According to the Oxford English Dictionary, the expression “a perfect storm” refers to a “particularly bad or critical state of affairs, arising from a number of negative and unpredictable factors.”
That fairly describes the disastrous toll the COVID-19 pandemic has taken on Canadians living in long-term care and retirement homes. It also happens to be the title of a report produced by one of Canada’s biggest private LTC companies, Revera Inc.
The report looks at the first wave of the pandemic, from March to September, during which 978 residents in Revera’s LTC and retirement homes were infected, and 286 died.
It was written by an independent and unpaid team of experts, and it tries to answer the question of why “the frail elderly, some of society’s most vulnerable members, were least protected.”
Nowhere was this more true than in Canada: 7,000 long-term care and retirement home residents died of COVID-19 in the pandemic’s first wave. That accounted for 80 per cent of Canada’s first-wave deaths – “a proportion far higher than other wealthy nations,” the report notes.
The report lays out the main causes of this disaster: the lack of personal protective equipment; a shortage of staff; outdated buildings with multiperson wards; and an early misunderstanding that the disease could be spread by people without symptoms.
Oh, and a disastrous lack of testing capacity.
The report points out that Canada used the gold-standard nasal swab test to identify the country’s first COVID-19 case on Jan. 27. The first wave of the pandemic didn’t start cresting until March, leaving plenty of time to ramp up testing. But that never happened.
Without testing, LTC homes and retirement homes had to settle for a screening system, in which visitors and staff had their temperatures taken and were asked if they had any symptoms. These were useless measures, given what we now know about the novel coronavirus.
Regular testing of staff and visitors would have saved lives, as would have better designed homes.
A study published in August in the Canadian Medical Association Journal said for-profit homes were not more apt to have COVID-19 outbreaks than non-profit or government-run homes in Ontario. But because for-profit chains like Revera tend to operate older homes with multiperson wards, their outbreaks were more widespread and deadly.
Revera’s own report says it needs to upgrade its facilities; the company says it’s working on it, but claims it’s been held back by government bureaucracy. Both need to work together to fix an obvious problem.
But if there’s one thing the report brings home above all else, it’s that governments and LTC operators failed to heed a critical recommendation from the inquiry into the 2003 SARS outbreak in Toronto.
The SARS Commission urged the adoption of the precautionary principle when outbreaks occur: When facing the unknown, assume the worst and err on the side of caution.
Had government officials and the people running LTC homes assumed from the start that the virus could be transmitted by asymptomatic carriers, instead of guessing otherwise and waiting for science to prove them wrong, there would have been a greater urgency to separate patients, ramp up testing and get masks on faces.
As it was, Canada’s Chief Public Health Officer recommended as late as March 30 that only people showing symptoms should wear masks. Barely a week later, on April 8, Dr. Theresa Tam switched gears and said all workers, visitors and residents in LTC homes should wear masks, but Revera didn’t have enough on hand to meet the requirement.
Data provided by Revera show that 97 per cent of its infections in the first wave of the pandemic stemmed from outbreaks that occurred before April 13.
The idea that the COVID-19 pandemic was the result of an unexpected virus is partly true, and partly a cop out. A pandemic’s date and place of arrival can never be known in advance. But what is well known is that pandemics, like bad weather, happen. If you go sailing in a fair-weather boat, and get swamped by a storm, perfect or otherwise, it’s because you weren’t adequately prepared.
That lack of preparation was a choice, and Canada’s governments and its long-term care homes made the wrong one.
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