(September 8, 2020)<\/p>\n
By: Joanna Frketich & Grant LaFleche, St. Catharines Standard<\/p>\n
\u201cDisaster upon disaster\u201d is how the Registered Nurses\u2019 Association of Ontario describes\u00a0long-term-care<\/span><\/a>\u00a0homes<\/span><\/span> during the pandemic.<\/p>\n \u201cNursing homes basically during COVID-19 for several months were abandoned,\u201d said CEO Doris Grinspun. \u201cAbandoned by government in very concrete ways.\u201d<\/p>\n Despite promises from the federal and provincial governments to end long-standing problems that led to\u00a0long-term care<\/a><\/span>\u00a0and\u00a0retirement homes<\/span>\u00a0<\/a>becoming the epicentre of\u00a0COVID-19<\/a><\/span>, accounting for at least two-thirds of Ontario\u2019s pandemic deaths, Grinspun says little has changed as Ontario prepares for an expected second wave of the virus over fall and winter.<\/p>\n \u201cIt will be one tragedy on top of another tragedy,\u201d she said. \u201cI basically am afraid we will finish a whole generation of seniors in nursing homes if we don\u2019t do something fast.\u201d<\/p>\n The lack of progress in properly staffing, overseeing, modernizing and funding long-term care raises questions about whether Ontario is prepared for the second wave of\u00a0COVID-19<\/a><\/span>. Will seniors\u2019 homes be the epicentre again? How will Ontario\u2019s normally overcrowded\u00a0hospitals<\/a><\/span>\u00a0cope? Will the public even know about outbreaks in businesses and workplaces? How do Ontarians know what\u00a0risks<\/a><\/span>\u00a0are worth taking as the province reopens?<\/p>\n \u201cNobody knows when that second wave will hit or how bad it will be,\u201d said Dr. Dominik Mertz, associate professor of infectious diseases at McMaster University. \u201cWe will see what happens when fall and winter comes.\u201d<\/p>\n Most Ontarians fear the second wave, according to a poll commissioned by the Canadian Mental Health Association. The vast majority expressed worry people are becoming relaxed too quickly and not following physical distancing requirements, found the survey of 1,002 Ontarians conducted by Pollara Strategic Insights from July 23 to Aug. 2.<\/p>\n Nearly 80 per cent are concerned the province will go back into lockdown and 85 per cent dread a second wave will \u201cput us back where we started.\u201d<\/p>\n \u201cEven when things are going well, there might be a turn for the worse,\u201d said Dr. Mark Loeb, infectious disease physician and professor at McMaster University. \u201cWhen you can move forward, you have to do it cautiously. There will be setbacks. It\u2019s going to be like this until there is a vaccine that is proven to be effective and that\u2019s available. We\u2019re going to be in this game for a while.\u201d<\/p>\n Some feel Ontario is ready for whatever hits.<\/p>\n \u201cWe have the resource capacity and the knowledge from the first wave to deal with the second wave,\u201d said Dr. Zain Chagla, infectious disease physician at St. Joseph\u2019s Healthcare.<\/p>\n But others say the province is vulnerable, especially in hard-hit areas such as long-term care where the situation has deteriorated over the pandemic, says the Ontario Health Coalition.<\/p>\n \u201cThe capacity to provide care is worse than it was entering the first wave,\u201d said executive director Natalie Mehra. \u201cIt\u2019s the lack of staffing that has been the biggest barrier.\u201d<\/p>\n Long-term care staffing challenges<\/strong><\/p>\n The province has limited staff to working at one long-term-care facility during the pandemic to stop the spread of the virus. Having to\u00a0choose between jobs<\/span>\u00a0<\/a>has \u201cdecimated\u201d the workforce in some homes, says the coalition.<\/p>\n \u201cThe workforce is so precarious they\u2019ve had to cobble together multiple jobs across multiple facilities,\u201d said Mehra. \u201cThat was a lesson the SARS commission highlighted that in the hospitals, workers went from hospital to hospital and that was a danger. But in long-term care it\u2019s much more extreme than in hospitals.\u201d<\/p>\n Compounding the problem is that families ordinarily take on some of the care in seniors\u2019 homes but their visits are restricted due to COVID-19.<\/p>\n \u201cThey don\u2019t have enough staff for regular times,\u201d said Mehra. \u201cWhat has been made very clear is that when you do have COVID-19 outbreaks, there is a need for more staff than the regular times. It has been a complete failure. Those things have been laid bare, but it\u2019s not like they\u2019ve actually been addressed.\u201d<\/p>\n The staffing shortages leave the homes relying on temporary agency workers who are exempt from the order prohibiting employees from working in multiple homes. It raises concern they will inadvertently spread\u00a0COVID-19<\/span><\/a>\u00a0from home to home in the same way workers did in the first wave before the new rule was put in place.<\/p>\n \u201cWe learned a lesson that the spread of infection is not necessarily from patient to health-care workers,\u201d said Chagla. \u201cIt was also that health-care workers \u2026 spread it to other health-care workers. That was a pocket we didn\u2019t anticipate.\u201d<\/p>\n Staff need to be hired immediately to avoid a repeat of the terrible toll the first wave took on Ontario\u2019s most vulnerable seniors, says Grinspun.<\/p>\n \u201cWe want increased staffing now so we don\u2019t find ourselves in the predicament that we did last time,\u201d she said. \u201cBecause, on top of everything, this time you will have influenza and you will have people who are exhausted.\u201d<\/p>\n She says she \u201chonestly believes\u201d Premier Doug Ford when he says he wants to fix the problems in long-term care, but the clock is ticking down to the second wave and no government has a good track record when it comes to seniors\u2019 homes.<\/p>\n \u201cThey were abandoned for the last two decades,\u201d said Grinspun. \u201cGovernment after government after government.\u201d<\/p>\n Niagara Health president Lynn Guerriero said establishing a better system of managing COVID-19 in nursing homes will also help ensure hospitals don\u2019t get overwhelmed if the next wave of the virus is more severe than the first, as it appears to be in other countries including Australia.<\/p>\n Backlogs in the hospital system<\/strong><\/p>\n Niagara Health, Hamilton Health Sciences and St. Joseph\u2019s Healthcare are still struggling to catch up with a massive backlog of surgeries and other patient procedures that were cancelled in the first wave of the pandemic. Research published in the\u00a0Canadian Medical Association Journal\u00a0<\/a><\/span>on Sept. 1, estimates 148,364 surgeries were postponed provincewide from March 15 to June 13. The Toronto researchers estimate it will take 84 weeks to clear the backlog.<\/p>\n \u201cThe best thing we need to do between now and the fall is make sure that we have a plan in place for congregate settings,\u201d said Guerriero. \u201cAs a hospital system, we can\u2019t really function if we have to always have the capacity to decant long-term care. So you saw that happening in various places where 10, 20, 50 patients, residents of a long-term-care home, with no other option, would have to go to a hospital.\u201d<\/p>\n In Hamilton\u2019s\u00a0deadliest<\/a><\/span>\u00a0COVID-19 outbreak, 63 seniors from the\u00a0Rosslyn Retirement Residence<\/span>\u00a0<\/a>had to be\u00a0evacuated<\/a><\/span>\u00a0to St. Joseph\u2019s Charlton Campus and Hamilton General Hospital \u2014 most within a matter of hours on May 15 \u2014 when the home had\u00a0no staff<\/span>\u00a0<\/a>left and was\u00a0shut down<\/a><\/span>. Hospital workers said they\u2019d never seen so many patients admitted at once in their careers.<\/p>\n In the second wave, such evacuations would be a bigger challenge as hospitals work to clear the backlog of postponed care.<\/p>\n \u201cWhat that means for the hospital is all of a sudden we have to ramp down our procedures,\u201d said Guerriero. \u201cWe don\u2019t want that to happen, so I think that the relationships we\u2019ve built with congregate settings and public health need to be strengthened and kept in place so that we are absolutely ready for whatever happens in the fall.\u201d<\/p>\n Many wonder how Ontario\u2019s normally overcrowded hospitals will juggle influenza, COVID-19 and the\u00a0backlog<\/a><\/span>.<\/p>\n \u201cWe are chronically above 100 per cent (occupancy) just to do what we are supposed to do without being faced with a pandemic at the same time,\u201d said Mertz. \u201cFinding the right balance between opening up as much as we can to provide care to those who have waited a very long time but still making sure we are nimble enough to reduce scheduled care when we see things are ticking up again, will continue to be a challenge throughout this pandemic.\u201d<\/p>\n The question is how to keep\u00a0beds open<\/span>\u00a0<\/a>\u2014 an issue that has increasingly challenged\u00a0hospitals<\/a><\/span>\u00a0for decades.<\/p>\n \u201cWe do have capacity,\u201d said Chagla. \u201cAt the same time, we have a plan on how to create more space relatively quickly. I think it\u2019s just part of the new normal that you have to have some capacity.\u201d<\/p>\n But hospitals usually have more patients than funded beds, especially during flu season, so they have to put people in unconventional spaces such as hallways, family rooms and sunrooms \u2014 something that has been coined\u00a0hallway medicine<\/a><\/span>.<\/p>\n \u201cEvery year I\u2019m screaming in the media about not enough beds,\u201d said Grinspun. \u201cPicture this year when you will have influenza plus COVID. Unless we really prepare primary care, nursing homes and home care for October, November and December, we are toast in my opinion. The entire system will crumble not only nursing homes.\u201d<\/p>\n Ontario has to break down the silos in the health-care system and improve co-ordination, said Guerriero.<\/p>\n \u201cI think one of the biggest things that has to change \u2026 is better integrating the response between hospital, home and community, and long-term-care and retirement homes,\u201d she said.<\/p>\n The RNAO says what\u2019s missing now is a sense of urgency from the provincial government to get ahead of the second wave.<\/p>\n \u201cI have been asking and asking for the plan for wave two and the answer is always, \u2018It\u2019s coming, it\u2019s coming.\u2019 \u201d she said. \u201cA key message is to move faster, much faster, and with a more serious sense of urgency.\u201d<\/p>\n Mertz is also frustrated by wasted opportunities, particularly when it came to the best way to get kids back in the classroom.<\/p>\n \u201cI think we lost valuable time in terms of testing models back in May and June in areas where there was hardly any COVID,\u201d he said. \u201cWe were stuck in a one-size-fits-all approach for the entire province for a very long time.\u201d<\/p>\n Local or partial lockdowns?<\/strong><\/p>\n He says sticking with a regional approach will be even more important as the second wave hits.<\/p>\n \u201cI don\u2019t think there will be a need to shut down the entire province anymore as a whole, but there might be need for local or partial lockdowns along the way,\u201d said Mertz. \u201cI think the main challenge is identifying clusters early and reacting quickly.\u201d<\/p>\n In the second wave, outbreaks are expected to shift more to stores, restaurants, bars, factories, transit and workplaces as services reopen.<\/p>\n \u201cThe bigger area of concern now is the community,\u201d said Chagla. \u201cThere\u2019s always a risk with some of these indoor, poorly ventilated activities that we see a big transmission event. I think we just have to be smart, universal mask, make sure people are getting tested. Every individual has to make their own risk assessment on how much they want to engage with society.\u201d<\/p>\n A need for transparency in reporting<\/strong><\/p>\n The Ontario Health Coalition fears the public won\u2019t even know about the majority of outbreaks in the second wave. While public health departments report outbreaks in congregate living and hospitals, they ordinarily don\u2019t reveal cases at businesses.<\/p>\n \u201cThe reporting is actually much worse,\u201d said Mehra. \u201cThe names are being shielded from public scrutiny. There is no reason why you can publish the name of a long-term-care home with an outbreak, but not a food production facility. It is in the public interest for transparency.\u201d<\/p>\n It leaves the community counting on the businesses themselves to make COVID-19 outbreaks public.<\/p>\n \u201cSome stores have been reporting publicly, but many others have not,\u201d said Mehra. \u201cThis is about protecting business interests and that should not supersede the public interest. There\u2019s no reason to hide it, so it shouldn\u2019t be hidden.\u201d<\/p>\n The lull right now between the waves is the time to find a new normal the community can live with for months or even years, say infectious disease experts.<\/p>\n \u201cWe\u2019ve gotten to a point that this is as good as it\u2019s going to get,\u201d said Chagla. \u201cWe\u2019re not going to eliminate COVID without something in terms of a treatment or a vaccine.\u201d<\/p>\n Over the summer, the numbers of new cases have been low meaning the community has been as safe as it can be.<\/p>\n \u201cI think people can \u2026 go back to some semblance of normalcy as long as they are practicing good hand hygiene, distancing and testing if they have symptoms,\u201d said Chagla.<\/p>\n The focus now needs to be on giving people the\u00a0tools<\/a><\/span>\u00a0to make the right decisions, said Mertz.<\/p>\n \u201cI think we need to stop asking the question if doing X or Y is safe,\u201d he said. \u201cWe really should say how can I do X or Y as safely as possible. Going back to simple principles like the three Cs: Avoid close spaces; crowded places and close contact.<\/p>\n \u201cI hear about people who are still scared to leave the house,\u201d he adds. \u201cIf you are not considering things safe enough now than this will be a major problem for you in the months to come because it will likely not get any safer.\u201d<\/p>\n \u2018Incredible\u2019 testing capacity<\/strong><\/p>\n The one piece that is already in place for the second wave is the ability to quickly test for COVID-19.<\/p>\n \u201cThe testing capacity is incredible in terms of 20,000 to 30,000 tests provincially (a day),\u201d said Chagla. \u201cI think we learned very quickly that you can\u2019t fight the enemy that you don\u2019t see.\u201d<\/p>\n What Mertz wants to stop in the second wave is the shaming of so-called \u201cCOVIDIOTS\u201d which he believes ultimately hampers the ability to stop the spread of the virus.<\/p>\n \u201cI think blaming will not help us moving forward,\u201d he said. \u201cIf anything, it will result in people hiding what they really did and then we fail with our contact tracing.\u201d<\/p>\n