Dr. Doris Grinspun is chief executive of the Registered Nurses’ Association of Ontario.
Canada did not listen to the specific and dire warnings of China, Italy or Spain, in order to be well prepared in managing the COVID-19 pandemic. Instead, we continued to adhere to the well-meaning, but flawed, thinking of public-health experts. We were told that we had nothing to be worried about and that the risk to our population was low.
Sadly, the powers that be also chose not to listen to insistent voices, like the Registered Nurses’ Association of Ontario (RNAO), which repeatedly called for early interventions in our nursing homes. We called for mandatory masking, surveillance testing of residents and staff, isolation of COVID-positive residents, an end to allowing personal-support workers to move between multiple facilities, and for staff who tested positive to be fully quarantined. We asked, we pleaded and we begged – to no avail. All the while, coronavirus trouble was brewing in the fertile, poorly funded, badly organized and dangerously low-staffed long-term care sector, with Ontario and Quebec eventually seeing the highest numbers of LTC virus cases in the country.
The results are well known: COVID-19 deaths in long-term care homes account for eight out of 10 coronavirus deaths in our country. Canada leads the way in this deadly statistic in all of the wealthiest countries globally: Our death rate in long-term care is double that of the Organization for Economic Co-operation and Development average. Added to this are the debilitating, and at times, deadly effects of the virus on health professionals working in the LTC sector, particularly personal-support workers and nurses. In Canada, more than 9,650 LTC health workers have been infected by COVID-19, representing about 10 per cent of the country’s cases, which is most likely because of a lack of personal protective equipment (PPE).
Why did this happen?
Canada has one of the best health care systems and some of the best health care intelligence in the world. We pride ourselves on inclusivity and acceptance. Unless we heed the very clear answers as to why the LTC COVID-19 disaster happened before the next wave arrives, we will completely devastate our country’s oldest citizens.
During the first wave, Ontario’s plan was to limit how severely it would alarm the public, but this was to our detriment. Poor advice and a total lack of early prevention measures and health-risk awareness constituted the modus operandi of Dr. David Williams, Ontario’s Chief Medical Officer of Health. Any preparation carried out was targeted to the already resource-rich hospital sector, leaving the other sectors to fend and fail for themselves. That our health system didn’t collapse is a fallacy: Hospitals were the only elements that didn’t crumble.
We did not learn from advance warnings from China and Europe. Now we must live with the consequences of the first wave of COVID-19 and immediately prepare for the next, because it will come. There is no time to wait for the results of an Ontario government commission looking into how the LTC system responded to COVID-19. The commission will deliberate until the sting of our failures wears off and our memories become clouded. We already have 21 years of evidence and 35 reports detailing the changes needed within the LTC sector – all of these are collecting dust. We do not need more reports – we need immediate corrective action.
First, we must fix the staffing in long-term care homes so that safe care and quality of life can be provided. The RNAO’s call for a Nursing Home Basic Care Guarantee is a well-researched start and we have urged Minister of Long-Term Care Merrilee Fullerton to adopt our recommendations by the end of the month.
Second, PPE needs to be fully available for all staff in long-term care and in other facilities caring for vulnerable persons. And, it must be available for families who want to be reunited with their loved ones. We have stolen precious time from them.
Third, immediate isolation for residents with the virus must be a mandatory practice and facilities need to have quarantine plans in place immediately.
Fourth, the provision of single-occupant rooms with personal bathroom facilities should be the required norm for all homes, with no exceptions. We must act now or we risk losing more LTC residents, and with them, the trust of Ontarians.
As we prepare for the second wave, we must change course. We must start with nursing homes as these house the Ontarians who have suffered the most. We must then focus on primary care and home care. We need these sectors to be ready to care for people in their communities, especially vulnerable populations. Let’s get on with the task so we can all feel proud again, with the knowledge that we have learned from our mistakes.
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