Covid and Long-Term Care: criticism of Canada from European countries

As the school year re-opens with all the joy and excitement that normally brings, of course the damper of more covid once again seems to be hitting the media and rumor mill.

​There have been calls from a variety of sources for a serious assessment of the response to the Covid-19 pandemic in Canada.  This was one of the most challenging social and health crises in the country in generations and anything that significant justifies an honest, arms-length review.  Such a review should not be a forum for finger-pointing, name-calling, or nastiness to be publicized; there has already been enough of that.  Canada, and each province individually, has serious lessons to be learned and hopefully corrections made before further variants throw the population back into panic.

Calls for such a review have appeared in the press by credible people in Canada but my eyes widened when I found three articles published in the British Medical Journal recently written by some stellar experts in aging and long-term care including two from Canada whose names carry weight.  Included in the authors are Dr. Janice Keefe, prominent Professor and researcher in Halifax; Dr. Carole Estabrooks, prominent professor and researcher at the University of Alberta, formerly of New Brunswick.

One line that caught my eye was: “There are lessons to learn from Canada’s covid-19 response to ensure accountability for decisions and actions, and to build confidence in the country’s health leadership, which faltered during the pandemic and created a strain on its already beleaguered public health and healthcare systems.”

Other criticisms in the articles contained the management of vaccines nationally.

Our systems in Canada, and certainly so in New Brunswick, were stretched beyond limits and we saw that in the daily briefings and media reports for 2 years.  Not only did professional staff become exhausted but the leaders showed visible signs of distress.

There are reasons for all the distress.  Canada survived SARS-CoV-1 from 2002-4 with a good deal of disruption in urban areas, in particular, but its health authorities were reprimanded by independent experts, and I remember it well, for “squabbling and dysfunctional relationships among public health officials, inability to collect and share epidemiological data, and ineffective leadership”.  That was 20 years ago and not much has changed over those years.

With all these viruses, the aging population is the most susceptible not only to illness but to death.  As with influenza, people of all ages are susceptible to becoming infected but we, in the older age brackets, are far more likely statistically to succumb to any serious assault on our bodies, particularly respiratory.  These folks, once shown to be infected, need to be managed and cared for by persons with state-of-the art training in eldercare, infection mitigation, prevention and more.  But not necessarily in hospital.

As recently as 2015 there were warnings of impending major outbreak, yet restructuring those essential relationships and pandemic planning did not seem to get off the ground.

Premier Higgs illustrated, early on in this pandemic, that it takes too many signatures to get simple things done!  And when he made some interim changes, things got better.  And, so it went with such things as access to essential supplies and equipment, information, training, and more.

The Covid-19 pandemic was the worst in modern history for many reasons:

1. The virus was alive and well in China in the fall of 2019 yet there was no acknowledgement and information withheld;
2. Once it became known as a serious outbreak, since there was a vacuum in correct, accurate information, politicians and public officials, aided by media, were thrown into a panic state.
3. While WHO is supposed to be the entity that provides expert direction to the world on the virus and containment, they, too, were trying to give guidance on something new; forecasts turned out to be wrong;
4. Within the world politics of the pandemic, the panic drove politicians and drug companies to a new level of frenzy to get a vaccine unprecedented in the developed world;
5. The Center for Disease Control in the U.S., traditionally cited as the gold standard for good information, became a major focal point of political feuding;
6. Somehow the public seemed to conclude that the vaccines would prevent them from contracting the disease and prevent the spread of the disease; both assumptions were later found to be flawed;
7. We, the public, came to believe things that turned out to be somewhat less than accurate such as strict segregation, universal masking, the drive to get the most sophisticated mask we could purchase, and on it went.  Time, new information, international comparisons have given cause for review.
   
   

The reality, as it turns out, is that the Covid has been treated and managed in a variety of ways around the world with some countries using strategies quite different from Canada yet getting results that were apparently better than Canada.

In North America we saw extremes implemented in the long-term care system as well as in hospitals seemingly due to the concern caused by lack of accurate information.  In nursing homes, for instance, residents and families suffered from the lack of ability to see and to communicate due to the rigor of the segregation practices implemented.  Stories are now numerous illustrating the emotional stress that created for residents, families and staff alone.  Many of the measures, as it turns out, may not have been necessary but they did not know at the time.

The changes that were thought to be required in 2002 outbreak languished and that, no doubt, contributed to much of the awkwardness in responding to the 2020 pandemic.  Why did government not jump on the obvious at the end of that outbreak and make meaningful pandemic planning a priority 15 years ago? 

Some of the governmental departments responsible for effective regulation of health and long-term care have experienced serious turnover in their senior staff since 2003.  The good people in office in 2020 undoubtedly were short on knowledge transfer and experience in regulating during major outbreaks. With that in mind, it has been difficult, if not impossible, to keep the essential policy line of Pandemic Preparedness moving and alive.  

In New Brunswick, the departments of Health and Social Services are overloaded with simply keeping up with current operations, current government and legislative direction.  Add to that the turnover and insecurity created by the changes in political leadership and focus and we have a huge problem.

Yet as we learned in these major outbreaks, there is a need for a much-improved approach to pandemic planning and management.  When the outbreak happens, that is not the time for regulatory or care staff to be learning the fundamentals of the skills essential to any large outbreak be it SARS-1, SARS Covid-19, or Influenza. 

This body of knowledge and techniques should be part of the DNA of those who regulate health and long-term care at any level in the same way that Disaster Planning is for EMO, the airline industry, and police.

This is not to cast blame in any direction but is simply to make the case that the province and the country has just emerged, or is just emerging, from a traumatic period with untold damage to people, we know it will not be the last. Good public policy suggests that we owe it to ourselves and our kids to assess the real issues leading to a plan for improving how the impact of the next outbreak can be minimized and managed better.  Just start with looking at the evidence and that should start intelligent discussion.

Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at [email protected] or www.kenmcgeorge.com