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
6. #LTC homes were initially not partnered with hospitals or public health units to benefit from their expertise in infectious disease outbreaks.

Here is a description of our hospital's partnership with a #LTC home: agsjournals.onlinelibrary.wiley.com/doi/full/10.11…

4/7
7. A problematic enforcement practice culminated with the Ministry completely discontinuing, in fall 2018, its proactive comprehensive inspections of homes to focus on clearing a growing backlog of critical incidents and complaints

5/7
8. A lack of structured collaboration between different government bodies and agencies on issues such as infection prevention and control inspections.

9. Measures to contain #COVID19 were initially left up to home operators.

6/7
The Auditor General of #Ontario's report unsurprisingly concludes that:

"Overall, the Ministry of Long-Term Care and the #LTC homes were not sufficiently positioned, prepared or equipped to respond to the issues created by the pandemic in an effective and expedient way."

7/7

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More from @NathanStall

28 Apr
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
9 Apr
One population I fear is being overlooked (yet again) during #Ontario's 3rd wave is community-dwelling older adults.

There is no doubt that the new variants of concern make #COVID19 a different disease, with increased risk for younger populations: covid19-sciencetable.ca/sciencebrief/c…

1/8
With this changing disease come more tragedies of younger adults—especially essential workers—being hospitalized and dying from #COVID19.

These stories must be told and Ontario must enact supports like paid sick leave.

But sometimes missing are the stories of older adults.

2/8
In #Ontario, 21.1% of people 60+ and 77.2% of people 80+ have received at least 1 dose of a #CovidVaccine: publichealthontario.ca/-/media/docume…

Yet in the last 14 days, older adults still accounted for 76/85 (89%) of deaths and 715/1171 (61%) of hospitalizations: publichealthontario.ca/en/data-and-an…

3/8
Read 8 tweets
8 Apr
ICMYI—Dr. @iPreetBrar on why the Canada Recovery Sickness Benefit (CRSB) is NOT paid sick leave: thestar.com/opinion/contri…

#CRSB is limited to those workers who miss at least 50% of their work week because they are unwell or isolating from #COVID19: canada.ca/en/revenue-age…

1/5
This means that #CRSB doesn't cover shorter absences, thereby excluding:

-Worker time off to get tested or vaccinated

-Workers who stay home due to symptoms or exposure, subsequently test negative for #COVID19, and are cleared for return to work within <50% of a work week.

2/5
#CRSB is limited to a 1-week period, is not renewable and can only be used 4 times/year.

This may not be enough for workers in high exposure occupations.

These limitations may discourage testing and isolation of workers, thereby hindering mitigation of workplace outbreaks.

3/5
Read 5 tweets
16 Feb
With #COVID19 vaccine supply ramping up, there is lots of discussion about #Ontario's vaccine distribution plan and how individuals are being prioritized.

Ontario's ethical framework is clear that prevention of illness/death is not the only priority: ontario.ca/page/ethical-f…

1/8
These multiple and divergent priorities (reduce illness/death vs. promote economic/social wellbeing) aren't clearly ranked.

e.g., 1.5 million essential workers have similar priority to 3.5 million older adults (who account for 96% of COVID19 deaths): files.ontario.ca/moh-covid-19-v…

2/8
This leads to frustration, anger and fear for older adults who are at highest risk of death and see other vaccination programs like the UK's focus on age and have the singular goal of "prevention of mortality and supporting the [healthcare system]": gov.uk/government/pub…

3/8
Read 8 tweets
12 Feb
#Ontario is trying to deploy 385,000 rapid antigen tests per week in #LTC homes for asymptomatic #COVID19 screening: news.ontario.ca/en/release/603…

This is a bad idea for several reasons—not only is this infeasible, but it will be practically impossible for most homes to complete.

1/9
Currently asymptomatic staff undergo weekly PCR testing, much of which is completed on-site at #LTC homes and testing is staggered throughout the week.

Essential family caregivers complete PCR testing off-site at assessment centres or pharmacies (some are done at homes).

2/9
A shifts towards rapid antigen testing will require testing 2-3x/week (in Yellow/Orange/Red/Grey high prevalence zones) or 1x/week (in Green zones): health.gov.on.ca/en/pro/program…

The high frequency of testing compensates for the test's poor sensitivity: bmj.com/content/372/bm…

3/9
Read 9 tweets
18 Nov 20
In the last few days and following the emergence of #COVIDzero, I've noticed an unsettling fissuring within the academic community.

As @IrfanDhalla says, people on both sides likely agree more than they disagree, but the divisiveness is unproductive: thestar.com/life/health_we…

1/8
The #COVIDzero approach recognizes that there is a disjointed approach to #COVID19 in Canada that is causing uncertainty, unnecessary suffering, economic hardship, and preventable deaths.

#COVIDzero is based on a goal of 0 cases with 0 tolerance for community transmission.

2/8
The "moderate" or "balanced" camp scoffs at this aspirational strategy, minimizing it to "hashtags and platitudes...on social media", highlighting its impossibility, and contends that we need to focus on "improving our ability to live with #COVID19": nationalpost.com/opinion/opinio…

3/8
Read 8 tweets

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