March 9:\u00a0Canada\u2019s first coronavirus death<\/a><\/span>\u00a0occurs at a nursing home in B.C., creating fear about COVID-19 spread in long-term care facilities. \u201cWe have vulnerable populations \u2014 and we have to pay particular attention to that group because they have heightened potential exposure and impact,\u201d said Vicki McKenna, president of the Ontario Nurses Association.<\/p>\n March 14: Two physicians who served on the SARS 2003 front line give an\u00a0early warning<\/a><\/span>\u00a0to provincial medical experts about the danger to long-term care homes.<\/p>\n<\/div>\n March 17:\u00a0Ontario<\/a><\/span>\u00a0declares a state of emergency and allocates $50 million for long-term care homes.<\/p>\n March 18: Early Italian studies confirm that 98 per cent of COVID-19 deaths were\u00a0elderly people with serious preconditions<\/a><\/span>. Roughly 90 per cent were 70 and older, while 10 per cent ranged in age from 50 to 69 years old. Nearly 50 per cent of deaths were in people who had \u201cthree or more preconditions.\u201d Deaths where there wereno preconditions were estimated to be 0.8 per cent.<\/p>\n March 19: B.C. reports\u00a0eight COVID-19 deaths<\/a><\/span>, with seven from the same long-term care facility.<\/p>\n “Instead of securing the most vulnerable demographics in health-care settings, experts chose to perform mass testing on the general population to ‘slow the spread.'”<\/p><\/blockquote>\n March 31: Ontario has coronavirus outbreaks in 10 long-term care residences. \u201cThis virus moves very quickly,\u00a0as public health officials have been telling us<\/a><\/span>,\u201d said Sue Graham-Nutter, CEO of the Rekai Centre.<\/p>\n April 9: Ontario public health officials\u00a0finally move testing to long-term care homes<\/a><\/span>, but only for those showing symptoms. Asymptomatic and pre-symptomatic residents and health-care staff do not meet the requirements. \u201cI\u2019m frustrated at the system,\u201d Mr. Doug Ford said.<\/p>\n April 9: Premier Ford calls for\u00a0widespread testing of everyone in the health-care system<\/a><\/span>. \u201cOur goal at the end of the day is (to) test every single front-line health-care worker, all workers, being nurses, doctors, (personal support workers), cleaners \u2026 Our priority is to make sure we target the long-term care residents and the workers there as well.”<\/p>\n Dr. David Williams, Ontario’s Chief Medical Officer of Health, finally relents on partial long-term care testing, but is still focused on viral spread in the community. Long-term care infections and deaths continue to rise.<\/p>\n April 13: Nearly\u00a050 per cent of COVID-19 deaths in Canada are in long-term care<\/a><\/span>\u00a0and seniors residences. Ford again calls for widespread testing, but Ontario public health officials aren\u2019t convinced.<\/p>\n<\/div>\n Barbara Yaffe, Ontario\u2019s associate chief medical officer of health, says that widespread testing in the health-care sector could result in \u201cwasting a lot of tests\u201d and that \u201cchanging that is not a simple thing \u2026I know it is being strongly considered.\u201d<\/p>\n Colin Furness, an infection control epidemiologist at the University of Toronto, said provinces need to be much more aggressive in testing staff members at long-term care facilities because some of the infected are showing no symptoms at all or just mild ones. \u201cWidespread testing of staff members could help identify more cases before they have a chance to spread.\u201d<\/p>\n April 13: \u2013 Health-care advocates clamour for\u00a0protection of at-risk seniors in long-term care<\/a><\/span>.<\/p>\n<\/div>\n \u201cThe risk to seniors in nursing homes is \u201cskyrocketing\u201d at the same time risk in the general community is coming under better control, says Dr.\u00a0David Fisman, an epidemiologist at the University of Toronto\u2019s Dalla Lana School of Public Health<\/a><\/span>. \u201cThe rate of death in long-term care is somewhere between 10 and 20 times higher than the same cohort outside long-term care.\u201d<\/p>\n April 14:\u00a0Chief Public Health Officer of Canada Dr. Theresa Tam<\/a><\/span>\u00a0admits that COVID-19\u00a0outbreaks in the health-care system are critical<\/a><\/span>. She urges \u201call Canadians to continue to stay home to keep older people, who are most at risk, from dying. We need to protect our seniors, so stay home and save lives.\u201d<\/p>\n April 17: It\u2019s reported that B.C. public health officials focused on senior homes in March. (SARS 2003 veteran Dr. Bonnie Henry is B.C.\u2019s provincial health officer.)<\/p>\n April 22: \u2013 After repeatedly resisting calls from advocates and the premier for widespread testing in the long-term care homes, Ontario medical experts\u00a0finally establish a comprehensive testing protocol<\/a><\/span>. The memo states that officials need to better understand \u201cthe prevalence of COVID-19 in long-term care homes and inform future planning.\u201d And that the plan will \u201caddress COVID-19 in this vulnerable population \u2026 in order to \u2026 stop the spread.\u201d<\/p>\n Ford says he was \u201cbeating the drum\u201d weeks ago to have everyone tested. \u201cAs much as people may think I can jump in there and overturn what the chief medical officer says, I can\u2019t.\u201d<\/p>\n Dr. Williams refers to \u201cstudies\u201d that prove \u201casymptomatic residents and staff at long-term care facilities were actually positive for COVID-19.\u201d He continued, \u201cI think in that case, we\u2019re going to have to start testing everybody.\u201d<\/p>\n May 9: –\u00a0The National Institute on Aging<\/span><\/a>\u00a0reports that 3,436 long-term care residents and six health-care workers make up 82 per cent of COVID-19 deaths nationwide. The institute\u2019s\u00a0Ontario long-term care tracker<\/a><\/span>\u00a0calculates that Ontario has outbreaks at 321 residences, resulting in 7,355 infected and 1,335 deaths.<\/p>\n Mass testing debacle<\/strong><\/p>\n There is and always has been a low risk of dying from coronavirus among the general population. According to\u00a0WHO\u2019s March 13, 2020 guidance<\/a><\/span>, 81 per cent of people with COVID-19 will have an \u201cuncomplicated or mild illness,\u201d 19 per cent will develop severe illness, and a small percentage will die. WHO also says that \u201colder age and co-morbid disease have been reported as risk factors for death.\u201d<\/p>\n The stay-at-home and distancing mandates protects those most at-risk in the general population. Instead of securing the most vulnerable demographics in health-care settings, experts chose to perform mass testing on the general population to \u201cslow the spread.\u201d Slowing the spread and preventing deaths were the reasons for the lockdown, we were told. What possible advantage is there to mass testing if Canadians are under self-quarantine? Someone either has it or they don\u2019t. They\u2019re sick enough to go to the hospital or they quarantine.<\/p>\n Here\u2019s what mass testing and tracing accomplishes:<\/p>\n 1) Symptomatic people show up at the testing centre. If they don\u2019t have serious symptoms, they\u2019re put under a 14-day quarantine.<\/p>\n 2) If they meet the criteria and test negative, they\u2019re put under a 14-day quarantine.<\/p>\n 3) If they meet the criteria and test positive, they\u2019re put under a 14-day quarantine and they trace contacts. Rinse and repeat.<\/p>\n Anyone see a pattern here? People with symptoms are already under a mandate to self-quarantine for 14-days.<\/p>\n With a significant per cent of the population asymptomatic, presymptomatic, or experiencing mild to moderate symptoms, how does community testing slow viral spread from asymptomatic and presymptomatic people? Further, if a significant portion of the population experiences mild to moderate symptoms, how does turning them away and not testing them prevent viral spread?<\/p>\n The front-line in this war is the health-care sector.<\/p>\n Canada-wide testing as of May 14<\/a><\/span><\/p>\n Positive tests reported 72,536 (6%)<\/p>\n Negative or pending 1,120,654 (94%)<\/p>\n Total tests 1,193,190 (100%)<\/p>\n Roughly 94 per cent of highly symptomatic people tested for COVID-19 have a cold, flu virus or other cause.<\/p>\n First priority: Protect the vulnerable<\/strong><\/p>\n It\u2019s impossible to stop the virus by chasing it. It moves too fast, as one expert mentioned. To slow or stop it, they needed to get in front of it. To repurpose Wayne Gretzky\u2019s scoring advice: \u201cGo to where the virus is going to be, not where it\u2019s been.\u201d All over the world, this thing is trying to get into the health-care system, where it thrives.<\/p>\n With limited test kits and PPE (personal protective equipment), the obvious protocol was to test, secure and set a perimeter around the long-term system. Test residents, health-care workers and support staff and quarantine positive cases. Test every seven days and repeat until new testing supplies are acquired to test the general population.<\/p>\n As\u00a0Dr. Tom Frieden<\/span><\/a>, the former director of the U.S. Centers for Disease Control and Prevention, said recently, \u201cWe need to box it in,\u201d utilizing a four-cornered approach of testing, isolating, quarantining and finding the virus.<\/p>\n \u201cThis is the essence of the box-in strategy \u2014 creating a closed loop. So that with each wave of infections, there are fewer and fewer secondary infections boxing the virus in and opening more and more space in society (for) safe movement,\u201d Frieden said.<\/p>\n Testing should be about quality, not quantity. Quantity is just a numbers game. There\u2019s no advantage to searching for a needle in a haystack by testing the community. We either get it or we don\u2019t. There\u2019s no cure. We\u2019re doing our part locking down to prevent viral spread. We need a new, more aggressive, approach.<\/p>\n We need warriors, not modellers<\/strong><\/p>\n The only positive from this preventable tragedy is that we know where the invisible enemy is now. It\u2019s in care homes. We have it surrounded. It\u2019s vulnerable. And we can\u2019t let it back out.<\/p>\n One doesn\u2019t have to be a doctor to plan strategy. In fact, business, tactical and military experts are the best sources for strategic planning.<\/p>\n Premier Doug Ford, you know what the right strategy is. You\u2019ve said it multiple times. We need to throw everything we\u2019ve got at the health-care system. The virus has taken it from us.<\/p>\n 1) Bring in SARS veterans Dr. Allan S. Detsky and Dr. Isaac I. Bogoch to consult, not only on how to attack this virus, but for advice on dealing with the trauma of surviving health-care warriors in the aftermath.<\/p>\n 2) Mobilize more military or contract with local cleaning companies in Ontario to disinfect health-care facilities 24\/7. Don\u2019t let it breathe. Test kits should be reserved to test patients, care home residents, and health workers. Just keep testing and isolating. The rest of us are fine.<\/p>\n