When Greg McVeigh and his brother, Rod, couldn’t get through to Toronto’s Seven Oaks, the nursing home where their parents lived, they started reaching out blindly through e-mail and Instagram to anyone who might be able to help protect the couple from the coronavirus.
In phone calls and e-mails, including one to Toronto Mayor John Tory on March 20, the brothers begged the city-owned facility to test more residents and to isolate their mother before the outbreak reached her floor. But Seven Oaks, following the advice of provincial public health officials, initially did neither.
On April 7, their mother, Joan McVeigh, died of COVID-19, making her one of at least 22 residents who have died in one of the worst coronavirus outbreaks at a long-term care home in Canada.
As the novel coronavirus continues to rampage through seniors’ homes, the experience of the McVeigh family raises questions about what more could have been done to contain the virus once it gained a toehold at Seven Oaks and hundreds of other facilities like it.
Nearly half of Canada’s approximately 900 coronavirus fatalities have been of residents of nursing or retirement complexes, according to Chief Public Health Officer Theresa Tam.
In Canada’s largest city, 68 of 115 COVID-19 deaths have been in residents of long-term care homes. One resident of a Toronto retirement home has also died.
“I’m truly concerned about the devastating impacts of COVID-19 that we are seeing at our long-term care homes," Eileen de Villa, Toronto’s Medical Officer of Health, said Tuesday. "These are affecting our loved ones in the community.”
The coronavirus outbreak at Seven Oaks, the first Toronto seniors’ home to publicly report a case, began on the night of March 19. The case was diagnosed in a third-floor resident who had been sent to hospital.
After learning through the media of the third-floor case, Greg McVeigh called Seven Oaks to ask that his mother be fed with her husband, rather than in the communal dining room on the fourth floor, where the couple lived in adjacent rooms.
Her husband, Joseph, a 77-year-old retired Toronto police detective who has congestive heart failure and dementia, was already bedridden and taking meals in his room, Greg said.
Ms. McVeigh was 79 and had mild dementia. She was otherwise healthy.
Barely five feet tall, “Wee Joanie,” an immigrant from Northern Ireland, doted on her five grandchildren, enjoyed sitting by her husband during the day and looked forward to tea, coffee and cookies at Seven Oaks.
In his March 20 e-mail to Mr. Tory, Greg described how the Seven Oaks staff member he reached by phone reacted to his request. “[T]he response I received is they are still eating in the dining hall regardless of a COVID-19 positive patient. The response was, 'They are not on that floor [where the outbreak is].’”
Four days later, a case of COVID-19 was confirmed on the McVeighs’ floor. Someone from the home called Rod to say his mother had developed a low-grade fever and that she would be tested for the virus.
Ontario’s policy of enacting infection-prevention and control precautions – such as isolating patients in their rooms – on one floor or unit at a time rather than across an entire building was created for routine outbreaks caused by the flu virus and other pathogens.
Asked why buildingwide precautions were not imposed when COVID-19 was first discovered on the third floor at Seven Oaks, Elizabeth Rea, Toronto’s associate medical officer of health, said it’s important during any outbreak to control the spread of the infection, “while balancing the daily life of residents in the [long-term care home]."
Long-term care homes drew on the same provincial playbook for routine outbreaks early in the coronavirus crisis when it came to testing.
They followed long-standing provincial advice to test only three or four sick residents on every floor to determine the pathogen at the root of an outbreak, after which the home was supposed to presume that everyone with symptoms was infected with it.
But Ms. McVeigh’s case makes plain how difficult it can be to identify and isolate COVID-19 patients based on symptoms alone.
Her fever never exceeded 37.8C and she wasn’t experiencing the respiratory distress typical of COVID-19, her sons learned through frequent calls to the nursing station. She was more tired than usual and had lost her appetite. Still, they expected her to recover.
The family did not find out that Ms. McVeigh was positive for COVID-19 until April 6.
The next morning, Rod got a call from the home’s doctor who told him that Ms. McVeigh had died of a cardiac arrest brought on by the virus.
It had been weeks since Rod or Greg had spoken to their mother. The province barred all but essential visitors from nursing homes beginning March 14 in a bid to keep the coronavirus out.
“Every time I called over the last week, my mom was sleeping. I called every single day,” Rod said. “I just didn’t fully appreciate the risk that my mom was under."
Greg added that the family did not want to put pressure on the home’s busy front-line workers – who had always been wonderful to Mr. and Ms. McVeigh – to take a phone into the room of a patient who might be infected.
Mr. Tory, whose spokesman confirmed that Greg’s March 20 e-mail was forwarded to the city’s Emergency Operations Centre, said he believes there needs to be more and faster testing in seniors’ homes, “so as to achieve rapid isolation where called for and so as to reassure residents and staff and their families."
On April 8, the day after Ms. McVeigh died, the Ministry of Health released new guidance that expanded significantly the criteria for who should be tested at nursing and retirement homes.
The policy stopped short of mandating tests for all residents of seniors’ facilities, despite Premier Doug Ford saying repeatedly that he wants all residents tested.
However, the revised criteria mean that every resident of Seven Oaks is now being tested, regardless of symptoms, because outbreaks have been detected on every floor of the home, Dr. Rea said in an e-mailed response to questions about Ms. McVeigh’s case.
As of Sunday, there were 82 confirmed cases in Seven Oaks residents and 14 in staff.
Joseph found out he tested negative for the coronavirus on Monday, his sons said.
According to Dr. Rea, Seven Oaks is starting to see the positive effects of the “stringent outbreak measures” applied early in the outbreak, including twice daily health screenings for residents and staff, enhanced cleaning for frequently touched surfaces, and the cancellation of all group activities.
Staff have been prohibited from working at more than one facility since the beginning of the outbreak, with extra hours and overtime pay provided, she added.
That wasn’t enough to save Ms. McVeigh.
“You won’t die in vain. We love you with all our hearts,” Greg said at his mother’s funeral, attended by just nine immediate family members and streamed on YouTube so that Joseph could watch from his room at Seven Oaks. “And we love you, too, Dad, okay?”
Greg said the COVID-19-related deaths of hundreds of Canadian seniors should never be deemed “acceptable.”
“I think we should demand that there’s a public inquiry into the systemic issues that give rise to the disproportionate deaths in our long-term care facilities,” he said.
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