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.
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…
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
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
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.
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…
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
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.
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…
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.
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").