What killed more than 80% of high-risk vulnerable people in old-aged homes, nursing homes, long-term care homes in Canada in 2020? Was it isolation? Sedatives (midazolam + morphine)? Remdesivir?

Was it DNR orders? or DO NOT treat with needed antibiotics for pneumonia, as in hospitals? Was it abuse, beatings by staff? Was it intubation and forced onto ventilator? poor wages? What? Dehydration?

I argue people did not due due to COVID. No, they may have died ‘with’ COVID but not ‘from’ COVID. The vast majority of deaths happened in 2020 and we must investigate what went wrong and hold people to account.

I argue it was the isolation, the misery, dehydration, malnourishment, the devastatingly poor abusive treatment especially as no one was allowed to visit the vulnerable persons. There were no ‘eyes’ and ‘ears’ on them. I argue COVID revealed the underbelly of a corrupted ‘for profit’ system and showed just how much the care homes, the assisted living homes, long-term facilities and the nursing homes in Canada are in deep crisis and Paul Webster wrote a strong piece in LANCET. I echo his findings and some. What happened, the ‘Killing Fields’ in Canada’s nursing homes during 2020 became a global embarrassment and terror story. It shocked the world. Alike how poorly Canada did in 2002-2003 with SARS-1, what happened in our nursing homes during COVID showed that the structural, systemic gaps and disasters still persist. Across our public health system and medical system in Canada. Among the worst globally.

‘When Canada's national health data agency reported in June, 2020, that Canada had the worst record among wealthy nations for COVID-19-related deaths in long-term care facilities for older people, many observers referred to it as a “national disgrace”. At that time, as the first wave of COVID-19 in Canada began to subside, its 2039 homes for older people accounted for about 80% of all COVID-19-related deaths.’ After 6 months during the second wave of COVID-19, ‘little has changed, and Canada's long-term facilities remain dangerously prone to the disease.’

Why?

I outline the key points made by Webster and invite you to comment (note this paper was written during 2020 but there has been no change):

i)The army was called into care homes last spring after COVID-19 outbreaks in Quebec killed 3890 residents and caused large numbers of staff illnesses and absences. Soldiers had to deliver basic services to the residents, while military medics delivered medical care.

ii)Pat Armstrong, a sociologist at York University in Toronto who has studied Canada's long-term care facilities for almost 30 years, firmly believes that Canada's dismal record stems from a historical decision to exclude long-term care facilities from Canada's network of 13 provincial and territorial public health systems. “This has resulted in under-training and poor treatment of workers, substandard and ageing facilities, overcrowding, and poor infection control capabilities”, she says.

iii)Armstrong also argues, on the basis of a weighty body of published research, that a lack of government oversight and accountability to residents, especially in Canada's privately owned, profit-oriented long-term care facilities—which account for 54% of all facilities—has deeply darkened the picture. “There's plenty of evidence of lower-quality care in the privately owned facilities”, says Armstrong.

iv)“It was noticed very early on during the COVID-19 pandemic that some of the worst outbreaks were happening in for-profit, privately owned homes”, explains Nathan Stall, a geriatrician at Toronto's Mount Sinai Hospital, and lead author of a recent study investigating care quality and rates of mortality in 623 Ontario care homes. “When we investigated, we found that they tend to deliver inferior care.”

v)Stall and colleagues found that the incidence of COVID-19 was higher among residents in for-profit facilities than those in other homes. And in facilities with an outbreak, 6·5% of all residents in for-profit facilities died of COVID-19, whereas 5·5% died in non-profit facilities and 1·7% in municipal homes.

vi)Armstrong and Stall both agree that, beyond immediate emergency measures like sending in the army, a set of key reforms are urgently needed in all types of homes. The conditions of work for staff must be dramatically improved, and tens of thousands of new staff must be hired across the country. Overcrowded living conditions for residents must also be dramatically improved, they say, and better infection control and better medical care are also urgently needed.

vii)Don Melady, a Toronto emergency department doctor specializing in geriatric care, recommends that hospital emergency departments work with long-term care facilities and local and regional health authorities to develop plans to cope with outbreaks.

See Paul Webster’s paper for the full article:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00083-0/fulltext?utm_source=substack&utm_medium=email