COVID-19

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IT’S TIME FOR GOVERNMENTS TO LISTEN TO WORKERS IN LONG-TERM CARE HOMES 

Jan Malek July 24, 2020

I recently had the opportunity to participate in a video conference where long-term care workers from across the country spoke about their experiences with the COVID-19 outbreak in Canada. Their stories echoed with sadness and frustration as they described the tragedy that has transpired in many homes across the country. 

To date, more than 8,800 people have died in seniors’ care homes across Canada from COVID-19, the majority of them in long-term care homes, according to numbers compiled by freelance journalist Nora Loreto. This number represents more than 80 per cent of all COVID-19 deaths in the country. 

Canada’s shameful record of COVID fatalities in long-term care is the highest of all developed country in the world. A report by the Canadian Institute of Health Information found that “the proportion of deaths occurring in long-term care (LTC) is double the OECD average.” It is a national tragedy that cannot be ignored, especially as the threat of another wave of COVID-19 infections looms. 

Workers in long-term care homes have unique insights on what is needed to avoid additional tragedies. Governments should be listening to their experiences closely – not to the managers or the corporate faces representing the homes – but the people who work and provide care in the homes (and whenever possible, the people who live in them too). 

Here are some things I learned from long-term care workers: 

  • There was a lack of communication in the first wave of COVID-19. Many workers reported difficulty getting information on infection rates and weren’t always made aware of who was sick with the virus. This lack of information made it difficult to limit the spread. 
  • In some provinces the health directives were unclear and poorly communicated within the homes. One worker said they knew they should wear a face mask, but the management of the home they worked in discouraged it because it would “scare the residents.”   
  • Many workers said they had to “beg” for proper personal protective equipment (PPE). Homes are required to have a three-month supply in case of outbreaks or pandemics but many workers found the supplies were old and degraded, or not substantial enough in quantity to last longer than a few weeks. A number of workers reported Unions stepping in with deliveries of hand sanitizer, face masks and other PPE. 
  • There was a lack of clarity about where care should occur – should infected residents stay in the home or be transported to a hospital? In one Ontario long-term care home, infected residents were moved from the home to a field hospital that was specifically set up to for COVID-19 patients. This lessened the spread and helped protect residents and workers who remained in the home. 
  • Workers said some homes took too long to stop visitors from entering, or to limit staff (while supplementing their hours and income) to working in only one home. 
  • By far, the most repeated concern workers expressed was staffing shortages. Workers have been sounding the alarm of staffing shortages in long-term care homes for years and they say the pandemic made this crisis even worse. 

The 2019 report Caring in Crisis, prepared by the Ontario Health Coalition and put directly into Ontario Premier Doug Ford’s hands in December – months before the pandemic hit – provides documentation on the staffing shortage crisis in Ontario. Other provinces are experiencing similar shortages. Quebec, for example, has said it will hire 10,000 new long-term care workers, pay them higher wages and give them a government pension. 

“In every town, in virtually every long-term care home, on virtually every shift, long-term care homes are working short-staffed. It is no overstatement to call the situation a crisis,” the report states. “It impacts the vital functions of care, leaving inadequate time to provide even basic care for residents. We heard that across Ontario as a result of the shortage, baths are skipped, care is rushed, and residents feel like a burden to overstretched staff.” 

Workers say these staffing shortages cause them immense stress and they worry about being able to provide the care those living in long-term care homes need. Added to that is their fear of contracting COVID-19, as many workers already have, and putting their own lives – and the lives of their family members – at risk. 

The Council of Canadians is calling on governments across the country to do more to support and protect both the residents of long-term care and those who work to care for them. 

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Surgical backlog must not be fixed at the expense of the healthcare system

Date: August 4, 2020 Authors: Lesley BarronThara Kumar

As we breathe a tentative sigh of relief that COVID-19 numbers are stabilizing, the ripple effects of the pandemic are becoming more apparent.

Thousands of surgical procedures were cancelled when hospitals adjusted operations to brace for the wave of COVID-19 patients. Now, as governments grapple with this backlog, some have announced their intention to contract out care to private for-profit investor-owned facilities.

British Columbia is using all available beds to address its backlog. This now includes contracting out publicly funded care to for-profit surgical centres such as False Creek Surgical Centre, owned by Kensington Capital Advisers, a private equity firm. Manitoba recently announced that it, too, is considering contracting with for-profit facilities to address its backlog, as has Alberta with its recently announced Bill 30.
There is no doubt that COVID-19 has demanded healthcare systems adapt quickly, without the benefit of the long-term planning usually required for systems change. In the case of surgical backlogs, we should treat an acute wait list problem differently than we treat a chronic one. We must, however, ensure that short-term fixes don’t cause long-term harms – and that they ideally benefit the system.

Investor-owned, for-profit facilities may seem like an obvious solution to COVID-19 surgical backlogs. But what does previous experience tell us about these facilities?
Care delivered in for-profit facilities costs more than not-for-profit care and mortality and morbidity are worse. Past contracts in Alberta have paid higher prices to for-profit facilities than to public hospitals for the same services. Death rates from COVID-19 have been dramatically higher in for-profit long-term care facilities than in publicly owned or not-for-profit homes; in eastern Ontario, 83% of long-term care deaths occurred in for-profit homes. Why this discrepancy? Because investor-owned facilities owe a fiduciary responsibility to earn money for their shareholders, meaning less money is available for patient care. This must not be the way forward for our healthcare system.

So how do we create lasting capacity within the public system beyond the current crisis? Our response must be rooted in the solid evidence about system reform.
To clear the surgical backlog, we must scale-up hospital capacity by extending operating hours to include evenings and weekends. We should immediately implement team-based single-entry centralized wait-lists for the first available surgeon so patients can access care as quickly as possible. This approach has dramatically improved surgery wait times.

Surgical smoothing would separate planned and unplanned surgeries into different operating room streams, eliminating the problem of emergencies bumping other surgeries. We must scale-up cost-effective, not-for-profit, publicly funded ambulatory surgical centres, such as rural and satellite sites, managed by hospitals.

In the short-term, if governments insist on using private investor-owned facilities in addition to, or instead of, exploring not-for-profit and public solutions, what are some critical elements that must be in place to minimize undermining the rest of our healthcare system?

First, provinces should only be turning to for-profit facilities after exhausting all efforts to increase capacity in the existing not-for-profit infrastructure. Where such for-profit facilities exist, government should consider purchasing them and bringing them under public ownership as B.C. did when it recently bought two private MRI facilities.

Second, any contracting out to investor-owned facilities must not delay or undermine initiatives to expand access to care within the public or private not-for-profit system (such as B.C.’s surgical strategy announced in 2018). Nor should new investor-owned facilities be built to address this pandemic-induced short-term backlog. This is the time to invest in our public health care system, not in a profit-driven industry.

Third, we must have full public oversight of investor-owned facilities. Governments must ensure they are transparent, operate within the law, and are subject to the same standards of inspection and certification as not-for-profit hospitals. This means not charging patients extra fees or selectively “cream skimming” healthier patients whose treatments cost less as a way to increase corporate profits. It means ensuring that proper personal protective equipment and infection control practices are in place.

We have a once-in-a-generation opportunity to learn from this pandemic and improve our healthcare system. We need to come out of this crisis with a stronger, more equitable public healthcare system, not a more fractured one.

As we recover from this crisis, we should be working toward a future that always puts patients above profits. If this crisis is instead used as an opportunity to expand and entrench for-profit investor-owned delivery of health services, it will be at our peril.

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US doctor in Canada: Medicare for All would have made America’s COVID response much better

America needs a health care system that puts public health ahead of profits. I know we can do better. I see it everyday in Canada amid the coronavirus.

Dr. Khati Hendry Opinion contributor
August 5, 2020

I’m a family physician who moved to Canada from California 14 years ago, largely because of Canadian Medicare, the country’s national health insurance program. I’ve been much happier practicing medicine where my patients have universal coverage. It frees up doctors like me to focus on patient care and frees patients to focus on their health, instead of worrying about how to pay for it.

But I have never felt more grateful to work in a universal health care system than during the COVID-19 pandemic. My heart aches for the millions of Americans who have fallen ill and then have had to worry about how they will pay for tests and treatment, who have gone to work while sick for fear of losing their health coverage or who have lost not only their jobs but their insurance, leaving them at risk for financial ruin.

While no country is immune from COVID-19, Canada has been able to mount a much more effective response. Canada’s infection rate is a tiny fraction of that of the United States, and trending downwards. Its health system has two big advantages when fighting the pandemic: universal health coverage and an administratively simpler system.

Canadian Medicare is good for patients

Canada’s publicly financed single-payer system covers everybody, regardless of age, health or job status. No one loses coverage due to COVID-19. Canadian Medicare covers services like hospital and emergency care, doctor appointments and lab tests—without copays, deductibles or medical bills. Everyone is in a single “network,” so there are no artificial limits on which hospital or health provider a patient can see. As a result, Canadians are much less likely to delay testing or treatment for COVID-19, or for the chronic medical conditions that increase the risk of severe illness and death from the virus.

Canada’s universal system also has made it easier for medical and public health professionals to respond quickly — and together — without the administrative headache of multiple insurance companies.

In my province of British Columbia, our ongoing history of collaboration between physicians and the provincial health system made it easier to coordinate responses from hospitals, primary care clinics and long-term care facilities. From the start, emergency response committees held daily meetings to address challenges of hospital capacity, distribution of supplies and protective equipment, testing procedures, staffing policies, telemedicine, COVID-19 protocols and the safety of health care workers. The British Columbia public health officer gives regular updates and guidance as we move through pandemic phases.

Instead of primary care practices shutting down and forcing patients to go without care, as reported in many parts of the United States, we have been able to work together through our province’s longstanding “Divisions of Family Practice.” Most of us work in private practice, but we get help to coordinate with other family doctors to make sure that on-call shifts are covered, our practices are safe and our patients get the care they need during the pandemic. I have not had to care for a patient with COVID directly yet, but I have been part of the extensive planning process. 

America should follow

As health care shifted from in-person to virtual practically overnight, Canadian health authorities put systems in place for more provincial phone triage, patient self-assessment protocols, virtual care software and better internet access to remote areas. The province made investments to support the needs of vulnerable populations, such as aboriginal communities, and those who are homeless, live in rural areas, travel for agricultural work or struggle with mental illness or addiction — groups that have suffered disproportionately from COVID-19 in the United States.

An ER visit could save your health or life: Don’t avoid hospitals during COVID pandemic.

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COVID-19 Has Exposed the Perils of ‘Financialized’ Seniors’ Care

Martine August 29 Jul 2020 | The Conversation Canada
Martine August is an assistant professor in the school of planning at the University of Waterloo in Kitchener, Ont. This article originally appeared in the Conversation Canada.

The pandemic has highlighted worse outcomes and more deaths in for-profit care homes.

In May, Orchard Villa, a long-term care home in Pickering, Ont., made headlines for a bad COVID-19 outbreak. Just two months into Ontario’s lockdown, 77 patients in the 233-bed home had died. A report by Canada’s military revealed horrifying conditions, short staffing and neglect.

Some family members blamed for-profit ownership, arguing that COVID-19 had simply exposed, in tragic fashion, the impact of prioritizing profits in the operation of seniors housing.

Notably, Orchard Villa had been purchased in 2015 by private equity firm Southbridge Capital, adding it to Canada’s growing stock of “financialized” seniors’ housing — bought by financial firms as an investment product.

To access the article, please click on: COVID-19 Has Exposed the Perils of ‘Financialized’ Seniors’ Care

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Scientists just beginning to understand the many health problems caused by COVID-19

Julie Steenhuysen

CHICAGO (Reuters) – Scientists are only starting to grasp the vast array of health problems caused by the novel coronavirus, some of which may have lingering effects on patients and health systems for years to come, according to doctors and infectious disease experts.

Besides the respiratory issues that leave patients gasping for breath, the virus that causes COVID-19 attacks many organ systems, in some cases causing catastrophic damage.

“We thought this was only a respiratory virus. Turns out, it goes after the pancreas. It goes after the heart. It goes after the liver, the brain, the kidney and other organs. We didn’t appreciate that in the beginning,” said Dr. Eric Topol, a cardiologist and director of the Scripps Research Translational Institute in La Jolla, California.


In addition to respiratory distress, patients with COVID-19 can experience blood clotting disorders that can lead to strokes, and extreme inflammation that attacks multiple organ systems. The virus can also cause neurological complications that range from headache, dizziness and loss of taste or smell to seizures and confusion.

To read the full article, click on: Scientists just beginning to understand the many health problems caused by COVID-19

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The Risks – Know Them – Avoid Them

Where are people getting sick?
How much Virus is released into the environment?
(Excerpts)
Erin Bromage – May 6

A Bathroom: Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk.
A Cough: A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds.
A Sneeze: A single sneeze releases about 30,000 droplets, with droplets traveling at up to 200 miles per hour. Most droplets are small and travel great distances (easily across a room).
If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them.
A breath: A single breath releases 50 – 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled.
Remember the formula: Successful Infection = Exposure to Virus x Time
If a person coughs or sneezes, those 200,000,000 viral particles go everywhere. Some virus hangs in the air, some falls into surfaces, most falls to the ground. So if you are face-to-face with a person, having a conversation, and that person sneezes or coughs straight at you, it’s pretty easy to see how it is possible to inhale 1,000 virus particles and become infected.
Speaking increases the release of respiratory droplets about 10 fold;
What is the role of asymptomatic people in spreading the virus?
Symptomatic people are not the only way the virus is shed. We know that at least 44% of all infections–and the majority of community-acquired transmissions–occur from people without any symptoms (asymptomatic or pre-symptomatic people). You can be shedding the virus into the environment for up to 5 days before symptoms begin.

To read the full article, click on The Risks – Know Them – Avoid Them

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For Renaissance Italians, combating black plague was as much about politics as it was science, according to Stanford scholar

MAY 12, 2020 [EXCERPTS]
The inability of 14th-century medicine to stop the plague from destroying societies throughout Europe and Asia helped advance scientific discovery and transformed politics and health policy, says Stanford historian Paula Findlen.

BY MELISSA DE WITTE – For Italians in the 14th-century, the bubonic plague at first seemed extraordinary but its repeated return made it so much a part of daily life that it became an economic annoyance and an administrative problem to resolve, and eventually led to advances in medicine and public health, according to Stanford historian and scholar of Renaissance Italy, Paula Findlen.

As the world confronts another global pandemic, Findlen spoke to us about the problems Renaissance Italians faced related to the Black Death, including ones that might seem familiar to us today, such as the difficulties of reliably reporting the disease, misinformation campaigns, and political tensions between states around their response.

Since antiquity, people have debated whether to remain or flee during an epidemic, and how to prevent others from coming. “Quarantine” is a specific legacy of how late medieval and Renaissance cities responded to plague, not during the initial pandemic of 1346-53, but after its return. The first known legislation (by the Venetians) in 1377 only specified thirty days but it evolved into forty, which is what quarantina means. Forty made more sense to physicians who read Hippocrates on the typical length of a highly contagious disease and also knew, as Christians, that this was the duration of Lenten fasting.

To read more, and find out about the answers to the following questions:
How did the bubonic plague change the relationship between science, government and society?
In what ways did the Black Death change medicine and scientific research?
You have studied the history of scientific networks and the spread of news and information. As scientists from around the world race to find treatment and a vaccine for COVID-19, are there lessons from the past that are applicable today?
Was there a figure like Anthony Fauci (director of the U.S. National Institute of Allergy and Infectious Diseases) in Renaissance Italy?
What enduring legacy did the bubonic plague leave on life in Italy and beyond?
What are the lessons from Renaissance Italy that can inform our response to COVID-19?
click on For Renaissance Italians, combating black plague was as much about politics as it was science

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Doctors keep discovering new ways the coronavirus attacks the body

Damage to the kidneys, heart, brain — even ‘covid toes’ — prompts reassessment of the disease and how to treat it

By Lenny Bernstein and Ariana Eunjung Cha MAY 10, 2020

002ea3 Deborah Coughlin was neither short of breath nor coughing. In those first days after she became infected by the novel coronavirus, her fever never spiked above 100 degrees. It was vomiting and diarrhea that brought her to a Hartford, Conn., emergency room on May 1.

“You would have thought it was a stomach virus,” said her daughter, Catherina Coleman. “She was talking and walking and completely coherent.”

But even as Coughlin, 67, chatted with her daughters on her cellphone, the oxygen level in her blood dropped so low that most patients would be near death. She is on a ventilator and in critical condition at St. Francis Hospital, one more patient with a strange constellation of symptoms that physicians are racing to recognize, explain and treat.

At the beginning, we didn’t know what we were dealing with,” said Valentin Fuster, physician-in-chief at Mount Sinai Hospital in New York City, the epicenter of the U.S. outbreak. “We were seeing patients dying in front of us. It was all of a sudden, you’re in a different ballgame, and you don’t know why.”

Today, there is widespread recognition the novel coronavirus is far more unpredictable than a simple respiratory virus. Often it attacks the lungs, but it can also strike anywhere from the brain to the toes. Many doctors are focused on treating the inflammatory reactions it triggers and its capacity to cause blood clots, even as they struggle to help patients breathe.

Learning about a new disease on the fly, with more than 78,000 U.S. deaths attributed to the pandemic, they have little solid research to guide them. The World Health Organization’s database already lists more than 14,600 papers on covid-19. Even the world’s premier public health agencies, including the Centers for Disease Control and Prevention, have constantly altered their advice to keep pace with new developments.

“We don’t know why there are so many disease presentations,” said Angela Rasmussen, a virologist at the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health. “Bottom line, this is just so new that there’s a lot we don’t know.”

More than four months of clinical experience across Asia, Europe and North America has shown the pathogen does much more than invade the lungs. “No one was expecting a disease that would not fit the pattern of pneumonia and respiratory illness,” said David Reich, a cardiac anesthesiologist and president of Mount Sinai Hospital in New York City.

It attacks the heart, weakening its muscles and disrupting its critical rhythm. It savages kidneys so badly some hospitals have run short of dialysis equipment. It crawls along the nervous system, destroying taste and smell and occasionally reaching the brain. It creates blood clots that can kill with sudden efficiency and inflames blood vessels throughout the body.

It can begin with a few symptoms or none at all, then days later, squeeze the air out of the lungs without warning. It picks on the elderlypeople weakened by previous disease, and, disproportionately, the obese. It harms men more than women, but there are also signs it complicates pregnancies.


To read the full article, click on Doctors keep discovering new ways the coronavirus attacks the body

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Canada’s for-profit model of long-term care has failed the elderly, says leading expert

“Elderly care needs to be recognized for the skilled work that it is”, says Pat Armstrong
CBC Radio · Posted: Apr 24, 2020 5:49 PM ET | Last Updated: April 24

To read the full article, click on: Canada’s for-profit model of long-term care has failed the elderly, says leading expert

Pat Armstrong is a distinguished research professor in sociology at York University and a fellow of the Royal Society of Canada. (Submitted by Pat Armstrong)

“We haven’t placed a high priority on providing care in nursing homes. I think that basically we’d rather not think about them,” Pat Armstrong told Michael Enright of The Sunday Edition.

“When Roy Romanow did his Royal Commission [on the Future of Health Care in Canada], he said that the health care we get is a matter of values — and I think that this is making our values pretty evident.”

Armstrong is one of Canada’s foremost thinkers on long-term care. She is a distinguished research professor in sociology at York University and a fellow of the Royal Society of Canada. 

Long-term care, she says, is one of the major gaps in Canada’s universal health-care system.
“It’s not clearly covered by the principles of the Canada Health Act, or in the funding,” she said. Instead, the act is “basically focused on hospitals and doctors. It was developed at a time, initially, when most care was provided in hospitals.”
Today, the country’s elderly population is increasingly in need of chronic care — and far more of that care is provided in nursing homes than in the past, Armstrong added.

‘The business of making a profit’
According to a report from the Canada Health Coalition in 2018, just under half of all long-term care facilities in the country are private, for-profit entities. 
But when it comes to health-care services as essential as long-term care, we can’t trust markets to do what is in seniors’ best interests, Armstrong said.

“We know from the research that for-profits tend to have lower staffing levels. They tend to have more transfers to hospitals. They tend to have more bed ulcers,” she said. “There are some good for-profit homes, just like there’s some poor not-for-profit homes, but the general pattern is there.”

Years of for-profit care has meant a serious deterioration in the labour conditions inside nursing homes, she said.

“If you’re in the business of making a profit … in nursing homes, the overwhelming majority of the cost is labour. And that’s where you are going to try and save money.”

The easiest way to cut labour costs, Armstrong added, is through “hiring more people part-time, more people casual, more people at the last minute when you need them — rather than staffing up with full-time workers that you have to pay benefits to and provide things like sick leave for.”

Given these conditions, it should come as no surprise that care providers would work at multiple sites to make ends meet, Armstrong said.
 
“It is about needing full-time work but not being offered full-time work in the home where they’re working,” she said. “And a significant proportion in our country are people who are new to Canada, who have very few employment options.”

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Surgeries across the country will slowly resume using a triage system…..

“Surgeries across the country will slowly resume using a triage system, health ministries and doctors say, starting with the most urgent cases.
If it can continue to ramp up surgical volumes, Keshavjee hopes to be caught up on “time-sensitive” surgeries by the fall.  

It’s not clear how long it will take to catch up on other surgeries. It will depend on when procedures get back to a normal pace, as the backlog grows the more time passes, experts say.   

Three key factors must be in place before a surgical ramp-up can proceed, Keshavjee said:

• Government funding to pay for surgical overtime, including running evenings and weekends.

• Enough COVID-19 testing kits for every patient to check if they are infected before undertaking surgery.

• A reliable supply of personal protective equipment (PPE) for surgical staff as well as the rest of the hospital.”

To access the full article, click on the TITLE

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Rural Emergency Departments & COVID19

FOR IMMEDIATE RELEASE

The Canadian Association of Emergency Physicians & The Society of Rural Physicians of Canada

Recommendations:

1. National licencing/credentialing: establishment of emergency pan-Canadian licensure of health care workers. Create a standardized national system for rapid / dynamic intra-provincial and cross-provincial regulatory licensing. Improving provincial health authority credentialing and privileging for multiple jurisdictions (rural to urban, urban to rural).

2. Utilize new grads: mandate that recently graduating MDs with provisional licenses (because of delayed formal certification exams) can do locums, be assigned billing numbers and sign employment contracts.

3. Increased Funding and coverage: Federal and provincial funding mandated to respond immediately to increase number of temporary rural positions. The majority of rural EDs are staffed with single physician coverage.

4. Create Rapid Rural Relief Teams: creation and deployment of centralized provincial teams that include MDs, core generalist specialties, RNs and Respiratory Therapists.

To access the full article, click on the TITLE

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