​Covid: the learning curve

Health Minister Dorothy Shepard was quoted in Savannah Awde’s article on March 23rd as suggesting perhaps a correlation between outbreaks in long term care facilities and learning curve.  I expect she was suggesting that staff had to learn about proper use of PPE and other elements in mitigating spread of infection in care facilities.

She made a good point.  For everyone in the health and long-term care systems, and their regulators, the Departments of Health and Social Development, the learning curve has been long, steep, and difficult.  In the early days of pandemic, mid-March 2020, all that the worldwide Scientific community knew for sure was that there was a bad virus on the loose, originating in Wuhan, China where that government’s official line, as recorded in the Wuhan Diary, was: “Not contagious between people; it’s controllable and preventable.”

The Diary goes on to note that the virus got out of control quickly resulting in the firing of several officials in China and suddenly the WHO declared pandemic and we all started learning the language of Covid-19!  Social Distancing, masking, stay home, shut down schools, churches, sports and all that was pleasurable.  Dr. Fauci, who has become a household name around the globe, said on the CBS show 60 Minutes on March 8 that walking around with a mask during a pandemic does not afford the perfect protection people may think.  Canada’s Dr. Tam was not absolute, either, in her pronouncements at that same time on CBC. 

Whether you believe the virus originated from a fish market in Wuhan or was accidentally escaped from a research lab in Wuhan matters not at all.  What has been established, and referenced in the WHO’s Interim Report on the Covid Virus, is that the information coming from China was very slow and guarded.  The Wuhan Diary explains some of the background to the slowness of getting an accurate assessment of what was happening on the ground.

Despite the warning in Bill Gates’ 2015 Ted Talk and Fauci’s statement to Georgetown University on January 12, 2017, countries around the world paid little heed to get serious about pandemic planning including Canada and New Brunswick.  An illustration of that could be found in the rather passive manner in which the volumes of outdated regulations governing Adult Residential Facilities have been reviewed.  So voluminous are they that it is doubtful if many have read them.  And, alas, there is nothing in the regulations that deals with Infectious Disease control and mitigation. 

Long-term care facilities in New Brunswick have now received direction on PPE, masking, visiting, and much more pandemic measures from the Department of Social Development which acts as the regulatory conduit for health direction that emanates from the Public Health Division of the Department of Health.  The directions have been handed down from the beginning with regulatory officials doing their best to interpret policy directives written by people with training in medicine, public health, epidemiology, and infectious diseases.

When the pandemic was declared in March 11, 2020 New Brunswick was not at all prepared, nor was anyone else, to deal totally with the pandemic as it has unfolded.  Suddenly and across the world the language of Covid was being spoken, directions were being given, people admonished to follow the science, regulations were hurriedly enacted based on history, but not based on an intimate and detailed knowledge of Covid-19.  Why was that and why is that important?

Each virus and infectious agent is different in its makeup, characteristics, aggressive behaviors, speed of spread and multiplication and much more.  Of this virus, information that may have been available in the city of origin was not immediately available.
Initially, there were a series of directions given by the World Health Organization that subsequently have been changed as new information has become available.  It has, despite the political misuse of the pandemic in some jurisdictions, been like re-building an airplane while flying it.

Neither hospitals, nursing homes, nor other long term care facilities could claim to have expertise in pandemics and all infectious diseases.  Some hospitals have fairly active Infection Committees and there are reported to be 11 physicians in New Brunswick who specialize in Infectious Disease.  Long term care facilities at all levels are at the mercy of direction from Public Health on managing during times of outbreak.  How much more difficult it is when the characteristics of the virus are not well known and much direction is based on statistical models, sometimes flawed, coming from international agencies such as WHO.

Then there is the issue of masks and all of PPE.  While hospitals and some nursing homes have masks, gloves, and gowns in inventory for routine use, such is not the case in the majority of long-term care facilities.  Gloves and masks would be available for the exceptional use not the routine use.  So immediately on March 11, hundreds of facilities, large and small, needed to start securing Personal Protective Equipment and teaching staff its appropriate use. 

Eventually, after having much difficulty securing gloves and masks from conventional retail sources, where prices suddenly jumped, government commenced making limited quantities of PPE available through a process that was just a bit cumbersome.

By June it was apparent that additional support was required so with the financial support of the Department of Post-Secondary Education and Training, the Special Care Home Associations contracted with Beacon Clinical Group to create a prototype Pandemic Plan along with a toolkit that contained detailed directions and sample forms for all the special care facilities.  This was followed with initial training and follow up consultation by this group of skilled professionals.

Throughout the pandemic, it has been apparent that all involved in responding to this have been learning on the fly.  The admonition to “follow the science” over-simplifies what is a complex administrative nightmare.  The recent declarations by the CDC regarding masks shows that the science keeps changing. In the early days of the pandemic, public health personnel made assumptions that special care homes are similar to large nursing homes who are somewhat similar to hospitals.  That assumption alone caused many weeks of communication challenges that hopefully are getting clarified.

The Extramural Program has become a great partner of the Special Care Sector with that partnership becoming strong as both parties invest hours in communicating and sharing issues and practices.

Learning Curve?  You bet.  The province, and the country, has been turned on its ear to protect against this awful enemy about little was known initially.  Specialists in infectious disease have been able to provide wise counsel based on their knowledge of the SARS group of viruses; but this one seems to have its own unique characteristics, now made more complicated with multiple variants.    The pandemic was cruel to persons living in long term care as well as to patients with serious illness in hospital.  Finally, months after the fact, the system is certifying designated caregivers, a strategy that could have and should have been enacted months ago.  But we did not know because we have all been on a learning curve.

Andrew Waugh, in his article on Monday, May 17, pointed to several examples of where policy and procedure have changed in the public dealing with Covid in New Brunswick during the drama of the last fifteen months.

The Premier’s interest in making vaccination mandatory for long term care workers, as noted in Savannah Awde’s article of May 20, suggests a solution with many probable repercussions.

The great lesson from all of this certainly must be that we need our leaders to acknowledge that this is a new virus with a new name and new characteristics; that we will work together with such information is available but understand that no one has, yet, complete and perfect understanding. 

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