Nathan Stall Profile picture
Sep 18, 2020 8 tweets 8 min read Read on X
In the last 24 hours, two more Ontario #LTC residents died of #COVID19: ottawacitizen.com/news/local-new…

There remain 22 active Ontario #LTC home outbreaks (see figure).

@ASPphysician has challenged me to say what must be done to get this under control.

Here it is (a thread).

1/8
We need swift action to control community transmission of #COVID19 which is getting out of control.

In our @CMAJ study, the prevalence of #COVID19 in the community surrounding a home was strongly associated with the odds of an outbreak (aOR = 1.91): cmaj.ca/content/192/33…

2/8
Controlling community transmission is imperative, as staff neighborhood characteristics are also significant predictors of outbreaks: medrxiv.org/content/medrxi…

As @DFisman showed, lagged staff infections were associated with death among #LTC residents: jamanetwork.com/journals/jaman…

3/8
The #LTC staffing study (ontario.ca/page/long-term…) and the @RSCTheAcademies report (rsc-src.ca/en/restoring-t…) emphasized the need to address the staffing crisis and make #LTC a better place to work.

Ontario's pandemic pay has dried up and staffing remains very precarious.

4/8
Immediate action is needed to:

1. Increase basic staffing levels: rnao.ca/news/rnao-resp…
2. Ensure full-time work with fair pay and benefits—part-time staff can still work at multiple homes within a 14-day period.
3. Create accelerated training programs for PSWs (like QC).

5/8
There is no clear emergency management plan—the province must:

1. Establish guidelines & expectations for hospital SWAT Teams, and provide the necessary support: news.ontario.ca/en/release/567…
2. Develop policies for transferring #LTC residents to hospital: advantageontario.informz.ca/advantageontar…

6/8
There is also no emergency workforce, and #LTC homes have been told they cannot rely on hospitals during this second wave (see enclosed letter).

The province must establish an emergency workforce—organizations like the @redcrosscanada could assist: redcross.ca/about-us/media…

7/8
Ontario's "identifiable lives bias" focused its initial pandemic response on acute & critical care to the exclusion of #LTC: jamanetwork.com/journals/jama/…

The current focus is similarly myopic with all attention on issues like back-to-school. We must act now to avoid catastrophe.

8/8

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More from @NathanStall

Feb 15, 2022
On the advice of the CMOH, yesterday the Ford government lifted Ontario’s proof of #COVID19 vaccination requirements effective March 1st.

While some have simply dismissed this as capitulation to the "Freedom Convoy," it's actually much more complex.

1/10
thestar.com/politics/provi…
In evaluating their decision, we must 1st consider whether a 2-dose vaccine certificate remains justified by a compelling purpose.

In July 2021 when Delta was dominant, our @COVIDSciOntario brief outlined key considerations for vaccine certificates.

2/10
covid19-sciencetable.ca/sciencebrief/c…
At the time, we found proof of vaccination requirements were effective in:

1. Increasing vaccine uptake

2. Reducing transmission in higher-risk settings (e.g. bars & restaurants)

3. Protecting our health care system by excluding the unvaccinated from higher-risk settings

3/10 Image
Read 10 tweets
Jun 8, 2021
To date, 23.5-million Canadians (71%) aged ≥12 years have received 1 dose of a #COVID19 vaccine and 3-million (9%) are fully vaccinated.

Incredibly, we still don't have guidance for the fully vaccinated.

Us Canadians seem to be experiencing Fear of Normalization (FONO).

1/10
The @CDCgov released its first guidance for the fully immunized on March 8.

@RobynUrback wrote about the need for similar Canadian guidance on April 16: theglobeandmail.com/opinion/articl…

Months later, all Canadians are still given the same guidance regardless of vaccination status.

2/10
The absence of guidance is highly problematic for several reasons:

-We might be able to motivate even more people to get vaccinated: tvo.org/article/we-nee…

-People will make up their own rules based on what @jm_mcgrath calls their "best guesses": tvo.org/article/we-nee…

3/10
Read 11 tweets
May 1, 2021
The final report of #Ontario’s Long-Term Care #COVID19 Commission is now available: ltccommission-commissionsld.ca/report/pdf/Ont…

The 322 page report released today details 85 recommendations focusing on:

1. Pandemic Preparedness

2. Addressing the Aftermath of COVID-19 for Residents and Staff

1/4
3. Infection Prevention and Control

4. Strengthen Health Care System Integration

5. Improve Resident-Focused Care and Quality of Life

6. French-Language Services

7. Address the Human Resources Challenges

8. Operational and #LTC Home Development Funding

2/4
9. Increase Accountability and Transparency in Long-Term Care

10. Comprehensive and Transparent Compliance and Enforcement

11. Health Protection and Promotion Act Investigations

12. Responding to the Commission’s Report

3/4
Read 4 tweets
Apr 30, 2021
From some reason, this @BusinessInsider article from Feb 23rd is making the rounds today on social media: businessinsider.com/new-data-calls…

The sensationalist headline "Scotland's vaccine rollout suggests delaying the 2nd #COVID19 shot is a bad idea" requires some serious nuance.

1/6
The news article references a Feb 19th pre-print: papers.ssrn.com/sol3/papers.cf…

This means that the study was neither peer-reviewed nor finalized when posted.

The pre-print reported a combined 58% vaccine effectiveness for #Pfizer and #AstraZeneca starting 42 days after 1 dose.

2/6
This pre-print went on to be peer-reviewed and published last week in @TheLancet: thelancet.com/journals/lance…

@TheLancet study reported a combined 74% vaccine effectiveness for #Pfizer and #AstraZeneca starting 42 days after the first dose (77% for the #Pfizer vaccine alone).

3/6
Read 6 tweets
Apr 28, 2021
Today #Ontario enacted a new emergency measure providing hospitals with the authority to transfer patients who no longer require acute care (so-called "alternate level of care" or ALC patients) to #LTC and retirement homes without their consent.

news.ontario.ca/en/release/100…

1/15
This action is being taken to create additional room in #Ontario's acute care sector for the 3rd wave of #COVID19.

There are currently 4,288 ALC patients in hospital, and 1,854 are waiting for #LTC beds.

There are also 5,401 vacant #LTC beds available for new admissions.

2/15
The reality is that many of the #LTC homes with large vacancies are those that had the deadliest #COVID19 outbreaks (e.g., Tendercare, St. George's, Orchard Villa).

Residents (and their families and caregivers) will be justifiably hesitant to move into these #LTC homes.

3/15
Read 15 tweets
Apr 28, 2021
Today #Ontario's Auditor General released a scathing report on pandemic readiness and response in long-term care: auditor.on.ca/en/content/spe…

The report details the many factors resulting in 3,919 residents dying of #COVID19 and countless others suffering during the pandemic.

1/7
1. Residents were living in rooms with 3 or 4 occupants

2. The transfer of patients designated as alternate level of care (ALC) from hospitals to #LTC homes contributed to crowding in homes

3. #LTC homes had insufficient staff and staff training to provide appropriate care

2/7
4. Restricting families from visiting homes consequently eliminated a valuable source of resident care providers.

5. Infection prevention and control (IPAC) were not consistently practised in homes even prior to the #COVID19 pandemic.

3/7
Read 7 tweets

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