medicalstaffinstructedto
denylife-savingtreatmentsto
anyin-patientwithlessthan
a70%chanceofsurviving
COVID-19orotherailment
SEAN FINETORONTO
MIKE HAGERVANCOUVER
TOM CARDOSOTORONTO
Health-care workers prepare to check people arriving at a COVID-19 testing area in Burnaby, B.C., on
Wednesday. During the weekend, the provincial government released documents that guide medical
staff on how to help patients during the pandemic.JONATHANHAYWARD/THECANADIANPRESS
Whenyouchange
fromnormalclinical
ethicstopandemic
ethics,thegoals
havetochange,to
saveasmanylives
aspossible.TIMOTHY CHRISTIE
REGIONALDIRECTOROF
ETHICSSERVICESFOR
HORIZONHEALTHNETWORK
INNEWBRUNSWICKA truckload of medical supplies
shipped from Canada to an
American accused of profiteer-
ing has been intercepted by au-
thorities, who are now redirect-
ing nearly 200,000 surgical
masks to doctors and nurses.
U.S. Federal Bureau of Investi-
gation agents arrested 43-year-
old Baruch Feldheim on Monday
in New York, which is among the
global epicentres of the corona-
virus crisis. U.S. authorities say
he is at the centre of the first
concluded case of many similar
price-gouging investigations re-
lated to COVID-19 equipment
that are already under way.
U.S. authorities are invoking
recently enacted emergency lawsto crack down on price-gouging.
Similar laws exist in Canada, but
they have not yet been enforced,
even amid mounting fears about
shortages of medical equipment.
The Brooklyn man has since
been released on a US$50,
bond and a promise not to deal
in medical equipment until his
trial.
He is accused of lying to feder-
al agents about the nature of his
business.
He is also charged with as-
saulting FBI detectives by alleg-
edly coughing on them during
his arrest.
An affidavit from an FBI agent
filed in a New Jersey court says
detectives spent several days
shadowing Mr. Feldheim in late
March, watching him acquire
and resell personal protectiveFBIredirectsmedicalsuppliestohea
COLIN FREEZE