The Globe and Mail - 09.03.2020

MONDAY,MARCH9,2020 | THEGLOBEANDMAIL O NEWS | A 9

monitored daily for respiratory

illness,personalprotectiveequip-

ment is used for all interactions

and communal gatherings have

been halted. Meals are delivered

toresidentsontraysinlieuofpeo-

ple dining together in a common

area.

Christine Sorensen, president

of the BC Nurses’ Union, said a

shortageofnursesintheprovince

means many are working at mul-

tiple sites, which could lead to ex-

haustion and further health risks.

“InthissituationatLynnValley

care home, those nurses will be

working long hours,” she said.

“There has to be extra time allot-

tedforhandwashingandandcar-

ing for patients who will be in the

facility and that additional time

needstobeaccountedforbecause

it needs extra staffing.”

A B.C. woman who was on the

GrandPrincesscruiseinFebruary,

andwhohadlingeringcoldsymp-

toms, got word Sunday that she

had tested negative.

Thewomanwentintoisolation

after undergoing testing. Howev-

er, for 12 days before hearing

about the cluster of cases, she in-

teracted with family members

and went to work, contact that

she had worried may have placed

others at risk. The Globe and Mail

is keeping her name confidential

because she is worried about the

stigma of being connected to the

virus.

Amidreportsaboutpanic-buy-

ing at grocery stores for food and

other staples, including toilet pa-

per, Dr. Hinshaw said people

should consider their neighbours

who may be quarantined.

“Rather than cleaning the

stores out of toilet paper, proba-

bly what would be helpful is talk-

ingtoneighbours,andfamilyand

friendsaboutanyoneinthatcom-

munity circle needing to stay

home for two weeks, who could

helpsupportthembygettingsup-

plies,” she said.

WithreportsfromCheriseSeucharan

andJillMahoney

ada

peciallyinthetourismandhospi-

tality industries. On Sunday, Al-

italia, which is in administration

• a process similar to filing for
  bankruptcy – announced that it
  was stopping flights from Milan’s
  Malpensa airport. It is also oper-
  ating a reduced number of na-
  tional flights from Milan’s Linate
  airport.

Amanwearingaprotectivemask

passesbytheColiseuminRome

onSaturday.BySunday,Italyhad

reported7,375COVID-19cases

and366fatalities.

ALBERTOPIZZOLI

/AFPVIAGETTYIMAGES

O

n Saturday, Bonnie Henry, British Co-

lumbia’s Provincial Health Officer,

convened the media to announce

that there was an outbreak of coro-

navirus at a long-term care facility in Vancouv-

er.

At one point in a seemingly routine press

conference, she was verklempt, overcome by

emotion.

Dr. Henry, a veteran of countless public-

health battles, domestically and international-

ly, is tough as nails.

Butheremotionalresponsetonewsthattwo

seniors at Lynn Valley Care Centre have been

infectedbycoronavirusisareminderthatwhat

we’re witnessing here is a nightmare scenario –

a novel respiratory virus infiltrating a facility

that is home to more than 200 seniors, many of

them frail and suffering from

chronic illnesses that place them

at high risk.

Worse yet, one of the health-

care workers at the facility is in-

fected and may have carried the

bug into the home. It’s unclear

how the worker contracted CO-

VID-19 because she has no travel

history, making her Canada’s

first-known case of community

transmission of coronavirus.

“This is one of the scenarios that we have

been, of course, most concerned about,” Dr.

Henry said diplomatically.

If we want a sense of how bad this can get,

and quickly, we need only cast our eyes a bit

south of B.C. to the horror story unfolding at

the Life Care Center in Kirkland, Wash.

The 120-bed facility in suburban Seattle has,

todate,recorded16COVID-19deaths.Dozensof

other residents are ill in hospital.

If that was not bad enough, 70 of the 180

workers employed in the care home have test-

ed positive.

What’s unfolding in Washington State

shouldsendashiverofdreaddownthespineof

anyone with a loved one in care – and there are

more than 350,000 people living in nursing

homes, chronic care and long-term care facil-

ities in Canada, and another 2.5 million in the

UnitedStates.Almostallofthemareolderthan

70 and in this pandemic-in-all-but-name, age

matters.Amongpeopleolderthan80whohave

contractedcoronavirus,thedeathrateisastag-

gering 22 per cent. In those older than 70, it’s 8

per cent.

Protecting seniors, especially those in insti-

tutional care, from infection and death is an

enormous challenge. So too is protecting staff,

who work tirelessly and intimately with their

charges.

But it has to be a priority of our response.

At the Lynn Valley Care Centre, they have in-

voked the outbreak protocol. That means daily

monitoring of residents for symptoms, staff in

protective equipment, a ban on public gather-

ings including communal meals, severe restric-

tions on visitors and cleaning like lives depend

on it (which they do).

Nursing homes and other care facilities have

afairbitofpracticewiththesemeasures.Acase

of the flu can rip through a home in no time,

leaving carnage in its wake.

What we don’t know is how much more

problematic COVID-19 might be. We do know

there is no vaccine (there is for the flu). Coro-

navirus also seems to spread more readily,

especially since it lives a lot longer on surfaces

than many other viruses.

But all the wonderful protocols on paper

cannot mask some of the persist-

ent challenges in care facilities,

chief among them residents’

great vulnerability to infection

because of their underlying

health conditions, and their in-

tensedependenceonstaffsuchas

personal support workers, who

can be vectors for transmission.

Complicating the response is

that many workers juggle shifts

between various facilities and

their pay and benefits are so abysmal that they

are reluctant to take time off if they are sick.

The Canadian Federation of Nurses Unions

has warned that nurses (and other health

workers)needmuchbetteraccesstoprotective

equipment. The experience at Washington’s

Life Care Center, where 40 per cent of staff end-

ed up infected, underlines how this is essential.

The U.S. Centers for Disease Control and Pre-

ventionhasrecommendedthateveryoneolder

than 60 “should stay at home as much as pos-

sible”tolimitthespreadofcoronavirus,aneye-

popping recommendation that has received

very little media attention.

Let’s hope that Canadian public-health offi-

cials continue to outshine their U.S. counter-

parts with thoughtful, evidence-based recom-

mendations and actions.

While we watch the situation at the Van-

couver care facility with trepidation, red flags

have to go up elsewhere, focusing on keeping

vulnerablesenior-seniors–those75andolder–

and their care providers as safe as possible, es-

pecially those in facilities that can easily be-

come incubators for epidemics.

Senior-carefacilitiesareespecially

vulnerabletoCOVID-19outbreaks

ANDRÉ

PICARD

OPINION

Amongpeopleolder

than80whohave

contracted

coronavirus,the

deathrateisa

staggering

22percent.

F

rom the restriction of fundamental lib-

erties to the rationing of scarce medical

resources, the spread of COVID-19 is ex-

pected to raise extraordinary ethical di-

lemmas for leadersin government and the

health-care system.

Experts say Canada will likely consider re-

strictions on movement and large gatherings,

as in China and Italy, to slow the progress of

the disease. Such measures have rarely been

considered in this country.

Canada may also have to consider how to

allocate scarce medical resources, such as ven-

tilators and intensive-care beds. How will it en-

sure that health-care workers, among the har-

dest hit in these outbreaks, can stay on the

job?

Here are some of the key ethical categories

identified by the pandemic influenza working

group of the University of Toronto Joint Centre

for Bioethics.

HEALTH CARE WORKERS

As COVID-19 spreads in Canada, doctors and

nurses may worry about the risk to themselves

and their families. In the SARS outbreak, 43

per cent of patients in Canada were health-

care workers. Afterward, a report concluded

the government failed to protect medical pro-

fessionals.

“We want to be able to protect them, both

because they’ve done a service treating the

public, but also because if we protect them

they’re able to continue treating patients,” said

Lorian Hardcastle, a professor in the faculties

of law and medicine at the University of Cal-

gary.

It’s critical that health-care workers stay on

the job and trust that they’re being looked af-

ter, Prof. Hardcastle said.

“The current ethical guidelines are not over-

ly helpful. ...They don’t provide a lot of con-

crete guidance about when health-care work-

ers can ethically refuse to work versus when

they have an ethical duty to treat patients,”

Prof. Hardcastle said.

Most doctors and nurses, though, accept the

risks in their work and are trained to protect

themselves.

“Most of us who went into the health-care

system did so because we score high on want-

ing to help others,” said John Conley, an epide-

miologist and professor of medicine at the

University of Calgary.

“There will be stresses on the system, but I

think the health-care profession will pull

through.”

Sally Bean, director of ethics and policy at

Sunnybrook Hospital in Toronto, said hospi-

tals are discussing how to assign staff. They

may decide that those who are pregnant, for

example, or elderly, or have underlying health

conditions, should be deployed elsewhere.

“The key thing is providing personal protec-

tive equipment or environmental settings so

that we minimize the risk of potential harm to

our health care providers,” Ms. Bean said.

RESTRICTING LIBERTY

It appears that social distancing and restric-

tion of movement have proved effective in

some countries at slowing the spread of CO-

VID-19. Canada has not yet instituted such po-

lices, but it may be only a matter of time.

Prof. Hardcastle says it’s a delicate balanc-

ing act for governments.

“Whenever thegovernment restricts rights,

we expect them to do so in a way that’s evi-

dence-based and justifiable and transparent,”

she said.

“It’s partly a public a public support and

public trust issue. If the public perceives what

the government’s doing to be evidence-based

and necessary and rational, then they’re more

likely to comply,” she said.

Quarantine often sounds reasonable so long

as the person in quarantine is not you, Prof.

Hardcastle added. It can also create real hard-

ship for those who are disabled or don’t have

the support of friends or family in the commu-

nity to help provide food and medicine.

Maintaining the willing support of the pub-

lic is crucial becausethe government doesn’t

have the capacity to compel compliance.

RATIONING MEDICAL CARE

An influx of coronavirus patients could forcea

strained health system to confront difficult

questions. Should coronavirus patients take

precedence over those with other conditions?

Should the elderly or those with underlying

conditions take precedence over younger and

healthier patients? In the event of a shortage,

who gets a ventilator?

“I think these conversations are starting to

happen in the abstract but I don’t think

they’re far enough along and I don’t think

they’re concrete enough,” Prof. Hardcastle

said.

“We don’t want to be making these deci-

sions on the fly. ...Those questions need to be

dealt with now, because that’s not an appro-

priate kind of pressure to put on health-care

professionals.”

Ms. Bean said Ontario is developing guide-

lines for allocating resources based on a frame-

work devised for the drug supply shortages of

2012. The guidelines have three parts: describ-
      ing the allocation criteria, identifying the val-
      ues that guide decision making and outlining
      the processes that guarantee fairness.
      “I think [the spread of COVID-19] poses re-
      ally acute ethical considerations because
      they’re urgent. We don’t know what this is or
      what the scope will look like when it when it
      arrives. That unknown dimension brings the
      ethical considerations into sharp focus,” Prof.
      Hardcastle said.

Somekeyethicalquestionsthatarebeing

raisedbythespreadofthecoronavirus

JOEFRIESEN

sscruiseship,operatedbyPrincessCruises,asitmaintainsaholdingpattern

cisco,Calif.,onSunday.JOSHEDELSON/AFPVIAGETTYIMAGES