An unacceptable level of unpreparedness

di Priscilla Pajdo del October 14, 2020

TORONTO - Ontario appears to be in the second wave of Covid-19. In recent weeks, the number of new infections among seniors is on the rise. This has prompted growing concern for our seniors living in Long-Term Care Homes (LTCH).

In the last month, new infections in people over the age of sixty have more than tripled. According to Public Heath Ontario data, on October 10th, there were 101 additional cases reported, up from thirty cases recorded on September 13th.

This is a worrying trend considering the human toll the virus has already taken in the older population, primarily, residents in LTCH. These individuals are valued members of society. Also, they are often the most vulnerable on account of their complex medical conditions. Since the start of the pandemic, fatalities in LTCH represent 65% of all Covid-19 deaths in Ontario.

In an on-going investigation by the Long-Term Care Covid-19 Commission Inquiry, transcripts from a September 30th meeting were recently made available to the public. They provide the testimonies of doctors from the Ontario Long-Term Care Clinicians (OLTCC) organization suggesting LTCH were not prepared during the first wave of the Covid-19 outbreak.

During the height of the public health crisis, when the province went into “lockdown” in March, it became almost impossible for family to visit their loved ones in LTCH. In many instances, family members were acting as essential caregivers to their relative in these facilities.

Considering the staffing shortages across the sector pre-pandemic, the systemic problems were exacerbated once the facilities entered into outbreak. Compounding this issue, caregivers were denied access at the time to their loved ones, many residents were left without the proper care and support they deserve.

In the transcript of the September meeting, Dr. Rhonda Collins, speaking for the Board of Directors of the OLTCC testified, “to increase capacity in the acute care sector to prepare for a surge, many homes were directed to keep residents out of hospital to the best of their abilities”.

It was also revealed that at some LTCH “executive directors and directors of care were asking physicians to not come on site for the fear of spreading Covid-19, particularly if they worked at other sites”. Part of the issue was the lack of personal protective equipment, the Commission heard.

Despite some physicians not visiting some homes, Dr. Collins added, “many physicians did do in-person visits with some making arrangements with colleagues to cover one another’s residents”. All to reduce traffic between different facilities.

The Inquiry heard of some positive effects that were discovered during the first wave. Dr. Fred Mather, President of OLTCC, mentioned one which was the development of good virtual care. Another is improved dialogue between LTCH clinicians and hospitals to avoid inappropriate transfers to the emergency department.

Part of the issue, the clinicians say, is that LTCH do not have access to the same resources available at hospitals, for instance, access to emergency diagnostic testing or ultrasound. Better collaboration between LTCH, acute care and other specialists can help determine the need whether an induvial should be transferred to hospital.

But, facing a second wave, the need for faster testing of residents and sta. is essential, the doctors say.

In some cases, results from Covid-19 tests could take up to six days or more. This is unacceptable. As of last week, a spokesperson from Ontario Health, said “the network is experiencing a seven-day average of 43.5% of test turnarounds within two days”.

Is this fast enough to detect and deter an outbreak in this “second wave”?

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