Heated disagreements over pandemic testing

Windsor Regional Hospital CEO David Musyj literally begged a reluctant medical officer of health Dr. Wajid Ahmed to let paramedics help mass test residents and staff in long-term care and retirement homes in early April after outbreaks were declared at seven homes and four residents died.

“I beg you personally to use resources that are available right now — EMS,” Musyj emailed Ahmed April 11.

He emailed Ahmed again hours later, writing, “please just do what we all have been begging you to do.”

The emails are among 65 pages of emails between Musyj and Ahmed — the two top figures in the pandemic response here — from April 9 until last week on testing at long-term care and retirement homes.

Obtained from Windsor Regional through the Municipal Freedom of Information and Protection of Privacy Act, the emails show Musyj, the hospital lead for Windsor, Essex, Chatham-kent and Sarnia, continually pressing for more testing and Ahmed, the top local public health officer who is responsible for seniors’ homes, hesitant to authorize it.

The emails, some extremely heated, show disagreement over who should be tested, when they should be tested and who should do the testing — with some testing scheduled, cancelled and rescheduled. They also show scrambling for swabs needed for testing.

This is now on your doorstep 100% ... Our community, residents and staff of LTC deserve action, not medical debate.

DAVID MUSYJ, CEO, Windsor Regional Hospital

DR. WAJID AHMED, medical officer of health

A provincial Ministry of Health official intervened at one point, ordering Windsor Regional to test four homes after Ahmed postponed testing.

“It’s very frustrating,” Musyj said in an interview. “We are in the middle of a pandemic. Everything is pointing to the need to continue to swab to be on top of this, be in front of it ... We’re just saying please, we’re just begging.”

“The testing guidelines evolved over time,” Ahmed said in an interview.

Partners like Windsor Regional “didn’t necessarily understand the role of public health, how these outbreaks are managed,” he said.

He accused Musyj of being “disrespectful and unreasonable” and saying “things that were inappropriate.”

The emails began with Musyj stating that EMS is “ready to go.” Ahmed responded that public health is working “closely” with homes, providing them with swabs, and the homes are doing the testing.

“As you know, we probably need to articulate a clear plan to bring back to (the government) on how we are dealing with these high risk areas,” Musyj wrote back.

EMS chief Bruce Krauter, copied on many emails, interjected, repeating that paramedics are ready — trained, outfitted with protective equipment, mobile and available “around the clock.”

“I am unsure why we are different here,” he wrote. “My colleagues in Renfrew, Peterborough, Peel, Durham, Dufferin have been doing this for weeks and we are not.”

EMS began offering in February to help test, and paramedics were trained by early March.

“We put those in place in the event we were needed,” Krauter said in an interview.

Musyj urged Ahmed again

April 10 to “leverage” EMS, saying they have longer lasting masks that would conserve other PPE. He also forwarded plans from other cities, saying, “I would expect we need to have one in place and started ASAP ...”

Ahmed replied he is focusing on outbreaks and “I still don’t think that it is a good idea to swab asymptomatic people (unless they are identified as a high risk exposure).”

Swabbing asymptomatic people doesn’t affect risk, and a negative test can provide a false sense of security, he wrote. But evidence was emerging that people can have and transmit the novel coronavirus while asymptomatic. Windsor Regional had had asymptomatic patients test positive.

The “best thing” is for staff to wear PPE, Ahmed wrote.

He repeated that the homes can test themselves, and he’ll ask for help if he needs it. The biggest problem was getting enough swabs. Public health had not received swabs they ordered.

Musyj wrote he had 200 swabs and offered to deliver them immediately.

He also wrote he was only “following up on” Premier Doug Ford’s comments.

Ford said earlier that week that his “patience has worn thin” regarding “absolutely unacceptable” low testing rates in Ontario. He wanted to test more long term care homes, something experts were calling for because the homes are vulnerable settings. There had already been several deadly outbreaks in homes across the province.

The disagreement here grew heated April 11, with Musyj begging Ahmed to use EMS to start testing that day.

Dropping off swabs and expecting “already stretched” staff to do the testing and “burn through PPE” is “not appropriate,” he wrote.

If testing rates are found to be low, despite outbreaks, “we are ALL to blame,” he warned.

Krauter again wrote that paramedics were “able to assist.”

Ahmed acknowledged that some homes wanted to swab everyone, but, while he agrees there should be a low threshold for testing, he was still reluctant to test asymptomatic people.

Give EMS swabs, send them to the home with the most cases, test the residents, Musyj practically ordered.

The health ministry is not calling for all asymptomatic residents to be tested, only those at high risk, for example those living in the same room as a symptomatic resident, Ahmed wrote. If that changes, “I need to see that in writing,” he wrote.

“This is now on your doorstep 100% ...,” Musyj responded. “Our community, residents and staff of LTC deserve action not medical debate.”

Ahmed retorted, “If you can let us do our job, we can address the REAL risk in the community ...”

Ahmed wrote he reports to his board (not Musyj) and complained about responding to Musyj’s emails “instead of doing actual public health work.”

Heron Terrace said it doesn’t need help testing, Ahmed wrote, but EMS can help test Country Village. He promised to “personally reach out” to other homes to “make sure their needs are met.”

Mass testing began at Country Village April 11, and continued with every home with an outbreak.

Musyj sent Ahmed a media report April 13 saying Ford said Ontario Health assured him that everyone in long-term care homes would be tested but that the province’s guidelines didn’t say that.

Ahmed responded, “I still have reservations.” He hoped for ministry direction. But if the lab sends him enough swabs — thousands — “we can develop a plan to systematically swab each of the homes ... with EMS support,” he concluded. He agreed to this, he said in an interview, because the number of cases was continuing to grow.

The government mandated mass testing in long-term care homes April 22.

Another ugly disagreement broke out two weeks later over who had how many swabs and who could provide swabs for continuing mass testing May 2-5.

“I truly do NOT want to play this game. People’s lives are at risk,” Musyj wrote May 1.

“THIS IS NOT A GAME AND PLEASE DO NOT REMIND ME

THAT PEOPLE(’S) LIVES ARE AT RISK,” Ahmed retorted.

The back-and-forth grew more heated, with Ahmed writing, “ENOUGH! AND BACK OFF! He told Musyj he is copying Bruce Lauckner, CEO of health care in Ontario’s West Region.

Ahmed cancelled testing for that weekend because he didn’t have the swabs. He rescheduled it after Musyj said he’d get swabs.

Then Ahmed cancelled testing Monday because he didn’t have swabs. Musyj thanked him for rescheduling weekend testing, writing it’s important for the health and safety of the community and province. But he urged him not to cancel testing Monday yet.

“Wow, only you care about the health and safety of your community and province and no one else,” Ahmed responded, repeating that basic infection prevention and control and proper staffing save lives, not testing. “Someday I can give you lessons in epidemiology, public health and clinical science. And I can learn political lessons from you.”

Monday is cancelled, he added, “doesn’t matter what happens now.”

And, he warned, if a home needs swabs and he doesn’t have any because of mass testing,

“I am not responsible and will not hesitate to say what kind of direction and pressure came from everyone involved instead of letting me make a decision based on the local circumstances.”

Musyj confirmed later on Friday that more swabs were coming by Sunday, but Ahmed repeated that Monday was cancelled.

“I won’t respond further on this topic,” he wrote.

“We’re talking about a lot of logistics,” Ahmed said in an interview. “People think you can just come out and do it. We have to do all the paperwork.”

A ministry official on Sunday directed Windsor Regional to do the testing Monday, Musyj wrote Ahmed. Ahmed then agreed public health would handle it, Musyj said in an interview. Public health agreed to do it because the swabs arrived, Ahmed said.

Mandatory mass testing was completed here before the provincial deadline May 15.

Less than one per cent of residents and 0.4 per cent of staff who were asymptomatic tested positive during mass testing, Ahmed said in an interview.

“That validated all the things I was saying,” he said.

The latest dispute occurred last week over continued testing in the homes, particularly staff at Heron Terrace, which has had an outbreak for two months. Residents who had been moved to the field hospital at St. Clair College and recovered couldn’t move back to Heron Terrace because of the outbreak. Windsor Regional thought the testing was planned but was told Ahmed cancelled it.

Ahmed advised that there was no provincial recommendation to do serial testing to assess ongoing spread. They should just test staff with symptoms. Public health was monitoring the homes daily, he said in an interview.

Musyj cited Ford’s recent comments that “we have to go back to long-term care and start testing again, especially front-line health-care workers in long-term care.”

He also sent Ahmed a CDC study showing serial testing in a long-term care home in California curbed the spread and a Reuters story that New York was testing all nursing home staff twice a week to curb the spread. He asked public health to authorize testing Heron Terrace staff weekly, writing that “as we all agreed, the way residents are currently being infected is as a result of staff being positive.”

Ahmed authorized the testing after learning new staff had started working at the home. He also issued an order with more staff restrictions designed to prevent spread.

There have been outbreaks at 19 homes in Windsor and Essex County. All but two have been resolved. Most pandemic deaths here and across Canada have been in seniors’ homes.

If you can let us do our job, we can address the REAL risk in the community ...