CANADA’S DEADLIEST OUTBREAK
What went wrong in nursing home?
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 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.
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.”
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.