CANADA’S DEAD­LI­EST OUT­BREAK

What went wrong in nurs­ing home?

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The con­voy ar­rived with hun­dreds in tow, horns blast­ing and bells ring­ing. Pas­sen­gers leaned out of the win­dows of the pass­ing ve­hi­cles, or stood in the beds of pickup trucks, or poked their heads through their sun­roofs. They waved and shouted en­cour­age­ment and of­fered grat­i­tude and wiped back tears as they slowly rolled past Pinecrest Nurs­ing Home in Bob­cay­geon, a town of about 3,500 peo­ple, framed by Stur­geon and Pi­geon Lake in cen­tral On­tario. Some ve­hi­cles looped around for a sec­ond pass.

Gath­ered out­side the front doors of the fa­cil­ity, the at­tend­ing health-care and per­sonal sup­port work­ers waved back. They wore blue gloves and yel­low gowns that hung loose over their tired bod­ies. The pas­sen­gers held signs over­head as they passed. “Thank you Health­care He­roes.” “Prayers for Pinecrest.” “Bob­cay­geon Strong,” the colours aflame with the warmth of the spring sun, one of few fa­mil­iar treats this sea­son in a world up­ended by the coro­n­avirus pan­demic.

Be­hind the health-care staff, and in­side the doors of Pinecrest, one of the worst COVID-19 tragedies in the coun­try was still un­fold­ing. As of Thurs­day, the virus had taken the lives of 29 res­i­dents in the 65-bed fa­cil­ity, and one vol­un­teer.

Pinecrest is not re­leas­ing the names of the vic­tims, but ac­cord­ing to fam­ily, who had spo­ken to the me­dia, the vol­un­teer’s name was Jean Pol­lock. Her hus­band, Ted, 92, a res­i­dent, died seven days af­ter her. In his obituary, it was re­quested that me­mo­rial do­na­tions be made to the nurs­ing home.

More deaths are ex­pected at Pinecrest. The hor­rific sit­u­a­tion at the long-term care home — as well as oth­ers across the coun­try — has cap­tured the at­ten­tion of the na­tion and left many won­der­ing what went wrong.

Dr. Jeremy Jones, a car­di­ol­o­gist at Ross Me­mo­rial Hos­pi­tal in Lind­say, about 30 kilo­me­tres from Bob­cay­geon, saw it com­ing.

He posted a note to so­cial me­dia on March 21, warn­ing the pub­lic that an out­break was oc­cur­ring at Pinecrest. The Hal­ibur­ton, Kawartha, Pine Ridge Dis­trict Health Unit con­firmed three cases in the fa­cil­ity on March 20, but Jones be­lieved the sit­u­a­tion was far worse.

“What they haven’t re­vealed is that there are 20 other res­i­dents and eight staff at the nurs­ing home that have symp­toms, but have not been tested. This ad­di­tional 28 peo­ple un­doubt­edly are fur­ther cases of COVID19,” he wrote at the time. “This means that there could be hun­dreds of cases in the com­mu­nity that have gone un­de­tected.”

WHAT WENT WRONG

Pinecrest, a pri­vately owned, ag­ing sin­gle-storey build­ing, with up to four res­i­dents in a room, sep­a­rated only by cur­tains, was uniquely po­si­tioned to be dev­as­tated by the pan­demic.

Like most long-term care fa­cil­i­ties in On­tario, it was chron­i­cally un­der­staffed be­fore the cri­sis be­gan. When the cri­sis fi­nally hit there was a lack of test­ing ca­pa­bil­ity, lim­ited com­mu­ni­ca­tion, and ques­tions as to why the pub­lic wasn’t made aware of the scope of the out­break sooner. And why a doc­tor in a neigh­bour­ing town was the first to sound the alarm.

When Dr. Jones posted his warn­ing on March 21, it was 10 days af­ter the World Health Or­ga­ni­za­tion had de­clared COVID-19 a global pan­demic. Five days af­ter that an­nounce­ment, the first two deaths at Pinecrest were con­firmed. An ad­di­tional 33 res­i­dents were al­ready show­ing symp­toms.

Then things be­gan to spi­ral out of con­trol. The deaths be­gan oc­cur­ring in bunches. Seven one day. Four an­other. For six straight days in early April, not a day passed with­out a death. Al­most half of the fa­cil­ity’s res­i­dents have now died — all be­fore the num­ber of COVID-19 cases in the prov­ince has peaked.

There are no sim­ple an­swers for what went wrong at Pinecrest, but a con­flu­ence of fac­tors of­fer some per­spec­tive. Ef­forts to iso­late res­i­dents were next to im­pos­si­ble, given the space con­straints of the dated build­ing. Trag­i­cally, it wasn’t un­til res­i­dents be­gan dy­ing that ex­tra rooms be­came avail­able.

“Pinecrest plans for and pri­or­i­tizes in­fec­tion con­trol — whether it is the flu or the com­mon cold. Un­for­tu­nately, the sever­ity of COVID-19 has pre­sented unique chal­lenges for our staff and our fa­cil­ity,” Pinecrest ad­min­is­tra­tor Mary Carr wrote in a state­ment pub­lished April 7. “At the be­gin­ning of this out­break, we fol­lowed ex­ist­ing out­break man­age­ment plans, in­clud­ing the iso­la­tion of symp­to­matic res­i­dents. How­ever, due to the size of our home and lim­ited front-line ca­pac­ity, we have been faced with un­prece­dented cir­cum­stances.”

City of Kawartha Lakes coun­cil­lor Kath­leen Sey­mour-fa­gan ques­tions why the com­mu­nity wasn’t given more no­tice about how quickly the sit­u­a­tion was ac­cel­er­at­ing.

“There was an out­break. No­body re­ally said there was an out­break,” she says, while try­ing to ex­plain how the cri­sis at Pinecrest un­folded. “Then the staff started get­ting sick and tests hadn’t come back. They were told to go home and self-iso­late, which meant there was no staff be­cause peo­ple were sick and then there was no­body to take care of the peo­ple. No­body. I’m se­ri­ous, like... four peo­ple for more than 60 peo­ple.”

THE WORK­ERS

The lack of avail­able work­ers re­sulted in fam­ily mem­bers of some Pinecrest em­ploy­ees vol­un­teer­ing to go in­side the fa­cil­ity and help with tasks like clean­ing. The work­ers that have re­mained, as well as those forced into iso­la­tion, are dev­as­tated, Sey­mour-fa­gan says. Heart­bro­ken.

“The PSWS and nurses that I’ve spo­ken to said there’s go­ing to be PTSD af­ter­wards be­cause it’s so stress­ful,” she says. “It was such a mess be­cause there was no staff there.”

On March 23, the prov­ince at­tempted to shore up front­line work­ers by en­act­ing a new or­der, al­low­ing, among other mea­sures, long-term care homes more free­dom in how they de­ploy staff. The prov­ince fol­lowed up on March 28 with ad­di­tional emer­gency mea­sures, grant­ing greater flex­i­bil­ity for homes to bring in ad­di­tional work­ers. Home in­spec­tors were also de­ployed to fo­cus on sup­port­ing work­ers.

THE REG­U­LA­TIONS

Unions and pa­tient ad­vo­cates fret­ted about the re­moval of mea­sures de­signed to pro­tect res­i­dents and staff, but Donna Dun­can, CEO at the On­tario Long-term Care As­so­ci­a­tion, says the or­ders were nec­es­sary.

On March 30, the OLTCA, along with five other or­ga­ni­za­tions, wrote an open let­ter high­light­ing the con­di­tions that long-term care em­ploy­ees face.

“The On­tario Long Term Care Homes Act has 193 sec­tions, and the reg­u­la­tion has 330 sec­tions, of­ten with mul­ti­ple sub­sec­tions, each im­pos­ing de­tailed re­stric­tions,” the let­ter reads.

“These rigid re­quire­ments have the prac­ti­cal ef­fect of for­bid­ding homes and em­ploy­ees from im­ple­ment­ing some mea­sures in pan­demic re­sponse plans — such as al­low­ing non-care staff to move a wheel­chair to en­sure re­quired phys­i­cal dis­tanc­ing, or al­low­ing homes to re­pur­pose space to iso­late res­i­dents with COVID-19 from oth­ers.”

Dun­can says one of the many take­aways from this cri­sis is that, de­spite best in­ten­tions, the leg­is­la­tion is so pre­scrip­tive that it cre­ates bar­ri­ers to how em­ploy­ees can re­spond to emer­gen­cies. Dun­can de­scribes it as a level of mi­cro­man­age­ment that in­fan­tilizes the sec­tor.

“The gov­ern­ment tried to over-reg­u­late and mi­cro­man­age through leg­is­la­tion how to ac­tu­ally pro­vide care,” she says. “To the point where nurses and RPNS and even PSWS were not al­lowed to work to their full scope of prac­tice at what they were ac­tu­ally trained to do, be­cause the leg­is­la­tion would say, you can do that but only up to a point.”

By the time the prov­ince had an­nounced the sec­ond round of emer­gency mea­sures, the first two res­i­dents at Pinecrest had al­ready died. Dun­can says the OLTCA had been ask­ing for flex­i­bil­ity around the reg­u­la­tory frame­work for some time, say­ing that the lim­i­ta­tions “set up a cul­ture of fail­ure.”

Still, she says the gov­ern­ment moved quickly. “I think the gov­ern­ment was very quick to re­spond once we said, ‘This is com­ing quickly, you need to give this to us now.’ ”

De­spite the emer­gency mea­sures, the sit­u­a­tion at Pinecrest re­mains dire, Sey­mour-fa­gan says. “There’s still not enough peo­ple to work,” she says, ex­plain­ing that Pinecrest em­ploy­ees have been pulling 12-hour days and most haven’t had a day off in weeks. “It’s been hor­rific and they still don’t have enough staff,” she says. And there’s no end in sight.

“No­body knows when that might be,” the Kawartha Lakes coun­cil­lor says. “We’ve been telling peo­ple as much as we could, but we weren’t get­ting straight an­swers from the home. We knew to an ex­tent, but we were not get­ting enough in­for­ma­tion. And the in­for­ma­tion break­down is how it could have spread fur­ther into the com­mu­nity.” It’s still too early to tell the sever­ity of com­mu­nity spread.

Sey­mour-fa­gan cites the lack of Pinecrest staff for the lim­ited com­mu­ni­ca­tion. She doesn’t fault the work­ers. She de­scribes Pinecrest as a close-knit, homey fa­cil­ity. “They’re do­ing the best they can,” she says. “They care about these pa­tients.”

But she ques­tions why there wasn’t a stronger re­sponse from the fa­cil­ity or from lo­cal pub­lic health units.

“There was re­ally no com­mu­ni­ca­tion from the home, to the mu­nic­i­pal­ity or to any­body, so we would know what is ac­tu­ally go­ing on there. And same with the Kawartha Pine Ridge Health Unit. They didn’t ac­knowl­edge any­thing ei­ther.”

The let­ter from Dr. Jones was one of the ear­li­est pieces of com­mu­ni­ca­tion about what was hap­pen­ing at the home, but beyond be­ing shared on Face­book, it wasn’t avail­able to the gen­eral pub­lic. “It should have been put out of­fi­cially, at that point,” Sey­mour-fa­gan says. “Some­body should have done that, and no­body did.”

THE COM­MU­NITY

In the mean­time, Sey­mour-fa­gan and a few lo­cal res­i­dents have started a Bob­cay­geon and Area COVID-19 Re­lief Fund. In less than one week, more than $70,000 has been raised. Pinecrest work­ers have also been re­ceiv­ing gift cards for gro­ceries and gas, she says. And com­mu­nity of­fi­cials are work­ing to bring more per­sonal pro­tec­tive equip­ment to the fa­cil­ity, sup­plies that Sey­mour-fa­gan says were lim­ited to be­gin with.

The fund will also go to­ward sup­port­ing men­tal well­ness coun­selling for front­line staff and lo­cal res­i­dents.

Else­where in the com­mu­nity, peo­ple are find­ing dif­fer­ent ways to help. Aaron Shaw is a lo­cal ar­borist who has lived in Bob­cay­geon for 43 years. For al­most three weeks his work truck has served a dif­fer­ent pur­pose. He and a half-dozen other lo­cals have been de­liv­er­ing gro­ceries free of charge to se­niors in the area, com­plet­ing up­wards of 30 de­liv­er­ies a day.

When reached for com­ment shortly af­ter 9 a.m., he’s in his truck, hav­ing just com­pleted a de­liv­ery, with three more en route.

“It’s dev­as­tat­ing,” he says, of the feel­ing around town. “This is a small com­mu­nity. I’ve never seen any­thing like it. It’s sad. But the big thing I’m get­ting out of it is see­ing how many peo­ple are com­ing to­gether. It’s beau­ti­ful to see.”

The com­mu­nity has also been do­nat­ing tablets to the re­main­ing Pinecrest res­i­dents so they can video-call their fam­i­lies. Shaw was also be­hind the live stream event of the fi­nal Trag­i­cally Hip concert that was broad­cast in the town dur­ing the sum­mer of 2016. Be­fore the pan­demic hit, most peo­ple, if they knew of Bob­cay­geon at all, knew about it be­cause of the epony­mous song.

“We’re known as the Hip town, but right now we’re known as the epi­demic cen­tre of it all,” he says. “But we will be known as the Hip town again. Mark my words.”

The down­town strip is empty now. Some res­i­dents re­main fear­ful of leav­ing their homes. Many are un­sure just how widely the virus might have spread and how safe it is to ven­ture out.

Many of Bob­cay­geon’s lo­cal busi­nesses are sea­sonal, en­tirely de­pen­dent on the sum­mer rush. Like ev­ery­thing else, it’s still un­cer­tain what im­pact the coro­n­avirus will have on the usual tourist sea­son.

“There’s so much in­for­ma­tion that’s com­ing in, so we’re work­ing as a group and we’re find­ing it help­ful to sup­port each other and share in­for­ma­tion and knowl­edge that we can then push out to our lo­cal busi­nesses,” says Denise Ben­ning-reid, the man­ager of the Bob­cay­geon Cham­ber of Com­merce. “But there’s so much com­mu­nity sup­port and love that’s com­ing out of it. It feels like a very Cana­dian thing.”

The cri­sis at Pinecrest has al­tered any sense of nor­malcy, and an in­quest could come in the months ahead, but the re­solve of the com­mu­nity re­mains un­de­terred.

Last Sun­day, The Trag­i­cally Hits, a lo­cal cover band, or­ga­nized a com­mu­nity-wide sin­ga­long. Shortly be­fore 6 p.m., front doors across the com­mu­nity be­gan to creak open. Peo­ple gath­ered on their porches, in their drive­ways, in the mid­dle of bar­ren streets, and their voices car­ried the epony­mous song that the na­tion has come to know.

It was only a few summers ago that the down­town core was jammed with thou­sands of res­i­dents and vis­it­ing cot­tagers, all gath­ered to cel­e­brate the Hip, and the spirit of this small town. That evening, the Hip waited un­til deep in their set to strum those fa­mil­iar chords. The sum­mer sky had shifted to deep ocean blue, and the street was alight with Gord Downie’s im­age and alive with the sound of his voice. When he stopped singing, the crowd kept go­ing.

Their voices echoed across the night, as the na­tion lis­tened in. Some­day soon, they will echo again.

THERE WAS NO STAFF BE­CAUSE PEO­PLE WERE SICK AND THEN THERE WAS NO­BODY TO TAKE CARE OF THE PEO­PLE. NO­BODY.

CAR­LOS OSORIO/REUTERS; SAMUEL RICHES/POST­MEDIA

The On­tario town of Bob­cay­geon is reel­ing from an out­break of COVID-19 that has killed 29 res­i­dents of a nurs­ing home, as well as one vol­un­teer.

HAND­OUT

Jean Pol­lock was a vol­un­teer at Pinecrest Nurs­ing Home, where her hus­band, Ted, was a res­i­dent. Both died from com­pli­ca­tions due to COVID-19.

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