Carnage in care homes foreseeable

The COVID- 19 pandemic is being described in military terms. We hear of the battle and front lines and war-footings. There’s another term familiar to soldiers that the public may soon be using: desertion.

As horror stories emerge from long-term-care facilities in Ontario and Quebec — just this week, 25 dead were reported in a Toronto nursing home, on top of comparable disasters in Bobcaygeon and Dorval — a common problem is already apparent. Staff have stopped going to work. In Bobcaygeon, as residents of Pinecrest Nursing Home fell ill, an entire shift of employees failed to report, according to the Globe and Mail. When authorities arrived at the Residence Herron in Dorval, they found patients soiled with feces, the staff having effectively abandoned the building and its residents. La Presse reported that the first official on the scene was so horrified she called in her husband and teenaged children to care for the residents. In a press conference on Tuesday, Ontario Premier Doug Ford said health-care personnel would be redirected into care homes to prevent further disasters.

There is anger, obviously, over these horrific failures. There will be investigations, and perhaps charges. But the stories of staff abandoning elderly residents isn’t quite one of cowardice. It’s one of failed planning.

For all of our attention on preserving hospital capacity in the face of a sneaky, deadly virus — including, critically, the frontline personnel themselves — little seems to have been paid to preventing outbreaks in other institutional settings. Long- term care facilities and nursing homes are one example, correctional institutions and homeless shelters are others. It was easy to foresee that these environments, with people, often with health issues, living in close confines, would be flash points of infection, just like the schools were — and we closed the schools. Public health experts and civil defence officials should have had contingency plans and stockpiles of personal protective equipment (PPE) for staff at institutions, which, unlike the schools, had to remain open and keep vulnerable people in close physical contact.

But they didn’t. Indeed, the lack of PPE and testing kits — the second line of defence, to continue the war metaphor — makes it even more clear that the pre- pandemic confidence in our apparently robust PPE stockpiles was catastrophically misguided. Frontline healthcare workers don’t have enough, which explains the ongoing scramble to secure PPE from abroad. Providing equipment to the second- line staff has obviously been a challenge, if not outright impossibility.

And that explains the desertions. Every person working with a COVID patient has to manage their own fears — fears for their own safety, and for the safety of their loved ones, should they become infected. Frontline Canadian health- care workers have mostly been able to obtain the PPE they need to minimize their risk. That’s the very least we can do for them. In a pandemic, our medical personnel are our soldiers, and if we’re going to send them into battle, we owe it to them to send them in properly armed and equipped. ( This is something Canada struggles to do with its actual soldiers in literal wars, mind you, but that’s another column.) But this crisis has laid bare how many other workers would need PPE during a pandemic of an infectious disease — or at least believe they need it.

That last point is a tricky one. When every mask is precious, tough decisions need to be made about who gets them. Logically, they should only be used when they are absolutely necessary. But part of crisis management in a pandemic is managing fears as well as equipment stockpiles. If workers don’t feel safe without equipment, a public health expert reassuring them they don’t really need it isn’t likely to prove convincing. They’ll stop showing up to work. This is especially true for workers in low-wage jobs that put them in direct contact with COVID victims. Asking them to work without PPE in a pandemic is asking them to put themselves and their families in at least perceived danger, and likely real danger.

Desertion is an ugly term, of course. In wartime, it can get you shot. The agonies and indignities suffered by our elderly when their caretakers stop showing up for work are painful to even ponder. But the decision of each individual worker choosing not to show up to work elbows- deep in an outbreak without proper masks, gowns and gloves, makes a brutal rational sense. We don’t pay them to be heroes, or equip them to guard against being exposed to a deadly virus, but that’s what was expected of them. It’s not a shock that some of them considered the danger, thought of their families, and decided that the barely minimum- wage job simply wasn’t worth it. They weren’t willing to die for the job — or put their families in danger.

You can draw your own conclusions about the morality of such a choice. But you can’t deny that it was a risk that should have been considered and planned for. Provisions to properly equip staff who are absolutely required to go to work will have to be factored into every future contingency. And answering why it wasn’t this time may prove one of the hardest questions to answer when this pandemic is finally behind us.