How Did The Risk to Long Term Care Residents from COVID-19 go from ‘Low Risk’ to Calling in the Army ?

April 28, 2020, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

In January and February, the federal and provincial governments faced with a novel corona virus COVID-19 were not flush with information about the virus. It appeared to many that the government was changing the official stance from week to week on how best to prevent, handle, control and deal with the pandemic we face.

Some of this evolution is natural, no one really knew or understood the disease transmission. Some of the reaction was pragmatic. Calling for a national shut down in January may have prevented the disease from spreading quickly but few politicians or the public would have bought into such drastic measures so early on. What was foreseeable though was how dangerous this virus is to the elderly, and how the populations of long term care homes were highly vulnerable to it.

More than a decade of provincial cost cutting to health care, institutional barriers to reform, underfunding of long term care, and labour laws that make employing several part time workers cheaper than employing a stable full time work force are all part of the problem. Poor oversight and lack of consistent inspections are part of the problem. Apathy from the government to the plight of our most vulnerable citizens is a problem. The lack of ability for these same people to advocate for themselves, and the lack of response to systemic serious problems with standards of care are also a problem.

With COVID-19 we have found ourselves in a situation where long term care homes are understaffed and many staff work in several institutions at once. We have a system that is poorly funded and equipped. It is a system where infection control has not been taken seriously and the results of this inaction and neglect are painfully clear.

Eight weeks ago Ontario had 4 cases of VOID-19 confirmed. Now there are 12, 000 . There are more than 800 deaths of which 2/3 lived in Ontario’s long-term care homes. How did it go from the government telling us not to worry, to the government making sudden and drastic changes to the care home staffing rules, and calling in the military to help staff them?

Here is the timeline as reported by CBC News. You can read the entire article with graphics here. We must demand better for our parents, grandparents and loved ones.

Feb 23

The number of deaths worldwide from COVID-19 surpasses 2,400. In Italy, police checkpoints seal off 11 towns and the Lombardy region closes schools and cinemas. Ontario reports one new positive test for the coronavirus. "Given the individual's clinical assessment and history, there is a low risk that she was infectious," says Ontario's chief medical officer of health Dr. David Williams. "I want to assure the public that the risk to Ontarians remains low."

March 2

Health Minister Christine Elliott announces the teams in charge of Ontario's strategic response to the novel coronavirus. It's led by a command table of senior officials. One of the members is the deputy minister of long-term care.

March 8

Canada's first death from COVID-19 is reported. The victim is a resident of a long-term care home in North Vancouver, B.C. The number of confirmed cases in Ontario reaches 29. "At this time, the virus is not circulating locally," Williams says in a news release.

March 9

In a memo, Ontario's assistant deputy minister for long-term care instructs homes to screen visitors for symptoms of the illness "where possible over the phone." The screening does not extend to staff until March 11, the day the World Health Organization declares COVID-19 a pandemic.

March 13

The province confirms 20 new positive cases of the virus, bringing the total to 79. Williams "strongly recommends" that long-term care homes cease non-essential visits, but stops short of making it an order.

March 16

"Our government is taking all the necessary precautions to ensure loved ones in Ontario's long-term care homes are safe and secure," says Health Minister Christine Elliott and Minister of Long-Term Care Merrillee Fullerton in a statement. Ontario is yet to report any deaths from COVID-19.

March 17

Premier Doug Ford declares a state of emergency in Ontario. There have been 189 confirmed cases across the province.

March 18

An outbreak is declared at the Pinecrest Nursing Home in Bobcaygeon, Ont. Within three weeks, 28 of the home's 64 residents will die.

March 19

A woman in her 90s at the Hillsdale Terraces long-term care home in Oshawa shows symptoms of COVID-19. However, the public health unit does not receive her test results until March 23, the day she dies.

As the end of March Break nears, Williams recommends 14 days of self-isolation for health-care workers who have travelled internationally, but does not make it mandatory. The federal government waits until March 25 before ordering a quarantine. 

March 22

Williams asks long-term care homes to limit the number of locations that employees are working at "wherever possible," in an effort to reduce the risk of staff carrying the virus from home to home. This does not become a mandatory policy until a month later.

March 26

The deaths in long-term care facilities begin to mount. Two at Seven Oaks in Scarborough. Two at Pinecrest in Bobcaygeon. One resident of the Heritage Green Nursing Home in Stoney Creek.

Still, the province continues to recommend against testing everyone in long-term care homes that see outbreaks. Ontario's capacity to test for COVID-19 shows strains, as the number of people waiting for lab results soars above 10,000.

March 27

There are confirmed cases in at least 16 homes in Ontario, the Globe and Mail reveals, although the government is not providing a province-wide figure.

The associate chief medical officer of health, Dr. Barbara Yaffe, is asked why the province does not order testing on all residents of long-term care homes where outbreaks are declared. "We don't want to use up the limited lab resources to test everybody when we already know what the cause of the outbreak is," she replies. 

March 28

The outbreak at Pinecrest Nursing Home in Bobcaygeon is raging. Roughly half the staff are reported sick with symptoms of COVID-19.

March 30

With nine deaths reported at Pinecrest, Ford tells the daily news briefing: "We're putting an iron ring of protection around our seniors. We must do everything we can to prevent further spread in these homes."

March 31

More deaths and outbreaks hit homes, and Ottawa's medical officer of health calls the long-term care sector her "top concern."

"We're doing everything we can to protect the most vulnerable," Ford says in his daily news conference. 

CBC reporter Lisa Xing challenges Ford: "We've known for some time that this is a vulnerable population. Why did the province not act sooner to stop the virus from spreading in long-term care homes?"

"I just wish I had a crystal ball a month ago, a month and a half ago to see where this was going," Ford replies. 

April 1

Research by CBC News reveals 40 people have died at long-term care and retirement homes and counts declared outbreaks in at least 41 facilities, although the numbers of outbreaks and deaths given by provincial officials are far lower.

"There's more that we can do," says Health Minister Christine Elliott. "We are very concerned about outbreaks in long-term-care homes," she tells the daily news briefing. "That's a very, very vulnerable group of people that we need to protect, absolutely."

April 2

"If my mom was in long-term care, I would pull her out. Now," says Dr. Samir Sinha, a geriatrics specialist with Sinai Health System in Toronto and a top provincial adviser on senior care.

In a separate interview with CBC News, Sinha urges Ontario to test every resident and staff member in any long-term care home that discovers an outbreak, pointing to evidence from the U.S. of confirmed cases among nursing home residents without symptoms.

April 3

Ontario reveals modelling that forecasts up to 15,000 deaths in the province, and lengthens its list of non-essential businesses, but announces no new measures regarding long-term care homes. 

April 6

Nearly 40 per cent of the residents of Anson Place Care Centre in Hagersville, Ont. (south of Hamilton) have tested positive, along with 22 staff. Five residents are dead, and within two weeks the death toll reaches 24.  

April 7

The province is reporting 78 deaths in long-term care and outbreaks in at least 58 homes. Meanwhile, Ontario's daily number of tests completed barely exceeds 2,500, lower than its daily rate of testing in mid-March.

April 8

Williams issues a new directive to long-term care homes. It requires all long-term staff to wear masks at all times for the duration of their shifts and increases the frequency of screening for symptoms to twice a day.

April 10

The impact of COVID-19 on Ontario's long-term care homes hits two grim milestones: the number of cases among residents and staff surpasses 1,000 and the number of deaths surpasses 100. Those are the official numbers from Public Health Ontario.

Ontario's releases new testing guidelines, which continue to recommend against testing all residents of long-term care homes, even when there's an outbreak. Provincial officials tell reporters in a not-for-attribution briefing that such testing is of limited value.

April 12

At the Anson Place Care Centre in Hagersville, south of Hamilton, 13 people are dead and more than half the home's residents have tested positive for COVID-19, along with 30 staff. 

April 13

News emerges that 25 residents of the Eatonville Care Centre in Etobicoke are dead.

Facing questions about the province's actions so far, Ford insists he and his government "are doing absolutely everything we possibly can" to protect long-term care residents.  "We could look backwards and point out every single little item. I'm sure there's areas in this whole pandemic that are, 'Could've, should've, would've.' I feel we're doing everything we can right now."

April 15

Ford announces what he calls Ontario's "action plan" for long-term care. "Today, we're throwing everything we've got at our long term care homes," he says. "We're mobilizing every available resource." 

The plan promises wider (but still not universal) testing in homes and offers help from hospital teams specializing in preventing and controlling infections. One of its provisions — a ban on employees working at more than one facility  — does not kick in for another week.

It's also been five weeks since the WHO declared the pandemic. Since then, according to Ontario's official figures:

• 162 long-term care residents have died.
• 933 residents are infected.
• 530 staff are infected.

April 17

Nearly 2,000 residents and staff of long-term care homes have been infected with COVID-19, and the death toll surpasses 200. A personal support worker at a home in Scarborough dies. "It's heartbreaking to hear of these tragedies and we're doing everything we possibly can, as we've said, to put an iron ring around these homes," says Ford.

April 20

The province releases new projections modelling the spread of infections in Ontario. While officials say this wave of COVID-19 has peaked in the border community, the spread of the virus is still accelerating in long-term care. The data show 367 people have died in long-term care homes.

 By: Mike Crawley CBC News

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