PANDEMIC #11 - It Didn’t Have To Be Like This
Hosted By
Arshy Mann
COMMONS
PANDEMIC #11 – It Didn’t Have To Be Like This
Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.
Hosted by Arshy Mann
July 22, 2020
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 - “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There's 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don't teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We've been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I've ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They're all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is... Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don't know if anybody really cares about all these people and what's actually happening. Like we're watching the carnage unfold before our eyes. And I don't know if people get it and why people aren't doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was thethe opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don't agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You're trying to grandstand and you're being so callous with your words. You're putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh... To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh... And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn't a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations... All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic... We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don't just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn't hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled... All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn't get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we're not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we're going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn't want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh... And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there's some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Albertathe number of cases, the number of deaths overallAlberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing themweeks, weeks later after B.C.resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn't have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that's what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDCthat the U.S., of all placesactually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provincesAlberta, Ontario, Quebec, and Nova Scotiamade the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name's Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I've always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn't test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I'm happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government's completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada's track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don't think we're really ready for a second wave. If “wave two” was to hit tomorrow, at least we'd now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven't. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don't. And if anybody tells you we do, we don't.  I think we're really deluding ourselves if we think we've actually, uh, you know, that we won't have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It's something we've never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we'll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.      
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Don’t Let Harper Happen Here: Wab Kinew on Entering Politics
Wab Kinew talks about systemic racism against Indigenous peoples in Canada and why he's turned to politics to try to make the changes he wants to see.
February 8, 2016
40
George Elliott Clarke: A Polyphony of Canadian Blacknesses
The Parliamentary Poet Laureate talks about working for a pioneering black MP, Canada's multitude of black histories and his problem with telephone companies.
February 15, 2016
41
Legal Weed is Bad for Poor People
We talk to a Liberal MP and a criminal defense lawyer about what legalisation means for the people who built the markets.
February 22, 2016
42
Live From U of Ottawa: Refugees Welcome, But Bad News About the Job Market…
When Canadian University grads work at Starbucks and immigrant doctors drive taxis, how will refugees get on their feet?
February 29, 2016
43
Rogue Senators
Senator Diane Bellemare quit the Conservative caucus, saying pressure to toe the party line is getting in the way of Senators doing their jobs.
March 14, 2016
44
Canada’s Arms Deals: Beyond Saudi Arabia
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
March 21, 2016
45
Police in Canada Get Away with Killing Black People
“It’s just the mindsets of the entire police force in which they don’t see us as human and if a life is lost of ours, they just don’t care."
March 30, 2016
46
Tom Mulcair: Hot Prosecutor or Wet Napkin?
Tom Mulcair's leadership review, corrupt Quebec politics and a ton of free advice on how the government can become more open.
April 4, 2016
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Should This Old Indian Guy Lead the Conservatives?
Conservatives jump into the leadership race, Desmond has questions about a Liberal Party flip flop on torture and economist Lindsay Tedds tells us why the Panama Papers matter.
April 11, 2016
48
Parliament Needs More Women’s Bathrooms
NOT SORRY writer Vicky Mochama talks to young women on Parliament Hill about the barriers they face and the work they do.
April 19, 2016
49
Can a Conservative Be a Feminist?
Should a politician's voting record prevent her from speaking up about sexism? Why protestors were living inside the offices of Indigenous and Northern Affairs Canada across the country. And Mike Duffy's acquitted. Jane Lytvenenko joins Supriya Dwivedi.
April 25, 2016
50
Debating Same-Sex Marriage and Other Ways to Stay Irrelevant
The Conservative Party is getting ready to debate same-sex marriage more than a decade after it became law. BC's Premier is getting rich off party funds. An economist on why Newfounland and Labrador are shutting down more than half their libraries. Desmond says goodbye.
May 2, 2016
51
How to Make Poor People Disappear (Census Edition)
Sex and the census, how the last government made poor people disappear and bailing out Bombardier.
May 11, 2016
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Are Libertarians Conservatives?
Libertarian Matt Bufton does not want to be lumped in with Conservatives; a story of a Brenna Kannick's death in remand; the NDP proposed a bill to create gender equity (nearly) on the ballot.
May 16, 2016
Celebrating Defeat: Dispatches from the Conservative Convention
The Syrup Trap's Winnie Code checks out the Conservative Convention, where she talks to a crude button maker and interim leader Rona Ambrose.
June 1, 2016
This Is Not Canada: Living as a Migrant Farm Worker
A farm worker wants better conditions for foreign labourers, and is Trudeau bending gender norms in politics?
June 6, 2016
Cheri DiNovo on How to Fix the NDP
MPP Cheri DiNovo on why she couldn't sit back and watch the NDP make any more mistakes.
June 14, 2016
Naming a Genocide
The government declared that ISIS is committing a genocide against Yazidis. Vicky and Supriya look into what that means for Canada's obligations.
June 21, 2016
57
Buy Gold and Raisin Bran: The Brexit and Canada
Supriya and Vicky want to know what the Brexit means for us. Does a vote for the United Kingdom to leave the EU change our lives on this side of the ocean?
July 5, 2016
58
When CSIS Comes Knocking
Vicky and Supriya talk to human rights activist Monia Mazigh about CSIS's unannounced visits to Muslim men's homes and workplaces.
July 12, 2016
Canadian Police Are Racist Too
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July 26, 2016
MMIW: What Justice Means for a Family Member
We talk to Maggie Cywink about the upcoming inquiry into missing and murdered Indigenous women. Her sister Sonya Cywink was murdered over 20 years ago and the case remains unsolved.
August 9, 2016
When CSIS Comes Knocking pt. 2
Earlier this summer, we heard about CSIS agents making unannounced visits to Muslims. Now, one of those men joins us.
August 23, 2016
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When Your Councillor Spams You On Facebook
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September 6, 2016
Conservative Leadership Showdown Part 1: Michael Chong & Brad Trost
Over the summer, Vicky and Supriya set out to interview all of the candidates for the leader of Conservative Party. Here are their interviews with Michael Chong and Brad Trost.
September 13, 2016
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Conservative Leadership Showdown Part 2: Tony Clement & Maxime Bernier
Our quest to get to know all the Conservative leadership contenders continues with Tony Clement and Maxime Bernier.
September 20, 2016
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Drunk On Liberal Power / Kellie Leitch On Anti-Canadian Values
Conservative leadership contender Kellie Leitch calls Trudeau a "Canadian identity denier" and defends her idea of screening immigrants for their values. Plus, a look at the year ahead in Parliament.
September 27, 2016
A Hat Trick Of Deceit: First Nations And The LNG Project
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October 4, 2016
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A Hodge Podge Of Political Hacks: Inside The War Room
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October 11, 2016
A Message About the Future of COMMONS
We have news.
October 18, 2016
COMMONS returns!
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
February 13, 2017
68
Strong Hearts To The Front
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
February 21, 2017
69
“I’m Ashamed Of Myself For Being Afraid”
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
March 7, 2017
70
You Have No Rights At The Border
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
March 21, 2017
71
Being Icky Is The Job
The Liberals, according to Conservative MP Scott Reid, are trying to "ram through whatever the f**** they want." In other, vaguely sexually-themed Conservative news, Brad Trost isn't down with the "the whole gay thing," while k.d. lang asks if Jason Kenney might be secretly fond of it. Kellie Leitch and Senator Lynn Beyak? Just crapping on Muslims and Indigenous peoples again, respectively. Nothing sexy there.
April 4, 2017
72
Commons Gets High
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
April 18, 2017
73
That’s Why We Live In A Democracy
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
May 2, 2017
74
Cultural Appropriation Is An Inherently Political Act
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
May 16, 2017
75
Drink Like A Conservative
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
May 30, 2017
76
Amy Goodman/The Constitutional Clusterf**k
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
June 13, 2017
77
The Rise Of The Right
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
July 4, 2017
78
Guy Caron, Guaranteed Income And Climate Refugees
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
September 12, 2017
79
Ashton, Angus & Singh – Oh My!
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
September 26, 2017
80
Why We Need Higher Taxes, A Canadian Mt. Rushmore And A Population Of 100 Million
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
October 10, 2017
81
Niqabs & Nafta
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
October 24, 2017
82
As If They Were Pets: The Sixties Scoop
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
November 6, 2017
No Protest is Genteel: On Antifa
Live from Vancouver: We speak with organizers Garth Mullins and Annie Ohana to unpack what it means to resist fascism in BC. Featuring Hadiya Roderique and guest host Sandy Garossino.
November 21, 2017
Invisible Victims: How Police Botched the Robert Pickton Case
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
December 5, 2017
Invisible Victims: The Quest for Police Accountability
"It was bad enough that I had lost my daughter. But the interaction with the police was even worse." A miniseries on policing.
December 19, 2017
Throwing Shade at 2017: A Political Awards Show
We look back on some notably weird political moments of 2017 and collectively cringe.
January 8, 2018
Unknown Road: Inside Immigration Detention
Each year, thousands of people are indefinitely jailed in prisons without any criminal charges. Babou was one of them.  
January 22, 2018
Our Mis(education): the Erasure of Blackness in Canadian Schools
"Only a few decades after slavery was abolished, you already had, in textbooks in Ontario, the removal of references of history of slavery in Canada, but still many examples of realities of slavery in the United States. This idea of identifying racism as an American phenomenon is an important part of how Canadian racism articulates itself."
February 12, 2018
Finding A Fix: Our Opioid Overdose Crisis
“I tried to count up the amount of people that I knew who had died from overdose. I got to fifty, and I just had to stop. You get used to it. It’s like it becomes normal.”
February 27, 2018
Unconstitutional Solitude
Support us at commonspodcast.com Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.   COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada. Featured in this episode: Samir Sinha, Isobel Mackenzie, Michael Schwandt, Kieran Moore   To learn more: “If you can get your relatives out of seniors’ homes, try to do so as fast as you can” by André Picard in The Globe and Mail “With an early focus on seniors’ residences, Kingston has so far avoided the brunt of COVID-19” by Karen Howlett in The Globe and Mail Luck and timing: How B.C. has managed to avoid the worst-case COVID-19 scenario by Briar Stewart in CBC News   This episode is sponsored by Rotman’s MBA Essentials Online Additional music from Audio Network “Clean Soul” by Kevin Macleod, adapted.   TRANSCRIPT:   EPISODE 11 – “IT DIDN’T HAVE TO BE LIKE THIS”   COLD OPEN   [ARSHY MANN] Samir Sinha is a rare breed of doctor. He’s a geriatrician. Doctors that focus on older patients are scarce.   [SAMIR SINHA] There’s 10 times as many pediatricians in Canada as there are geriatricians, and partly because we still have medical schools that don’t teach geriatrics, even though we now have older people outnumbering younger people.   [ARSHY] And in this select group, Sinha stands out. He’s a Rhode’s scholar who also did a fellowship at Johns Hopkins’ prestigious medical school. In 2012, the Ontario government chose him to overhaul the province’s senior strategy. He was only 36 years old. The Toronto Star, understandably, labeled him a wunderkind.  Today he’s the director of geriatrics at Sinai Health System and the University Health Network in Toronto, the director of health policy research at the National Institute on Ageing and easily one of the most respected doctors in his field. And over the last decade, he’s been happy to see interest in the medicine of ageing grow among his peers and policymakers.   [SINHA] We’ve been able to start, you know, changing the mold a bit, attracting more people into the specialty. You know, making some headway, showing what we could do in Canada and starting to kind of bend the needle a bit and make progress.    [ARSHY] But then, this year, the novel coronavirus hit    [SINHA] The last four months have been perhaps some of the toughest professionally and personally I’ve ever had. This virus was just kind of like the geriatric nemesis, where every one of my older patients now is basically in the line of fire. They’re all at increased risk of dying, and not by an insignificant amount, but in a significant amount.   [ARSHY] When the first reports about the coronavirus were coming out of China, Sinha wasn’t too worried.  But then it spread to Iran and to Italy.    [SINHA] Being in a hospital where we often hear about SARS or we talk about SARS, you kind of then wonder, “Is… Is this that SARS thing again?”    [ARSHY] Sinha watched aghast as older Italians died because ventilators went to the young. He saw Spanish long-term care residents die from neglect as workers abandoned the facilities. And by the time there were outbreaks and deaths in American nursing homes, he knew that Canada wasn’t ready. He remembers the day he started ringing the alarm.    [SINHA] I remember it was on April 2nd. It was the day before, I think it was the Thursday. André Picard from The Globe and Mail called me. He was distressed. You know, he was following what was happening in long term care.   [ARSHY] André Picard is the Globe’s health columnist.   [SINHA] And he basically said, “I don’t know if anybody really cares about all these people and what’s actually happening. Like we’re watching the carnage unfold before our eyes. And I don’t know if people get it and why people aren’t doing the things that we know we should be doing.”   [ARSHY] And Picard asked him the kind of question that so many people had asked Sinha in the past. “What if it was your family?” “What would you do if your mother was in a long-term care home?”    [SINHA] And I said, “I’d pull her out right now.” But, my God, that was the headline, you know, piece of his story the next day. That was the—the opening statement. And do you know how much hate mail I received immediately? My professional society put an open letter to all the members basically saying, “We think Dr. Sinha is alarmist and we don’t agree with his view.” I got people that, you know, I thought were relatively supportive, saying, “Why are you being so alarmist and trying to be an attention whore?”, really, is what they were kind of saying. You know, “You’re trying to grandstand and you’re being so callous with your words. You’re putting families under unnecessary distress.” And, really, I said, “Did you read the article?” Because the article actually exquisitely details what are the problems and what are the solutions. It was a call to action.   [ARSHY] For a decade, Samir Sinha had been the wunderkind, the guy that everyone in Canada turned to when they needed a geriatrician. But at this crucial moment, he wasn’t just ignored, he was denounced.   [SINHA] I want to remind you that, at that time, we had a few dozen homes that were in outbreak, okay? Two weeks later, by the time Ontario finally followed my recommendations, we had hundreds of homes in outbreak.    [ARSHY] I’m Arshy Mann and from CANADALAND, this is Commons.   PART ONE [ARSHY] If I’m being honest, doing this reporting about the COVID-19 pandemic the last few months has been incredibly frustrating. When we started this series in April, the scale of the crisis in long-term care was just coming into focus. But months later, we know what happened. Here are some numbers. Over 7,000 people have died in long-term care. That’s more than 80 percent of all Canadian who died during this pandemic. Canada has, by far, the greatest proportion of long-term care deaths of any OECD country. And part of that is because we’ve done a pretty good job of limiting the number of deaths in the rest of the community.  But if you think about these deaths in long-term care as a single event, they constitute one of the worst catastrophes to have taken place on Canadian soil since the Spanish Flu a century ago. And if you look at the news or at social media or at the political debates, it seems like we’ve already moved on. I feel like I’ve been screaming into the void. Thousands of people have died. Most of them died alone, away from their families, not understanding what was happening around them. We’re unwilling to actually look this horror in its face.  And there’s a lot of reasons for that. Ageism and ableism are certainly a huge part of it. But I think there’s something else at play. A feeling of… inevitability. That we didn’t know. That there’s nothing we could have done. That we did our best.  Well, in many cases, that’s just not true. Decisions were made, by elected officials and public health leaders. And the reason we know that this incredible loss of human life wasn’t inevitable is because some of them made the right decisions and saved hundreds, maybe thousands, of lives. This is the second-to-last episode of our season investigating long-term care, and we’re going to use this as an opportunity to take stock, and to try to understand exactly what happened. To distill some lessons on how to prevent this tragedy from happening all over again in a few months. And to call out the politicians who made the wrong decisions. And the obvious place to start is in B.C..    [ISOBEL MACKENZIE] B.C. did not have the first case of COVID-19, but we were pretty quick to, I think, be about the second case.    [ARSHY] That’s Isobel Mackenzie, the Seniors Advocate for the province of British Columbia.  Looking back, B.C. had the odds stacked against it. Vancouver has the strongest ties to China of any Canadian city, the Lower Mainland is densely populated, and it’s nestled right next to Washington State, where the pandemic surged early.   [MACKENZIE] We thought we would be an epicenter, and so we reacted not in naiveté or denial. We reacted with, “We could very well become northern Italy.”   [ARSHY] And, at the beginning of the year, that’s exactly where it looked like B.C. might be headed. The first institutional outbreak took place at the Lynn Valley Care Centre in North Vancouver on March 6th.   [MACKENZIE] We are deeply saddened to, uh… To hear that, uh, one of the residents of the Lynn Valley Care Home, who was infected with COVID-19, passed away last night.   [ARSHY] Lynn Valley was a galvanizing moment For Michael Schwandt..    [MICHAEL SCHWANDT] Within our team at Vancouver Coastal Health and, uh… And with that long term care home, it was really all hands on deck from an early stage, I think, because there was such a high level of concern.    [ARSHY] Schwandt is a public health officer with Vancouver Coastal Health, which covers much of the Lower Mainland including North Vancouver.   [SCHWANDT] It wasn’t a case where just one or two people got involved. Really, the whole team of medical health officers, our communications and patient relations… All of those sorts of people did get activated and involved.   [ARSHY] Lynn Valley quickly turned into a disaster. Fifty-two residents came down with COVID-19, and 20 of them died.    [MACKENZIE] It was effectively ground zero and patient zero, in terms of our learning about exactly how the many fault lines that exist in our fragmented long-term care system in British Columbia are going to have an impact on our ability to manage this outbreak.   [ARSHY] The Lynn Valley outbreak seemed to confirm the worst fears of the authorities in B.C.. The province was destined to be a hotspot.    [MACKENZIE] But that tragedy, because it was early on in the pandemic… We learned from that and prevented further tragedy down the road in other care homes   [ARSHY] It helped that right next door in Washington State, similar outbreaks had been ravaging nursing homes. But B.C. was paying attention. Here’s Samir Sinha again.   [SINHA] The United States actually came to our rescue, courtesy of the CDC. They actually traced what they called the epidemiology of COVID-19, you know, in the first nursing home. And they showed everything. Everything we know now, they were able to document in a beautiful study, and a series of studies, that were coming out by mid- to late-March.  And they were telling us that there are key things that we now know we need to do, masking of all staff, for example, in these settings. We can’t have people working between multiple homes. We need to make sure that we are recognizing asymptomatic, pre-symptomatic presentations and atypical presentations. And that means that you don’t just simply test those people who look sick, but you actually make sure that anybody who is a positive contact gets isolated and tested as well.   [ARSHY] On March 27th, Sinha’s team at the National Institute of Ageing put out what they called their “Iron Ring” document, that made recommendations drawing upon the CDC study.   [SINHA] And immediately, B.C. took those actions. All of those things we were doing, they didn’t hesitate. They simply locked down their homes, they made sure they actually masked everybody, they prevented people from working in multiple places. Or frankly, they “enabled people,” is a better way to just stay in one home by putting everyone on a full-time salary and actually giving them full-time work.  Like, they just solved issues that had been lingering for years in a matter of days.   [ARSHY] In retrospect, B.C.’s single-site order certainly prevented the virus from spreading into even more long-term care homes. And it was a logistical feat.    [MACKENZIE] There were 48,000 staff in about 500 different locations that had to be identified, organized, scheduled… All the rest of it.   [ARSHY] But it was only one part of the approach. What distinguished B.C. from almost every other province is that they took a centralized, coordinated approach to dealing with outbreaks at long-term care facilities. If a worker or a resident at a B.C. long-term care home tested positive for COVID-19, a public health team would be there on the ground to help immediately.    Here’s Michael Schwandt again.    [SCHWANDT] The rapid response teams, or SWAT teams, as they were often called, evolved quite organically from our earliest outbreaks.   [ARSHY] Medical staff, infection control specialists, communication experts and administrative leaders would all be at the home within the same day.   [SCHWANDT]  And because that seemed to be successful and because the homes were well supported by that team, we very quickly formalized that structure and provided basically the same set of personnel, almost as a package, anytime a new outbreak came up.   [ARSHY] Because of that approach, B.C. was able to limit many of its long-term care outbreaks to only a handful of people infected.   [MACKENZIE] When you look at Ontario and Quebec, a number of the cases, the most horrendous cases that we are seeing in the media and hearing about, you also will find that public health didn’t get in there for several days, if not weeks. So by the time we got into the care home, it had was already out of control.   [ARSHY] And B.C. took a similar approach when it came to personal protective equipment.   [MACKENZIE] When it became clear that this PPE issue was significant, in part because we’re not accustomed to using it in long-term care and in part because of the global disruption of supply chains, the province said, “OK, we’re going to take over. If you are a care home and you need PPE, you call us, we will get it to you.”   [SCHWANDT]  So we would often tell sites to please let us know if they were running low, that we didn’t want them to see the bottom of the box or even think about the bottom of the box, uh, to be confident that there would be masks, that there would be gowns and, uh… And face shields when it was needed.   [ARSHY] And then there’s the fact that B.C.’s hospitals and long-term care homes were able to work together. In past episodes, we’ve talked about how governments focused heavily on acute care early in the pandemic, at the expense of the long-term care system. And while that over-focus on hospitals also happened in B.C., the structure of the province’s health care system meant that they were able to act nimbly.   [SCHWANDT]  Within the structure in B.C., the long term care sector is closely associated with the, with the hospital system. So the regional health authorities are funding most of long-term care and are also running the hospital system as well. So, there’s some continuity in that way, and that the people who are giving directions around infection prevention and control in hospitals are also supports for the long term care system, too.   PART TWO [ARSHY] Now remember, much of this was taking place in B.C. in March, early in the pandemic. So what were the other provinces doing?  Well, let’s start with B.C.’s neighbour.    [SINHA] You just look at the province next door. You look at Alberta, not as populous as B.C., not where COVID-19 landed, but when you actually look at the number of homes that were affected in Alberta—the number of cases, the number of deaths overall—Alberta did far worse than B.C But then, when you actually look at when Alberta started taking action by implementing them—weeks, weeks later after B.C.—resulted in about 18 percent of their homes being infected, compared to only 10 percent of British Columbia homes.    [ARSHY] Deena Hinshaw, the chief medical officer for Alberta, announced on April 10th that long-term care workers would be limited to one facility. But the policy wouldn’t go into effect until April 23rd, and the guidance was so confusing that they had to extend that date and roll out the order in waves.   [SINHA] Then you venture over to Ontario and Quebec, for example, where, really, their long-term care systems largely collapsed.   [ARSHY] The first outbreak at a long-term care home in Ontario was declared on March 18 at the Pinecrest Nursing Home in Bobcaygeon. The next day, Dr. David Williams, Ontario’s chief public health officer recommended that long-term care workers returning from international travel over spring break should self-isolate. But he didn’t make it mandatory. And, on March 22nd, he recommended that long-term care homes limit the number of locations that they work in. Again, not mandatory.  And over the next two-and-a-half weeks, the Ford government started to take measures that they said would free up staff and resources for long-term care homes. But it wasn’t until April 8th that David Williams made it compulsory for all long-term care workers to wear masks at all times. And as for the single-site order? Well, that didn’t come until April 15th. By that point, almost 2,000 long-term care residents and staff had tested positive. And within another week, by April 22nd, 125 nursing homes were in outbreak, and the military had to be called in to help.    [SINHA] And you see that 32 percent of Ontario homes, 26 percent of Quebec homes, and then, even in the small province of Nova Scotia, 10 percent of their homes ended up getting infected. And you realize these things shouldn’t have gotten as bad as they did. But when you actually look back at the chart and you actually compare every province and territory, you see that Ontario, Nova Scotia, Quebec all took weeks, if not even a month, after B.C. to implement the same recommendations. And that’s what really pained me, when I see that we have nearly 7,000 dead now in these homes, and it really was the result of delayed implementation of things that the CDC—that the U.S., of all places—actually told us what we need to do, and things that B.C. took to heart and got right. And we dithered for various reasons.   [ARSHY] Because of chronic underfunding and the fragmented nature of the long-term care system, it was almost a certainty that some people would die of COVID-19. But the premiers and chief medical officers of those four provinces—Alberta, Ontario, Quebec, and Nova Scotia—made the wrong choices. They didn’t act on the information that was available at that time. The workers spread the coronavirus within homes and between facilities, that asymptomatic spread is real and poses a major risk. And because of that, hundreds, if not thousands, of people died unnecessarily as a result.   PART THREE [ARSHY] But even in the provinces that hesitated to take the necessary steps, there were bright spots, places where public health leaders had been preparing for a moment like this. And Kingston is one of those places.   [KIERAN MOORE] My name’s Kieran Moore. I’m the medical officer of health of Kingston, Frontenac, Lennox and Addington Public Health, which is a local public health agency in Ontario. Of note, a quarter of our population is over 60 years of age.    [ARSHY] Like B.C., Kingston and the surrounding area have attributes that should make it especially vulnerable to COVID-19.   [MOORE] Very early on, we were worried about our community, given that we have a high proportion of retirees. We are worried about our patients and community members in our congregate settings.   [ARSHY] Moore has been expecting a pandemic for a long time. But he was anticipating something different: influenza. Moore is a little bit obsessed with influenza.   [MOORE] I do think our approach to influenza locally is unique. We work very hard for influenza preparedness. I’ve always believed that if you can prepare your health system well for influenza, that will pay off in dividends for any other viral threat.   [ARSHY] Every year his office does preparation exercises and education on how to detect and respond to flu outbreaks, how to do proper testing. And, back in the summer of 2019, Moore and his team were closely monitoring the particularly brutal flu season that was happening in Australia. So in August, he brought together around 100 people from long-term care facilities, retirement homes and other stakeholders for a full-day exercise on how to prepare for the fall.    When he realized that COVID-19 was coming, he was ready.   [MOORE] We had already practiced and rehearsed how to respond to a severe viral threat. It was influenza in August of 2019, but we knew who to call. We knew the partnerships. They knew they could trust us in terms of our outbreak management and response.   [ARSHY] Moore quickly recognized how deadly the novel coronavirus could be for older people.   [MOORE] So, when we saw this threat and saw COVID-19 had a predilection for the elderly, it was my biggest nightmare was that the virus would get into any of our facilities.   [ARSHY] And like Samir Sinha and B.C.’s public health leaders, Kieran Moore was watching what was taking place in Washington State.    [MOORE] We learned from what was going on in Washington that you just didn’t test the case. You had to test everyone around that initial case within the facility and isolate them quickly.   [ARSHY] When the province of Ontario shut down on March 17th, closing down all the bars and restaurants, Kingston took their food inspectors, paired them with nurses and immediately sent them into long-term care homes and retirement homes to make sure everything was up to snuff.    [MOORE] And I’m happy to say we had one outbreak of one health-care worker within one long-term care facility that was caught on the first day of symptoms of this health-care worker. There was no transmission anywhere in KFL&A to any patients within our long term care facilities or retirement homes.    [ARSHY] Because of their preparation, their quick thinking and, honestly, a little bit of luck, there hasn’t been a single death from COVID-19 in a Kingston long-term care home.    OUTRO [ARSHY] It feels like Canada is already trying to turn the page on the disaster in long-term care.   [SINHA] I think now the government’s completely embroiled in this whole WE scandal and stuff. So the headlines, if you will, have actually already shifted already. And so now the question is, “Is this government gonna be judged by an ethics scandal or Canada’s track record in long term care?”   [ARSHY] But a second wave of the coronavirus is coming. And the lingering question is if the long-term care system is ready for that.   [SINHA] I don’t think we’re really ready for a second wave. If “wave two” was to hit tomorrow, at least we’d now recognize the importance of training staff and, and doing that. But have we filled up all the staffing gaps, especially in places like Ontario and Quebec? No, we haven’t. Do we have incredible contact tracing mechanisms and testing capacity ready at the go? No, we don’t. And if anybody tells you we do, we don’t.  I think we’re really deluding ourselves if we think we’ve actually, uh, you know, that we won’t have many more deaths occurring in these homes.   [ARSHY] And if it comes this autumn, it won’t only be COVID-19 that we have to worry about. Influenza and other viruses will be circulating as well.   [MOORE] It’s something we’ve never had to deal with. Two circulating severe pathogens that will need early testing, identification and cohorting of the patients within hospital settings, within long-term care settings. And we’ll have to start making room for that cohorting of these patients.   [ARSHY] We know what we have to do. The question is if we have the will to do it.   CREDITS [ARSHY] That’s your episode of Commons for the week. If you want to support us, click on the link in your shownotes or go to commonspodcast.com. This episode relied on reporting from Karen Howlett at the Globe and Mail, Briar Stewart at CBC News Vancouver, Nora Loreto and many others. If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com. This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.       I think you should be getting our newsletterGet a weekly note about our top stories.This is a good thing that we do. You'll like this.johnsmith@example.comSign UpForm is being submitted, please wait a bit.Please fill out all required fields.
March 12, 2018
Stories From Solitude
Two stories take us inside solitary confinement cells across Canada.
March 27, 2018
92
Canadian History X
As a teen, Elisa Hategan joined Canada's most notorious and well-organized white supremacist group, the Heritage Front. What can we learn from the past about how white supremacists operate today? And what do we do about all these Nazis?
April 9, 2018
93
The All-White Jury In Canada
There's a simple legal mechanism that allows lawyers to whitewash juries. A new bill proposes getting rid of it, but some lawyers are saying that will make things worse. We look back to how we got here.
April 24, 2018
Life In Canada Without Clean Water
Canada has 20 per cent of the world's freshwater and yet some Indigenous communities across the country have not had clean drinking water for decades.
May 7, 2018
What Do Peacekeepers Actually Do?
The Liberal government announced that it would be sending around 200 troops to assist in a UN peacekeeping mission in Mali. But what does "peacekeeping" look like today and what do peacekeepers actually do?
May 22, 2018
Canada Is Not Racist… According To The Stats
If you look at the stats, Canada has a low incidence of hate crimes, but the numbers that we rely on to tell us if we're racist or not are wrong.
June 5, 2018
What The Hell Is A Fairness Letter?
We speak to someone who might not be let into Canada for trying to bring democracy to Syria.
June 19, 2018
CORRUPTION #1 – The Most Crime-Ridden Neighbourhood In Canada
This season, Commons will be focusing on stories at the intersection of money, influence and politics in Canada. In this episode, we take you to what may be Canada’s most criminal neighbourhood — Toronto’s financial district.
October 2, 2018
CORRUPTION #2 – How Vancouver Became a Money Laundering Paradise
For years, people could walk into Vancouver-area casinos with tens of thousands of dollars of suspicious cash and walk out with clean money, no questions asked. That money may be fuelling the city's housing crisis and opiate epidemic.
October 16, 2018
CORRUPTION #3 – The Trouble With Paradise: How Canadians Built The Offshore World
The Panama Papers revealed to the world just how deeply enmeshed tax havens are in the global economy. And for 100 years, Canadian banks, businessmen and politicians have worked to build that offshore system, alongside crooks, fraudsters and corrupt officials.
October 30, 2018
CORRUPTION #4 – Papa Pump and the Small Town Shakedown
In the eleven years that Marolyn Morrison was the mayor of Caledon, Ontario, she faced down deep-pocketed developers, mafia enforcers and corrupt federal officials. When millions of dollars are at stake, things get heated.
November 13, 2018
CORRUPTION #5 – The King of Cabbagetown
For two decades, he's controlled public institutions and bragged about his connections to organized crime. So who exactly is the King of Cabbagetown?
November 27, 2018
CORRUPTION #6 – Charlottetown’s Web
It might be small, but it when it comes to graft, Prince Edward Island plays in the big leagues. Inside PEI’s long, strange attempt to become Canada’s online gambling hub.
December 11, 2018
CORRUPTION #7 – The Only Canadian Imprisoned For Insider Trading
One of Canada's most notorious white-collar criminals speaks about his crimes.
January 8, 2019
CORRUPTION #8 – Hockey’s Hall of Shame
Canada is hockey crazy. But at the heart of the sport is a system of unpaid labour that scars some boys for life. And the teams and leagues are doing whatever it takes to make sure things stay exactly the way they are.
January 22, 2019
CORRUPTION #9 – Victoria’s Secrets
Tens of thousands of dollars in suits, luggage, magazines and mustard. An epic booze heist from the legislature. An undercover legislator exposing corruption. And a wood-splitter that’s transfixed a province.
February 5, 2019
CORRUPTION #10 – The Canadian Company Accused of Using Slaves Today
Canadian companies have committed all kinds of wrongdoing abroad. But this is on a different level. One Vancouver-based company has been accused by the United Nations and Human Rights Watch of using slaves to build a mine with one of the world’s most oppressive governments.
February 19, 2019
Introducing Our New Season: CRUDE
Canada was built on oil.
March 28, 2019
CRUDE #1 – Smell This Town
If you don’t understand oil, you can’t understand Canada. We take you to a place unlike anywhere else in the world, where the booms and busts all began. And find out why just a short distance away, children grow up afraid of the very air they breathe.
April 2, 2019
CRUDE #2 – Bombs, Blood & the Battle of Trickle Creek
A family poisoned in their homes. Bombs going off in the night. Shots fired and inside jobs. The story of Wiebo Ludwig is There Will Be Blood come to life. So was he a man of faith facing down the full might of Big Oil? Or a terrorist with blood on his hands?
April 16, 2019
CRUDE #3 – Let the Bastards Freeze in the Dark
The Alberta oil sands. It’s a cold patch of land (which we once almost nuked into oblivion) that’s become Canada’s economic engine. Governments have fought over it for decades. And now it’s one of the most controversial places on the planet. Will it finally tear our politics apart?
April 30, 2019
CRUDE #4 – Orphan Wells: Citizen Con
What happens when the oil wells run dry? Environmental damage, government bailouts and a scheme that some are comparing to the subprime mortgage crisis. And all of this is just the beginning.
May 14, 2019
CRUDE #5 – A Town, Annihilated
The Lac-Mégantic rail disaster was a calamity like we’ve never seen before. The families of the victims never got justice. But the conditions that made it possible have barely changed. And the next time could be far worse.
May 28, 2019
CRUDE #6 – The Devil in the Deep Blue Sea
An unspeakable tragedy occurs off the coast of Newfoundland. But this isn’t just a story about a nautical disaster. It’s about what happens when a poor province finds immense riches just within reach. And how the promise of oil wealth can twist history around itself.
June 11, 2019
CRUDE #7 – The Billionaire Plot to Destroy Alberta’s Economy is Totally Real!
Has Canada been a casualty of a nefarious campaign by foreign-funded radicals to landlock our country’s energy resources? Is Big Oil the victim of a vast international conspiracy? Naaaah. But there is, of course, another conspiracy afoot.
June 25, 2019
Introducing Wag The Doug
Over the past few weeks, Ontario Premier Doug Ford was booed at the Raptors' victory parade, demoted a bunch of star members of his Cabinet amid sagging poll numbers and lost his Chief of Staff, who got caught up in a nepotism scandal.  Are we witnessing the downfall of a government, or is this just another month in Ontario? 
July 8, 2019
CRUDE #8 – Spies, Lies and Private Eyes
Ever get the feeling someone is watching you? If you’ve been to an environmental protest recently, you might be right. Private intelligence firms, the RCMP and even Canada’s spies have all been caught collecting information on everyday Canadians speaking out against the oil industry.
July 23, 2019
CRUDE #9 – Tar Teck: The Final Frontier
Teck Resources just got approval to build the largest tar sands operation ever. The Frontier mine would have serious and permanent consequences for the local environment, Indigenous peoples and the global climate. So why haven’t you ever heard about it?
August 6, 2019
CRUDE #10 – The Apocalypse is Now
Canoe-borne bandits strike an underwater town. A new generation of wealthy lobstermen is minted. An island disappears. And hellfire engulfs a highway jammed with broken heroes on a last chance power drive. Just another normal day amidst Canada’s climate catastrophe. 
August 20, 2019
Our New Season: DYNASTIES
Stories about the rich and powerful families who run Canada.
September 11, 2019
DYNASTIES #1 – The Stronachs
Canada is a country ruled by dynasties — political, commercial and criminal. In the first episode of our new series, we bring you the story of an eccentric, billionaire patriarch; his famous, charismatic daughter; a fire-breathing monument the size of the Statue of Liberty; and the battle over one of Canada’s great business empires.
September 17, 2019
DYNASTIES #2 – The Irvings
For almost a century, the Irving family has run New Brunswick like a personal fiefdom. They own the newspapers, the industry, and, according to some, even the government. So how does a single family come to so thoroughly dominate an entire province? And what happens when that family starts to fracture and split apart at the seams?
October 1, 2019
DYNASTIES #3 – The Fords
They call themselves the Canadian Kennedys. And they’re one of the most famous political dynasties to ever exist in this country. But the rise of the Ford family has been marred by violence and self-destruction at almost every turn. The story of the Fords is tragic — for them, for everyone who falls into their orbit, and for the people of Toronto.
October 15, 2019
COMMONS Needs Your Help
Canada is a big, weird, and complicated place. We want to keep telling you these stories, but we need your help.
October 29, 2019
DYNASTIES #4 – The Rizzutos
The Rizzutos are Canada’s first family of crime. For decades, they dominated Montreal’s underworld with an iron fist. With the help of corrupt politicians and police officers, the Rizzutos built one of the most fearsome and lucrative criminal enterprises this country has ever seen. Their reign was long and bloody. But their fall was even more gruesome.
November 12, 2019
DYNASTIES #5 – The Sahotas
The Sahotas are Vancouver’s most notorious slumlords. For decades they’ve let their buildings rot, leaving their tenants to live in filth and desolation. But the Sahotas are not like any other dynasty you’ve ever heard of. Their story is far stranger, and far darker, than anything you can imagine.
November 27, 2019
DYNASTIES #6 – The Desmarais
The Desmarais family is by far the most influential Canadian dynasty of the last half-century. But if you don’t live in Quebec, chances are you haven’t even heard of them. Paul Desmarais had Prime Ministers and Premiers in his pocket and billions of dollars at his disposal. He wasn’t just a Laurentian elite; he was the Laurentian emperor.
December 11, 2019
DYNASTIES #7 – The Olands
For 150 years, the Olands have been one of Canada’s most prominent brewing dynasties, the makers of Moosehead Beer. But in the last decade, they’ve made the news for much darker reasons. Richard Oland was murdered in 2011. And police and prosecutors believe that he was killed by his only son.
January 8, 2020
DYNASTIES #8 – The Regans
Gerald Regan was the premier of Nova Scotia, the founder of a powerful political dynasty, and one of the most prolific sexual predators in Canadian political history. Even after his death last November, few in the establishment are willing to recognize, let alone reckon with, his crimes.
January 22, 2020
DYNASTIES #9 – The Harts
The Harts are Canada’s first family of professional wrestling and one of the most famous dynasties the country has ever produced. And sure, wrestling is scripted. But what happens when reality begins to invade that fiction? The story of the Harts is one of triumph and tragedy that transcends the world of pro wrestling.
February 5, 2020
Introducing: Cool Mules
A new investigative series about the cocaine smuggling ring inside Vice Media.
March 1, 2020
Our New Season: RADICALS
Our new season is about the people who go to extreme lengths for what they believe in.
March 12, 2020
RADICALS #1 – Nazi Island in the Sun
It’s one of the most audacious plots in North American history. Turn a Caribbean island nation into a criminal state — then use the money to fund Neo-Nazis and Klansmen across Canada, the US and Europe. The scariest part? They almost pulled it off.
March 18, 2020
RADICALS #2 – They Buried Her Heart at Wounded Knee
There have been books and songs and plays written about Anna Mae Aquash. But she was no folk hero — she was flesh and blood. A young Mi'kmaq woman who took up arms against the United States government, Anna Mae was a revolutionary. But when she was found murdered in the South Dakotan countryside, it tore her movement apart. It took thirty years to find out who pulled the trigger. But that’s not the same thing as knowing who’s responsible for her murder.
April 1, 2020
RADICALS #3 – The Last Pandemic
It began as a mysterious disease from a far off place. It turned into the deadliest plague humanity has faced since the Black Death. AIDS has ravaged and reshaped us in so many ways. But in Canada, the battle against AIDS wasn’t just a fight against a virus. It was a fight against a system that didn’t care if some people lived or died.
April 15, 2020
An emergency season: PANDEMIC
A new season of COMMONS
April 27, 2020
PANDEMIC #1 – 33 Dead in Dorval
They were found abandoned in the facility. The conditions were described as “akin to a concentration camp.” Within two weeks, over thirty of them would be dead. The story of the Résidence Herron in Dorval, Quebec is a national shame. And a preview of the carnage still to come.
April 29, 2020
PANDEMIC #2 – When the Plague Came
Why did Commons drop everything and focus in on long-term care? Because the vast majority of deaths are happening in those homes. Because we should have known that was going to be the case, but we let it happen anyways. And because the level of suffering, isolation and trauma happening in long-term care today is almost too much for us to face up to.
May 2, 2020
PANDEMIC #3 – McKenzie Towne
The McKenzie Towne Continuing Care Centre has experienced the deadliest COVID-19 outbreak in Alberta. But some people say that their loved ones were killed by neglect at McKenzie Towne long before the pandemic even began.
May 6, 2020
PANDEMIC #4 – Ontario Reaps its Dividends
Over 1700 Ontarians have already been killed by COVID-19. And the vast majority of them died in long-term care. But if you live in a private, for-profit home, you’re much more likely to die from this virus. The for-profit long-term care industry is politically powerful and deeply entrenched. Is this their moment of reckoning?
May 13, 2020
PANDEMIC #5 – Shirley and Tracy
Tracy Rowley lost her surrogate mother to COVID-19 in a long-term care facility. But she’s determined that Shirley Egerdeen doesn’t become just another statistic. Tracy’s suing the company that runs the home. But one of the strangest things in this story is exactly who owns them.
May 20, 2020
PANDEMIC #6 – Northwood
Over the last two months, Nova Scotians have endured tragedy upon tragedy. The worst mass murder in modern Canadian history. A helicopter crash and the death of a Snowbirds’ pilot. And all the while, COVID-19 ravaged the biggest long-term care home in Atlantic Canada.
May 27, 2020
PANDEMIC #7 – The Frontline
Long-term care workers are in the vanguard in the war against COVID-19. They’re not the kinds of workers who get movies or TV shows made about them. In fact, their stories are rarely told. But not only are they battling heroically against this pandemic. They’re fighting for recognition and respect within a system built to marginalize them.
June 3, 2020
BONUS: The Honest Fakery of Wrestling
Wrestling is very real and Stampede Wrestling helped build World Wrestling Entertainment. Damian Abraham, host and creator of The Wrestlers, explains in this week's bonus COMMONS episode.
June 10, 2020
PANDEMIC #8 – Hunger Strike
Innis Ingram’s mother is his hero. But today, she’s living in one of the worst hit long-term care homes in Ontario. She has a terminal illness. Dozens and dozens of people around her have died, including her friend and roommate. And she’s had minimal human contact for three months. But even though he can’t be there with her, Innis is determined to get her the care she needs.
June 17, 2020
PANDEMIC #9 – Mend the World
After a stroke left him locked in his own body, Rabbi Ronnie Cahana has found ways to lead an incredibly full life. Then the pandemic came. It swept through Quebec, leaving a trail of devastation. Today, Rabbi Cahana is one of the thousands of Quebeckers left stranded in the middle of one of the worst disasters in modern Canadian history.
June 24, 2020
PANDEMIC #10 – Burn It Down
Jonathan Marchand is one of the thousands of young disabled people living in long-term care. But Marchand doesn’t want to fix the system. He doesn’t think it can be reformed. Marchand is an abolitionist. For a century and a half, Canada has hidden away disabled people in institutions where they were neglected and abused. Is long-term care just the latest incarnation of this dark history?
July 8, 2020
PANDEMIC #11 – It Didn’t Have To Be Like This
Four months after the first outbreak in a Canadian nursing home, over 7000 long-term residents have died of COVID-19. But if you look at the news or social media or our political debates, it seems like we’ve already moved on. Maybe that’s because it feels like this kind of tragedy was inevitable during a pandemic. It wasn’t. And we know that because in some places in Canada, politicians and public health officials made decisions that saved hundreds, if not thousands of lives.
July 22, 2020
PANDEMIC #12 – The Most Dangerous Story
In the final episode in our series about the COVID-19 pandemic and the crisis in long-term care, we’re going to tell you a different kind of story. A story of hope. About how the people we treat as disposable, can have lives of joy and dignity. And about one place where they were given exactly that.
August 5, 2020
Introducing our new season…
Stories about the power the police wield in Canada, and about the lengths they’re willing to go to hold on to it.
October 7, 2020
THE POLICE #1 – Julian Fantino
Julian Fantino may be the most famous cop in Canadian history, but during his rise, people critical of the police had a way of finding themselves in the crosshairs.
October 14, 2020
We Need Your Support
We want to keep doing this work. So this week we’re reflecting on the year behind us and talking about our goals for the future.
October 20, 2020
THE POLICE #2 – The Secret History of the RCMP
The RCMP is one of the most famous police forces in the world — the red serge and stetson hat are practically synonymous with Canada. But that image obscures the profound power the Mounties have held throughout Canadian history. And the dark legacy of ethnic cleansing and genocide at their core.
October 28, 2020
THE POLICE #3 – Dirty Tricks
He called himself the General. And he was at the heart of the RCMP's biggest scandal.
November 11, 2020
THE POLICE #4 – Starlight Tours
Thirty years later, we know some of what happened to Neil Stonechild. But we still don’t have justice. 
November 25, 2020
THE POLICE #5 – Toronto’s Finest
A Toronto police officer shoots and kills two Black men and is accused of beating another, all within a five-year span. He’s never found guilty of committing a crime. And he continues to rise through the ranks.   
December 9, 2020
THE POLICE #6 – Who Killed Myles Gray?
Myles Gray was an unarmed man who died after seven Vancouver police officers beat him mercilessly. Half a decade after he died, not only does his family not have justice, they don’t even know the names of the people who killed him.
December 23, 2020
THE POLICE #7 – The G20: Conspiracy
In the first of a two-part series on the G20, two mysterious strangers start volunteering with activist networks in southern Ontario. It’s all part of one of the biggest undercover police operations in Canadian history
January 13, 2021
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