Manitoba's Health Minister called out the "motivation" of >200 doctors who wrote an open letter calling for stronger action: cbc.ca/news/canada/ma…

Remember @CameronFriesen called care home deaths "unavoidable"—let me explain how when it comes to #LTC he hasn't "got this".

1/9
Let's review the escalating #COVID19 catastrophe in the province's care homes.

There are 14 active #LTC home outbreaks and 38 cumulative resident deaths. Today the @redcrosscanada was called into Parkview Place and Maples, the two hardest hit homes: cbc.ca/news/canada/ma…

2/9
Earlier this year, @LTCcovid published international examples of measures to prevent and manage #COVID19 outbreaks in residential care and nursing home settings: ltccovid.org/wp-content/upl…

#Manitoba is failing miserably on almost every key measure.

3/9
First, as we reported in our @CMAJ study on Ontario's #LTC homes, the strongest risk factor for an outbreak is the prevalence of #COVID19 in the community surrounding homes: cmaj.ca/content/192/33…

By any measure, the transmission of #COVID19 is OUT OF CONTROL in #Manitoba.

4/9
Second, timely and accessible data on the impact of #COVID19 in #LTC homes is vital to preventing outbreaks and guiding response efforts.

Several months into the pandemic, #Manitoba still doesn't report data on #LTC home outbreaks, cases and deaths: gov.mb.ca/covid19/update…

5/9
Third, the response to #COVID19 in #LTC homes needs to be coordinated across all levels, including with hospitals.

In #Ontario, hospitals were partnered with #LTC homes: news.ontario.ca/en/release/567…

We reported our own hospital's response in @AGSJournal: onlinelibrary.wiley.com/doi/full/10.11…

6/9
Fourth, access to medical and palliative care (personnel, medicines and equipment) must be guaranteed.

Our hospital's response involved a large operations team including senior leaders, nurses, and clinicians in geriatrics, palliative care, psychiatry, pharmacy, and #IPAC.

7/9
Fifth, many homes are crowded and unable to cohort and isolate residents infected with #COVID19, something occurring at Parkview Place home: cbc.ca/news/canada/ma…

#Manitoba needs to look at alternative accommodations, including field hospitals: windsor.ctvnews.ca/dozens-of-pati…

8/9
So @CameronFriesen you don't "got this". Shame on you for criticizing my Manitoban colleagues and for overseeing this disaster.

As @JillianHortonMD says "let's forget about staying in our lane...this is our call to speak out...there is no more time": macleans.ca/opinion/forget…

9/9

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More from @NathanStall

4 Nov
Yesterday, despite rising #COVID19 cases, hospitalizations, and deaths in LTC, Ontario released a framework to "keep the province safe and open": news.ontario.ca/en/release/590…

This is nothing more than an ageist, ableist & unethical "shielding" or "focused protection" strategy.

1/12 Image
A "shielding" or "focused protection" strategy (the latter was popularized by the Great Barrington Declaration: gbdeclaration.org) segments the oldest and most vulnerable to #COVID19, while allowing everyone else to resume life as normal with simple hygiene measures.

2/12 Image
As many have already highlighted, the #Ontario framework establishes a very high threshold for closures and lockdowns: cbc.ca/news/canada/to…

Specifically, the 10% test positivity and incidence rate ≥100/100,000 thresholds for return to a modified stage 2 are very high.

3/12 Image
Read 12 tweets
18 Sep
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
Read 8 tweets
18 Jun
The @ONlongtermcare released an FAQ document on the updated directives for visitation in nursing and retirement homes: ltchomes.net/LTCHPORTAL/Con…

The details in this document further highlights the restrictive, onerous and even cruel conditions for visitation.

@picardonhealth

1/8
The nonsensical requirement for potential visitors to test negative for #COVID19 within the previous two weeks holds visitors to a higher testing standard than healthcare workers!

As @drlesleybarron writes "I'm a HCW but my first #COVID19 test will be so I can visit my mom"

2/8
The biweekly testing requirement for a weekly visit is ridiculously onerous.

Many visitors will themselves be frail older adults with mobility issues, they're being asked to travel to and from #COVID19 assessment centres, often standing outside in the heat to await testing.

3/8
Read 8 tweets
14 Jun
The approach to "reopening" nursing and retirement homes in Ontario is 1) misinformed, 2) overly restrictive, 3) prone to abuse, 4) not evidence-based, 5) inequitable, and 6) stinks of ageism.

Let me break down the changes announced by the @ONgov: news.ontario.ca/opo/en/2020/06…

1/7
Misinformed: the reopening policies still fail to recognize that many of these so-called "visitors" are family caregivers, essential partners in care who provide hands-on care and support to residents: medium.com/in-this-time-o…

@MaggieKeresteci @SolidFooting @clairehsnyman

2/7
Overly restrictive: for frail older nursing home residents with limited life expectancies, restricting them to one outdoor visit a week by one visitor is not enough: files.ontario.ca/mltc-resuming-…

We are robbing residents and their family and friends of precious limited time.

3/7
Read 7 tweets
24 Mar
1/7 What is the max daily number of incident #COVIDー19 cases a healthcare system could manage?

@vasilepi @BreslowDay @mattwrkntn @BogochIsaac and I made an interactive tool modelling the capacity of acute and critical care resources during the pandemic: caic-rt.shinyapps.io/CAIC-RT/?utm_s…
2/7 The tool determines the max daily number of incident #COVIDー19 cases where the rate of #COVIDー19 patients being admitted to acute care, critical care or requiring mechanical ventilation ("patients in") equals the max daily turnover rate of those resources ("patients out").
3/7 Data from the @CDCgov @CDCMMWR on age-based case distribution and severity (cdc.gov/mmwr/volumes/6…) are used to estimate the population-weighted proportion of #COVIDー19 patients requiring acute and critical care resources ("patients in").
Read 7 tweets

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