Long Term Care Home Analysis – Part 1 – please study this article about Ontario’s care homes during COVID & do something with it to save our society
(1.1: June 25)
I want anybody and everybody to challenge the dubious new rules imposed on Canadian society during the COVID-19 crisis.
Specifically, Rosemary Frei, a medical journalist, wrote this article which includes many documents about the treatment of residents in Ontario long term care facilities.
We need motivated people who care about right and wrong, legal professionals or anybody, to:
- Read this medical journalist’s article
- Study the references she provides.
- Consider that existing and more humane laws and rules were cleverly circumvented.
- Then find ways to seek justice through the legal system for victims, including all of us affected by the abusive and unprecedented economic lock-down, isolation and social distancing rules.
- Defend our rights and freedoms.
I’m going to appeal to these institutions again:
1) The oath for Ontario lawyers – defend rights and freedoms
2) The values of the Ontario Provincial Police
Notes
1. “. . . late March Chief Medical Officer of Health for Ontario, Dr. David Williams, and the Associate Chief Medical Officer of Health, Dr. Barbara Yaffe, described the criteria verbally during their daily press briefings”.
An outbreak should be declared when two or three people show symptoms of infection with the novel coronavirus, . . .
Also, polymerase chain reaction testing for viral RNA wasn’t required . . .
No link to this. Looked here but I am just guessing at the date, which wasn’t mentioned. But the March archives are here for reviewing.
2.
. . [the above was] loosened version of criteria used in the province prior to the novel-coronavirus epidemic. These previous criteria defined an outbreak as either: two people in the same area of a facility developing symptoms within two days of each other (making their infections ‘epidemiologically linked’) and at least one of them testing positive for viral RNA; or three people in the same area developing symptoms within two days of each other.
The document:
Ministry of Health and Long-Term Care Infectious Diseases Protocol Appendix B: Provincial Case Definitions for Diseases of Public Health Significance
Disease: Respiratory Infection Outbreaks in Institutions and Public Hospitals
Effective: February 2019
Page 2:
3.1 Confirmed Outbreak Definition*
Confirmed respiratory infection outbreak:Two cases of acute respiratory infections (ARI) within 48 hours with any common epidemiological link (e.g., unit, floor), at least one of which must be laboratory-confirmed;
OR
Three cases of ARI (laboratory confirmation not necessary) occurring within 48 hours with any common epidemiological link (e.g., unit, floor).
3.2 Suspect Outbreak Definition*
Suspect respiratory infection outbreak:Two cases of ARI occurring within 48 hours with any common epidemiological link (e.g., unit, floor);
OR
One laboratory-confirmed case of influenza.
3.
On March 30 the Ontario health ministry released new rules for defining and managing care-home outbreaks (with the document confusingly dated April 1). Staff at all Ontario care nursing homes were trained on the new rules via webinars two days later, on April 1.
Ministry of Health
COVID-19 Outbreak Guidance for Long-Term Care Homes (LTCH)
Version 1 – April 1 , 2020
Public health units (PHU) should refer to the 2018 Recommendations for the Control of Respiratory Infection Outbreaks in Long-Term Care Homes [pdf] as the foundational document for respiratory outbreak related guidance on the preparedness, prevention and management of COVID-19 related outbreaks. . . .
From the article:
The new rules included an even broader outbreak definition: the presence of only one person with just one symptom of a SARS-CoV-2 infection. Outbreaks were deemed confirmed when just one resident or staff member tested positive; subsequently, every resident in the care home showing any coronavirus-infection symptoms is deemed to have COVID-19.
Document, Page 4:
. . . In the context of the pandemic, a single laboratory confirmed case of COVID-19 in a LTCH, in a resident or staff member would trigger an outbreak and would be declared. . . .
That is a broader definition of an “outbreak” compared to the 2019 document.
And I think the author’s reference to “deemed to have COVID-19” comes from page 6:
There should be a low threshold to test residents and health care workers within the home for COVID-19; even one compatible symptom should lead to testing. . . .
Once an outbreak is established, any additional illness in residents should be managed as a probable case (symptoms and close contact with a confirmed case) and presumed COVID-19, while waiting for their testing results.
Testing of asymptomatic residents or staff is generally not recommended.
4. From the article:
Notably, however, there wasn’t a symptom list in the document.
There isn’t any formal list, just scattered mention of “cough,” “fever,” “sneezing,” or “runny nose.”
5.
Dr. Williams said on April 1 during that day’s press briefing they deliberately did not include a list of infection [sic, symptoms].
“to look for those symptoms [in the rest of the care-home residents after the initial case is identified] is a challenge, particularly in seniors,” […] “They may not mount a fever, they may have a lot of other symptoms and they may not have obvious symptoms. [Rather,] any change in their health condition really [can be considered a symptom].”
A few minutes later Dr. Williams added:
I don’t mind false alarms. [As a result of the looser outbreak criteria] the numbers [of outbreaks that] we see might be[come] quite [a bit] larger …. [But that’s because w]e want to ramp up the sensitivity. [That] means the number of outbreaks will go up, because we’ve widened the definition.”
I found the April 1 video archive here: https://video.isilive.ca/ontariomhms/archives/2020-04.html after clicking on “April 1” on the left side. (Queen’s Park Media Studio -> Video Archives ). It’s maybe easier to use YouTube: April 1
The first quote starts after 39min. Just starting at 39 min because it’s interesting for other reasons:
[I corrected some errors in the YouTube transcript]
[Dr. Yaffe] what we’re seeing certainly in the States and starting to see you know in all parts of Canada is that as we know residents in long term care are a very vulnerable group for a variety of reasons they tend to be older they tend to have comorbidities other underlying illnesses their immune system may not be what it used to be and they’re living in a congregate setting that is their home And so we do see outbreaks and we see very serious outbreaks that spread quickly with a lot of illness and unfortunately death so we were using the general infection control guidelines that we have always used for respiratory infections which we use for influenza every year and those were basically that you would test up to four people in an institution. If they all came back with the same organism, let’s say it was influenza or another virus or whatever, it’s, okay, anybody else who fits the case definition who has those symptoms that’s what they have. It’s called what we call an epidemiologically linked case, so you don’t need to do the test [Notice what she says. Her statement implies that tests are not normally done for most patients when deciding someone has a certain infectious illness! There is a lot of implications in that for media messaging about influenza cases by the way, but in this situation, why is there so much focus on testing? How much value do the tests have? The main point I would make is that nobody ever tried to test all the patients before, let alone everyone, but all of a sudden the focus is on testing everyone] So what we’re seeing though with these outbreaks is we need to really get a better handle on who’s infected [Question: what kind of care are they normally supposed to get? Are they supposed to be sent to hospital and at what point?] and making sure that they’re the strongest possible measures are in place so the directive one of the things in there was that [40:31] when you have one suspect case and that’s one of the things just to look for those symptoms is a challenge particularly in seniors in elderly people. They may not mount a fever they may have a lot of other symptoms and they may not have obvious symptoms Any change in their health condition, really it’s important to say okay let them get tested for COVID 19 and if we have one positive case that’s called in that we call that an outbreak for COVID 19 [Question: does that help the ones who are sick get treated?] and it’s important to test every other person in that facility, resident or staff and staff who have the symptoms not not just four and say the rest are assumed. We’re gonna test everybody who has the symptoms so we get a better picture of all the cases and make sure all the preventive measures [Question: are they effective preventive measures compared to making sure the ones who are sick get proper attention and are separated from the healthy?] are in place the control measures and there’s lots of other things that came through in that directive around screening of staff screening of residents twice a day including temperature a lot more infection prevention and control use of PPE cleaning communication with the families and they’re like it’s a very comprehensive directive but the testing was one part of it public health perspective. . .
Questions: Did these measures prevent more deaths? Basically all the focus is on testing rather than on procedures for dealing with those who are sick. And there were just as many or more outbreaks after they gave these talks as in other years. Just a general point I have about this quote is that it seems like it would be much easier to NOTICE who had obvious enough symptoms and then TREAT them. Does everybody’s temperature need to be taken? Does it make any difference if someone is tested or not? If someone is sick and has symptoms, they should be obvious enough. That seems like common-sense to me. We have already observed measures and a way of thinking that goes beyond common sense. It seems to me the more they tested–staff and patients–the more “cases” they counted rather than focusing resources (time and energy) on care and following normal quarantine procedures.
At 54:48, Dr. Yaffe mentions she was aware of 12 outbreaks at long term care homes at that point.
At 55:05, Dr. Williams mentions that there were 6 suspected outbreaks at retirement homes.
The second quote starts at about 55:11 in the video. Spelling it all out fully:
Dr. Williams:
. . . and sometimes what we’re trying to do with the long term care homes as Dr. Yaffe [.. ?..] my directive the first sign of some symptoms even though you haven’t got identified cluster, we’re doing the part of declaring an outbreak right from the get-go. That we may say oh okay it wasn’t–a false alarm–but that’s fine. As I said I don’t mind false alarms. That means the numbers you might see may be quite larger as they go through that initial phase of saying, is it really an outbreak or is it some other illness? Is it another viral illnesses? or is it influenza? Is it a different thing altogether? And so it may be an outbreak but it may not be a COVID outbreak in there, but we want to ramp up the sensitivity, to raise the alerts. That means those number of outbreaks by the numbers, or by the classification, will go up just because we’ve widened the definition
[End of Session]
I notice at the beginning he says “a number of those will have to be ventilated” (as if that’s appropriate!)
He refers to a “command table.” He refers to “scientists” and “modelling.”
The introduction is very interesting if you notice how he seems to set up the whole situation and how we are supposed to think about it. If people are getting sick, then they could just focus on treating them as far as I’m concerned. All of this is like a stage play with multiple layers of artificiality:
Dr. Williams, just at the beginning:
. . . and so we’re halfway through what I call the the week of lots of intensity as far as looking at how well we’re doing with our physical distancing [note his focus] as well as the we start to see as the numbers rise [note his focus] that we’ve noted with our laboratory testing [the numbers rise with the testing–what about patients?] and we’ll give you the numbers here in a moment, with the ones that came back and others that made contact with some of those about nearly two weeks ago a bit a week and a half ago, and as those numbers increase they your backtrack a certain percent of those will be hospitalized and a certain percent of those will end up in ICU and a number of those will have to be ventilated and unfortunately some in that time they’re a certain percent at least based on population data [based on computer modeling? see below] may succumb to the illness so we are seeing those other numbers go up [Logically, I would think that the more they test, the more the numbers go up but what about the number of actual patients? Remember how the premier was screaming for more tests] and we’re looking at those intently with all our planning at the command table as we’re doing a lot of scenario design and planning based on the evidence we’re getting from various scientists and groups who have done versions of modeling and I continue to look at the modeling and revise the modeling and we hope to have some report on some of their projections perhaps by next week but they keep changing and altering depending on our data just because we’re so in the modeling projections were so early in the curve [he’s just going on and on about modeling and projections but surely they just need to focus on treating the ill and preventing the spread of the illness, but that’s not it–they’re creating an elaborate justification for a new way of managing disease and people] so we’re going to be able to talk about that maybe better next week in that regard so with that in mind we’ll first go over to the numbers and let Dr. Yaffe talk about those because the numbers and this time we’re getting larger numbers coming forward, more things happen every day with many sectors in different ways. The tasks and the logistics of pulling all those together and making sure they’re exactly correct as all these new groups are bringing brought in whether it’s new labs being brought in, new institutions being brought in new regional groups and new offices, this is all part of the multi team approach [notice all the NEW groups, etc. – how elaboratae it is] here in Ontario and that’s one of our strengths we have. We have many people at the table, many people taking part but then the coordination is one of our challenges in there and the overall purpose in the end is to use that collected knowledge base to protect the health of Ontarians to the best we can under these circumstances. . .
So I kind of doubt that’s the point of this out-of-proportion coordination.
Dr. Yaffe uses a term that sounds like “ISIS”–I think the term is IPHIS which is their Integrated Public Health Information System.
The totalitarian line of questioning comes from Allison Jones at Canadian Press who asks about “contact tracing” as if spying on people and sharing private information is a valid concept:
[14:10]
I wanted to ask about contract contact tracing with the increasing numbers of cases that we’re seeing. How are public health units keeping pace with contact tracing and do you think that we’re going to reach a point where we need to start using technology like from other countries [authoritarian ones] have to keep tabs on those patients and their contacts.
Invading privacy on an unprecedented scale–I mean in free countries–except China and others set the precedent in a more authoritarian context–so that became the precedent.
Dr. Williams:
yes thank you for that. And this is a concern of ours so we have been quickly asking our health units to say if we go up with this kind of case contact management which is what we’re hoping to do because even if we were able to flatten the curve the real grunt work of the public health really then kicks into gear even more where all these cases are going to have to a lot more contacting them doing more phone calling, more investigating and you’re looking at the numbers there and we’re asking our health units how might or could should we do this one as we face this including we may have more work to do if we deal with in a more assertive way with those who are returning from – from outside Canada and to monitor their their home quarantine if you may. So this is a matter that we’re trying to address how would we add extra resources to them both technological as an I team information systems phone systems other communication systems other staff other groups of volunteers and different things we’re trying to address that to say each Health Unit . . . [15:58] so we’re looking at quickly how to ramp that up not only for today but tomorrow and in the future because this [16:02] is going to be very important in the days and weeks going ahead even if we were able to flatten the first wave [already talking as if there are going to be more waves] there’s a lot of that action that has to play take place throughout the whole spring into the summer to monitor and follow those ones so you don’t get I guess like a forest fire analogy flare-ups [so wouldn’t they have recovered by summer? Why do they need to keep following them? These things die down.] because that that’s that work even after the front goes through you have to do a lot of going around and putting out those hot spots and stuff because if you don’t they can flare up and you got back into the same situation again and that is very much intensive and takes a lot of staff and time so we’re really looking at to ramp up the resources at the healthy level so we can invest in that and to make sure they’re engaged and ready to take part and do the whole package and so it’s a good point you’ve raised technology we’re going to use what we can the technology we’re using that to give a sense of some other measures in there I know what people do with the web-based and cell phone matters and that we do want to make sure that we connect with the people we’re using our self assessment tool already and we may want to build on that and use that more so we’re always looking at different ideas we have many proposals coming in . . . all things are possible with these challenges ahead of us and we have to go full force into it
Notice how they were planning to follow up on the cases into the summer.
[17:35]
Follow up question:
Is your recommendation today to the local medical offices of health that they use the health protection promotion act powers to require the the patients and their contacts itself isolate is that going to increase the contact tracing load on the Public Health Unit
She uses the term “contact tracing load”.
[17:48]
Dr. Williams:
I don’t imagine it will because those ones are already being monitored by that we’ve already if they’re a positive case that’s supposed to be an isolation [Question: if they are sick? Do they have to test negative to be released from isolation or just recover from symptoms?? What is the procedure?] what we’re trying to deal with is that we hear some reports for individuals for various reasons not because it’s essential in that because they help and support choose to ignore we’ve already had some have issued section twenty two orders as it was in the H pallet of health protection and promotion Act and that’s warning that this is not a casual thing. This is a serious issue and we want the Medical Officer health to use their powers and authority That’s one of the strengths we have in our system here in Ontario to engage in that and to apply those to those individuals not many but there’s few who choose to do that and they have to know this is a serious issue and it’s not taken lightly
So very authoritarian language. This sort of thing has never been done before response to an illness. And it seems clear to me they have every intention of repeating the lockdown again when flu season comes around at the latest (I’m writing this July 3).
[18:35]
Question and answer about the modeling numbers being so high and so varied:
hi doctor I wondered if we could get a little bit into the modeling. Premier Ford’s earlier created a bit of a stir when he said the models are kind of divergent right now, and if they released one that overestimates, it could create a panic, so this is going to worry a lot of people. Yesterday we had the United States release those modeling numbers of a hundred thousand to two hundred thousand deaths. Where where what’s the range where Ontario could fall right now?
Dr. Williams:
and and you know that discussion yes they had one hundred thousand twenty thousand then I heard 1 million two million so when you’re doing this type of modeling we’ve asked our scientists we have some a group look at that and I have one of my staff who is a PhD in epidemiology as well looking at it When you’re on the start of don’t want to technical here it’s a logarithmic scale and that means it moves up exponentially very quickly and in those early steps if you move it just a slight percent even there you go from like the States’ 100,000 to 200,000 and we want to be a bit more exact than that that means as we get more data coming in and we get further up the curve a bit we can get more accurate projections from our modelers . . .
The Health Protection and Promotion Act is mentioned several times. There is an interesting legal question asked here:
[28 min 47s]
our next question comes from Jeff gray with The Globe and Mail. . . . Oh hi doctors I wanted to ask question because I thought I heard dr. Davila in Toronto today say that she had issued I think she said a class order under the health promotion and Protection Act to keep people in self-isolation. Can you explain is that something different than what you were talking about with? It sound like you’re talking about an individual
[Question: Maybe some contradiction here. Maybe they didn’t follow the new rules properly.]
Dr. Williams:
so I’d have to ask her how that applies in that situation under the health protection and promotion act. Having worked the local level when I’m doing section 22s I have to name a certain agency or entity or an individual in that I can’t put it out for a wide group if it’s a class one. It may be a large group but then you’re going to have to do some of the proper legal paperwork in that regard so I think we’ll have to let their legal counsel discuss that how that might be applied in the city of Toronto in that and using the health protection promotion act accordingly but I haven’t had not been briefed on exactly how that’s going to be undertaken by the
medical officer of health in Toronto.
Follow-up question:
. . . on the list of businesses that have been allowed to stay open the premier suggested today but that’s under review and it might be some more restrictions coming. Are you recommending some some other businesses maybe construction sites or something shut down.
Answer:
we have our members working on that committee and we’re getting feedback on different aspects and getting input from not only for for myself as necessary from our wider team group as i talked about in my pre-amble it comes from many sources that feed into that that discussion as we proceed forward in that and as we compare ourselves with other jurisdictions and to see what is quote essential [so “quote essential” – which illustrates how arbitrary the process is of deciding which businesses are “essential” and it also conveys the meaning of “we’re just letting you stay open–you are just lucky we’re letting you have grocery stores stay open with our business-destroying policy] and how best to do that and are we convinced that even those that are staying open [see what I mean?] are they doing what they can do to continue doing the physical distancing in an appropriate way [are they being “good”?]. If they’re failing to do so then further considerations would have to put into effect if they’re unable or unwilling to comply with that that direction
So notice the authoritarian phrase “unable or unwilling to comply.” Maybe they feel that they need to survive and eat. What the hell! And they’re going to do this again and again to us. People don’t get it. Nobody has ever done anything like this before.
At 31:10, a reporter asks a question about the discrepancy between the death count being put out by the public health units and the province. Dr. Yaffe mentions “adding some resources to the local health units to do more intensive contact follow-up”
She answers another question about those who are very sick:
it’s hard to understand why they’re such a long you know such a high number of so-called suspected cases when we know that people who are hospitalized with acute respiratory infection are a high priority group for testing . . .
However, why should testing anyone be any kind of priority? Why not just treat those who are sick. The emphasis is on counting and getting the numbers up, and publicizing numbers.
The next question is very interesting from a Toronto Star reporter:
[33:07]
hi doctor thanks for taking my question um I know we come back to this question a lot but I’m still hearing a lot of confusion from the public about whether or not they can or should go for a walk and dr. Davila included that in the very short list of things or short list of good reasons to leave the house [incredible!] but I have heard some people who are confused about the province’s recommendations and whether parks being open for walk through access means you can walk through it just to go to the pharmacy and get your medications or whether we should in fact be going out for walks and I think there’s some compounded confusion in Toronto because you know we’re being told to go outside if we go outside to say two meters away from everyone but in a dense you know downtown urban environment [because it’s stupid and contradictory nonsense without any justification] it can sometimes be hard to find places where you can do that so I’m wondering if you can clarify are you are you not just allowing but recommending that people go out for walks and can you help trontonians interprets that advice I’m giving this for the dense environments that we live in
So you notice that people were confused by the orders, and I think that’s intentional. They are put in tension by them. “Go out” “Don’t go out”.
So his answer is interesting: “permissive, … allowable, … forbidden …” All this insane, incredible totalitarian nonsense that has never been heard of before. We have new “problems” to solve we never thought of before in history:
About 34 min
okay and I’ve heard that I’ve had people asking individuals asking emailing to say what did what do we mean on that one how much is permissive how much is allowable what is forbidden in that area because some our neighbors and friends are interpreting it right down to some letter no you can’t go out I think what we were really trying to do is to make sure that the physical distancing is maintained in your activities and we found some we’re going out and going into large gathering areas where it was
pretty impossible to maintain the physical distancing and so they did some steps to reduce their parks and especially these known large gathering centers that were a problem especially as the weather is getting better and people want to get out we want to be sensitive also that why we’re asking people primary to stay home because it’s easier to maintain their social requirements and its physical distancing in that we know that as we’re going to week 2 week 3 and that and going on [notice how he doesn’t stop at week 3] people do need to have some ability to not get what we call cabin fever and that kind of stuff there and of course physical exercise is important the health is important too our only recommendation our main recommendation if you’re going to do so think about it [as if life isn’t difficult enough already–what total nonsense to quarantine healthy people] plan it out if you’re going to go out or yourself or with your children you’re going to go out at a time when you’re going keep that physical distancing and I think you’re correct with the dense urban settings there’s more of a challenge there that includes a corridor taking the elevator down different aspects there and then where do you go in there and we’re trying to leave some green spaces open so you can go there there’s concerns about the play equipment because there was not able to keep it clean and some were concerned that that could be an actual ongoing source of transmission and so that was probably unfortunate for some of the smaller children who would like to do that but you can always bring some of your own toys with you so I think if it’s a planned event and you go at times when it’s not busy plan your exercise your jog when it’s of course still safe for you in different hours but when there’s not crowds around and your route accordingly not to the most popular busy spots so I think I agree with dr. Davilla on that well we’re not saying everybody get out and do it all the time try and stay home try and keep that distance up in that sense all the time and if you need to get out for essential things yes you should go out and get those when you go to the store do the same type of discipline and I’m I’m very impressed with number of stores that are doing that and various ways to handle that so that it’s done in a very I think a civil way people taking their turns and doing that so all these things are planned out and timed and with the concept totally of trying to maintain your physical distance.
Notice how he refers to playground equipment and that “some were concerned” that these could be a continued source of transmission. He doesn’t say that they are correct. That’s the same with the CDC changing their official statement later on their website from something fuzzy when it came to the possibility of physical transmission from objects to a clear statement that it was very unlikely.
But are children susceptible at all to COVID-19? What are the numbers?
It’s all about controlling behavior–making them worry about whether they should go outside or not and use “physical distancing.”
Nobody ever quarantined healthy people in history.
Further Research
1. To read Control of Respiratory Infection Outbreaks in Long-Term Care Homes, 2018
2. Study further the April 1 document regarding “physical distancing” measures, etc.
3. Study COVID-19: Guidance for the Health Sector
4. Study this document on testing.
5. Someone might want to analyze the contradictions and propaganda patterns in the video archive.