Long Term Care Home Analysis – Part 3 – COVID in Ontario
Continuing from Part 2 | Part 1 and analysis of this article:
Then on April 22 the province produced the first COVID-19-screening guidelines for care homes. It’s broadly similar to the April 8 document, except that two or more of some of the symptoms – for example sore throat, runny nose and sneezing, stuffed-up nose, diarrhea – need to be present for a person to be deemed positive.
So we’ll just take a look at it:
Ministry of Health: COVID-19 Patient Screening Guidance Document
This screening tool is based on the latest COVID-19 case definitions and the Coronavirus disease (COVID-2019) situation reports published by the World Health Organization.
This document should be used to screen people who are suspected or confirmed of having COVID-19 throughout the health and emergency response system. . . .
So the World Health Organization is at the top of this.
COVID-19 Patient Screening Guidance
• This checklist provides basic information only and contains recommendations for COVID-19 screening and should be used with applicable health sector or service specific guidance and training documents. It is not intended to take the place of medical advice, diagnosis, or treatment.
• The screening result is not equivalent to a confirmed diagnosis of COVID-19.
• At a minimum, the following questions should be used to screen individuals for COVID-19 and can be adapted based on need/setting.
• This information is current as of the date effective and may be updated . . .
• Once the person has been screened as positive (answered YES to a question), additional COVID-19 screening instrument questions may discontinue.
. . .
It’s interesting they use the term “screened as positive” to apply to answering YES to one of the questions. I assume this is different from testing positive?
To discontinue asking questions highlights how inappropriate the whole thing is I think. If a person needs a doctor, then they can go to a doctor (or be taken to one) and in that situation–which is normal–they can share ALL the symptoms with the doctor–because they are sick and need some treatment. I would want to share as many symptoms as possible with a doctor but not blurt them out to just anybody who–usually multiple people– does whatever they want with the information. The person asking questions is like part of an algorithm, part of a scanning and tracking system, like we’re a mass of farm animals who are mostly not sick.
Next:
Dispatch question for Long-Term Care or Retirement Home
*Q1: Do you have a concern for a potential COVID-19 infection for the person?*
This question is only to be asked to Long-Term Care or Retirement Home staff by Dispatch Centres.
Regular Screening Questions
Q2: Is the person presenting with fever, new onset of cough, worsening chronic cough, shortness of breath, or difficulty breathing?
Just going to add my comments: I notice they are being careful in this version not to include all coughs.
Q3: Did the person have close contact with anyone with acute respiratory Illness or travelled outside of Canada in the past 14 days?
Many people could answer YES to this question or the last one.
Q4: Does the person have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19?
This is part of the contact tracing–which normally would be considered possibly an invasion of privacy. Is the person required to answer these questions and especially the ones involving other people? On what grounds? Do these types of questions violate privacy laws? After all, it isn’t a doctor, is it? And is it a medical record? What happens to the information? It’s the same concern we should have about businesses asking these questions of employees and possibly collecting this information or sharing it (whether legally or not) with outside institutions–government or otherwise. Is it just information floating around loose?. I think it must be–otherwise how can they be advocating contact tracing apps and phones detecting other phones and collecting information on contacts. This is outrageous but people aren’t putting a stop to this. Is the person’s name attached to this info? I have too many questions.
Q5: Does the person have two (2) or more of the following symptoms: sore throat, runny nose/sneezing, nasal congestion, hoarse voice, difficulty swallowing, decrease or loss of sense of smell, chills, headaches, unexplained fatigue/malaise, diarrhea, abdominal pain, or nausea/vomiting?
So “two or more” is more stringent than the last document. But the list of symptoms is very long also and could cover many illnesses that people have. “fatigue/malaise”? “abdominal pain”? Yikes. Looking back at all these things and events, I think they just wanted to test as many people as possible for whatever reason. And I think that so much time and resources were misused this way–which led to the neglect of people who had symptoms like that anyway because they had some other illness which needed someone’s attention. Read what happened with Canadian hospitals.
Q6: If the person is over 65 years of age, are they experiencing any of the following: delirium, falls, acute functional decline, or worsening of chronic conditions?
Many people over 65 are going to match YES to that question because of other conditions they have–which are obviously not being addressed by the single focus on COVID. Why leave behind normal health care for an inflated exaggerated situation with one illness?
Most people who are dying are dying of something else! Don’t people know that?!
Then the interpretation:
COVID-19 Screening Results
If response to ALL of the screening questions is NO: COVID Screen Negative
If response to ANY of the screening questions is YES: COVID Screen Positive
As of July 3, 2020: This is the current Ontario self-assessment page: https://covid-19.ontario.ca/self-assessment/ and there is a link to a “test results” page:
The Website is connected to the Ministry’s Ontario Laboratories Information System (“OLIS”) database, which contains your laboratory test information, including your COVID-19 test report, submitted to the Ministry by participating laboratories across Ontario.
This is a later document from May 11 for research: Case Definition – Novel Coronavirus (COVID-19). It has some specifics defining “probable case” and “confirmed case” and it has some detailed information about the tests, mentioning “false signals” and “inconclusive” results. It says that the laboratory test methods can keep changing! It looks like there are later updates of this definition document, for June for example.
So based on that, I believe that “case” refers to the “confirmed case” definition which means there was a confirmed laboratory test, but I don’t see a definition on the following page:
This is the COVID-19 website updated daily for Canada, province by province, which I have referred to occasionally. It gives a count for “people tested”, “total cases”, “deaths” and “cases recovered.” On July 3, 2020, for Canada, “people tested” is 2,885,746. Total cases for Canada is 105,091. Total deaths is 8,663 (which is part of what some of us are questioning as to cause of death). Cases recovered: 68,693. Looking at it again, I wonder if they are actually most interested in the “people tested” number. 2,885,746 people–that’s a lot of money to spend on tests for COVID-19. I think it would be better spent on actual health care and homelessness. So there is some other reason (or multiple reasons) for all of this.
Ontario page on COVID-19 data surveillance: https://www.publichealthontario.ca/en/data-and-analysis/infectious-disease/covid-19-data-surveillance
At this older page at the CDC regarding SARS, I noticed this:
Surveillance case definitions are used primarily for identifying and classifying cases for national reporting purposes
(Another page on the same subject).
Anyway, all of this is really about surveillance of the population and having constant monitoring of our biology for one reason or another–without getting into the different consequences of that. Jacques Attali wrote about this topic of people participating in their own monitoring in his book A Brief History of the Future. It’s just portrayed in the media and entertainment to be something that is always benevolent. Actually healing patients would be benevolent. Monitoring all of us is about power and control.