We know who to protect, so let’s do it

Long-term care homes clearly the focus

When Ontarians look back on the COVID- 19 pandemic as the moment when their government finally ponied up the big bucks and fixed the province’s longterm care system, they will likely also wonder what the hell took so long. As appalled as everyone quite rightly is by the Canadian Forces’ report into the state of five long- term care homes that were in dire enough shape to require military intervention, we really shouldn’t be shocked. As the Ottawa Citizen in particular has reported in recent years, the system’s staffing levels were designed for a much less old, much less sick and much less Alzheimer’s- afflicted population than lives in them today — and it led to some terrible outcomes in normal times.

Perhaps it was easy to blame such incidents on individual villains: Ottawa support worker Jie Xiao, who was caught on video punching 89- year- old Georges Karam 11 times in the face; or Elizabeth Wettlaufer, one of Canada’s most prolific and yet somehow least- famous serial killers, who murdered at least eight senior citizens in long- term care homes during her red flag- festooned nursing career. Perhaps tales of society’s most vulnerable being forced to wallow in their own filth, or even just left alone in confusion and misery, are too much to contemplate at length.

In any event, it only stood to reason that a virus as potent as the one that causes COVID- 19 would exploit weak points in a long- term care system. Between wandering patients, fans circulating air throughout facilities and a lack of basic sterilization control, you would almost think these five facilities wanted the virus to spread. It’s a wretched understatement to say we can do better.

We shouldn’t fool ourselves, though: Long- term care homes will always be uniquely vulnerable. And as the economy reopens, it’s essential we keep focusing on them. It’s essential that we focus, period.

There is a tendency among media in Central Canada to treat “Canada’s COVID-19” outbreak as a single thing affecting all of society. It clearly isn’t. The numbers are all over the map. Quebec has reported by far the most cases and deaths: 5,655 and 480 per million population, respectively. Ontario is at roughly onethird of that: 1,778 cases per million and 144 deaths per million. At 1,569 cases per million, Alberta has a comparable number of cases to Ontario — but far fewer deaths, at just 31 per million. British Columbia has the same death rate as Alberta, but with only one- third as many cases. Saskatchewan, Manitoba, Newfoundland and New Brunswick have reported just 18 deaths among them. Quebec has nearly 30,000 active cases; Ontario has just over 6,000; Manitoba has 16.

What explains all this, beyond some obvious factors, will be the subject of years of research and inquiry. But as it stands, it should inform how we think about the next phases of recovery.

First of all, except when it comes to border and airport issues, there is no reason whatsoever we should be hanging so much on Justin Trudeau’s every word. It’s increasingly illogical even for Ontarians to be looking to Queen’s Park, where Premier Doug Ford seems strangely reluctant to treat the pandemic as a regional concern — more so than his colleague in Quebec, François Legault. The vast majority of new cases in Ontario nowadays are cropping up in the Greater Toronto Area. The cumulative infection rate in Toronto is seven times higher than in Northwestern Ontario. There is no reason not to make the appropriate policy distinctions.

Second of all, we know where the greatest risk lives: not just among the elderly — 96 per cent of fatalities were over 60, according to the latest federal reporting — but very specifically in long-term care homes. Ryerson University’s National Institute on Ageing estimates 81 per cent of deaths nationwide and in Ontario, 82 per cent in Quebec and 95 per cent in Nova Scotia, which has the third-highest fatality rate among provinces, are linked to such environments.

Thus far, Canadians who aren’t elderly or in long-term care homes have faced a risk of death that’s no worse than the H1N1 flu posed during the 2009 outbreak — a bad strain, but not an economy- crippling one. Not to say the we should shrug at mass gatherings or let our guards down, or that the lockdown was misguided. Anyone with COVID-19 is a risk to anyone else, the elderly especially. But we are reopening — count on it. There will be no “second lockdown,” and nor should there need to be, when we know exactly whom we need to protect.

Protecting the elderly and otherwise vulnerable and keeping the rest of society more or less open has been the Swedish approach all along, of course, and Canadians have tended to sneer at it. Sweden has one of the highest death rates in the world, they note. Sorry to say, but Quebec’s is higher. Ontario’s is nothing to write home about. It’s too early to know why, exactly, and there’s no telling exactly how the rest of the COVID- 19 story will play out. But with governments all over the world essentially rolling the dice, it’s at least comforting to know where we need to focus our life-saving resources. Better late than never.