“If my mom was in long-term care, I would pull her out. Now.”
Dr. Samir Sinha, Canada’s foremost geriatrics expert, is blunt. The rapid spread of coronavirus in seniors’ residences is “very, very bad news” and, unless the response changes dramatically, families should seriously consider bringing their loved ones to relative safety.
The virus that causes COVID-19 is spread through airborne droplets by coughing or sneezing, through touching a surface those droplets have touched, or through personal contact with infected people.
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The World Health Organization recommends regular hand-washing and physical distancing – that is, keeping at least two metres from someone with a cough. If you have to cough or sneeze, do it into your sleeve or a tissue, not your hands. Avoid touching your eyes, mouth or nose if you can.
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COVID-19 is much more serious for older adults. As a precaution, older adults should continue frequent and thorough hand-washing, and avoid exposure to people with respiratory symptoms.
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One cannot overstate how grim the news is that at least 600 seniors’ residences have been hit by COVID-19.
This is a wildfire that could soon grow far worse.
More than 75 residents of long-term care facilities, nursing homes and retirement homes have already died (at least half of all coronavirus deaths). These facilities are living up to their macabre nickname: God’s waiting room.
One can scarcely imagine a more nightmarish scenario than a novel virus spreading among a high-risk group such as seniors.
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Making matters worse is that the structure of the long-term care system in much of Canada facilitates the spread of infectious diseases such as coronavirus.
Many facilities suffer from chronic understaffing. They depend largely on part-time workers who juggle jobs at a variety of institutions and are rewarded with abysmal pay and no benefits.
If that were not bad enough, these essential care providers are treated as second class, with little access to the personal protective equipment available to hospital workers, and no paid sick leave if they fall ill.
Ontario’s Premier has spoken of creating an “iron ring” around seniors’ facilities; Quebec’s Premier has warned that keeping outsiders away is “a matter of life and death.”
But sealing them off from the outside world is a lot easier said than done, again because of what bureaucrats call “systemic vulnerabilities.” A typical 200-bed home, for example, will have about 40 staff, and then another 40 care workers coming from the outside, all of them deemed essential. Then there is the structure of homes themselves. Sharing rooms is common. Communal dining is the norm. Activities are often done in groups.
In short, seniors’ homes are much like cruise ships, except without the luxury. They are petri dishes.
There can be lockdowns – with no group gatherings, meals brought to rooms, aggressive social distancing and so on. But can understaffed, underequipped facilities maintain these rigorous standards?
The outbreak of at long-term care facility in Washington State shows just how quickly things can go bad in this environment.
At the Life Care Center in Kirkland, Wash., one worker unwittingly infected one resident. In a little more than two weeks, there were 167 infections, including 101 residents, 50 staff and 16 visitors. Half the residents were hospitalized and 33 died.
Just as importantly, the director of the Centers for Disease Control and Prevention said this week that as many as 25 per cent of people infected with the new coronavirus may not show symptoms, meaning they can transmit the illness without feeling ill.
Practically, that means current protocols, which involve isolating people once they are sick, are not good enough.
Neither is the policy of testing only the symptomatic sufficient. Even a single case in a seniors’ home has to be considered an outbreak, with everyone tested, masked and isolated.
As the number of patients admitted to hospitals, and to intensive-care units in particular, continues to climb in Canada, we have to consider the affect that will have on seniors in institutional care.
Once hospitals became overwhelmed, as they did in in Italy and Spain – which have health systems as good as Canada’s – they ran out of ventilators. Then, they simply stopped accepting patients from other facilities.
Older people were left to die alone in their nursing homes. So many workers fell ill or abandoned their jobs that some facilities were left with no care providers.
These deaths were not even included in the already mind-numbing mortality statistics.
More than 400,000 Canadians are in some kind of communal or institutional care.
It is estimated that 30 per cent to 70 per cent of people in the world will be infected with coronavirus, with the more vulnerable in the upper range. In Canada, about 7 per cent of those who test positive are ending up in hospital, but that figure jumps to as high as 50 per cent among nursing-home patients. Half of the hospitalized end up in ICU, but that figure is higher for the elderly. The overall death rate is 1 per cent but, again, it is as high as one-third in the frail elderly.
A disaster is not inevitable, but it is quite possible. The ghoulish math can be done easily enough.
But if you have a loved one in long-term care and you realize that, if they fall ill with COVID-19, they may have a one in three chance in dying, it’s pretty clear what you should do.
If you can, get them out while you still have a chance.
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