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A Cape Breton woman in her 80s died from COVID-19 today; she is the fourth person in Nova Scotia to die from the disease. She had underlying health issues.

And yesterday, 27 more people tested positive for COVID-19, bringing the total to 606. Eleven people with the disease are in hospital, and five of those are in ICU. One more person has recovered, bringing the total to 177. There are 425 active cases in the province.

Today, the premier extended the State of Emergency two weeks, to May 3. The Emergency Measures Act only allows for two-week declarations.

Also today, the Nova Scotia Health Authority (NSHA) issued another advisory about potential exposures to the disease in Dartmouth:

NSHA Public Health is advising of potential exposure to COVID-19 at the following locations in Halifax Regional Municipality:

• Giant Tiger, 114 Woodlawn Rd, Dartmouth on April 13 from 10:30am to 12pm. It is anticipated that anyone exposed to the virus on the named date at this location may develop symptoms up to, and including, April 27, 2020.

• Bob’s Taxi, based in Dartmouth, on April 4 – April 15 from 10am to 1pm. It is only one car of the cab fleet for which a confirmed exposure has been identified. Precautions were taken by the driver during this time. It is anticipated that anyone exposed to the virus on the named dates may develop symptoms up to, and including, April 29, 2020.

Public Health is directly contacting anyone known to be a close contact of the person(s) confirmed to have COVID-19. While most people have been contacted, there could be some contacts that Public Health is not aware of.

Health system capacity

While the deaths are tragic, the disease’s impact on the health care system has been limited. As the crisis was beginning the hospitals were preparing to be overwhelmed by COVID-19 patients, and so started moving as many patients out of the facilities as possible, to make room. As Jennifer Henderson reported on April 2:

[T]here has been significant movement of people out of hospital over the past month. Late last week, NSHA CEO Dr. Brendan Carr said hospitals across the province were at 70% occupancy when usually at this time of year they would at 100% capacity. Those reductions came mostly from cancelling surgeries and elective procedures, Carr explained, although 42 patients have been transferred to nursing homes in the past three weeks.

The Health Authority CEO said 122 beds in Intensive Care Units (ICUs)  across the province are currently standing at 50% capacity in preparation for an anticipated surge of COVID-19 admissions two to three weeks following travel from March break.

Also in anticipation of that surge, NSHA prepared a plan to repurpose facilities and otherwise improvise to bring the potential number of ICU beds to the 190-200 range.

But that surge didn’t happen. There are today just five people with COVID-19 in ICU, and even the worst case scenario as envisioned by the modelling released Tuesday shows that at the peak of the disease, only 85 people with COVID-19 will be hospitalized at any given time, and only about 30 of those will be occupying ICU beds:

This is good news, but I wonder if we might be unreasonably endangering others. The elective surgeries and non-urgent procedures that were cancelled or postponed to make room for the expected surge of COVID-19 patients include people in pain, and some of them might die.

A hip replacement, for example, isn’t considered urgent, but the ongoing pain is first of all miserable, but might also aggravate other illnesses. And some percentage of people — small, for sure, but some — are discovered to have fatal illnesses when they go to their routine doctor’s appointment, or when having other procedures performed at the hospital. Putting those appointments and procedures off for a couple of months might lead to a significant increase in non-COVID-19-related mortality.

I’m trying to do more reporting on that issue, and hope to have some answers soon, but in the meanwhile, today I asked Dr. Robert Strang, the province’s chief medical officer of health, if given the relatively low number of COVID-19 patients in hospital, it might be time to begin rescheduling elective and other non-urgent hospital procedures. He answered:

That is certainly an issue the health authority can look at. I think we need to remember that we don’t want to start making changes prematurely. The modelling is numbers that gives guidance — they’re not numbers that you can hold anyone to, a firm number.

I think the point where we know, based on the modelling, as long as we stay to the scenario where we’re having strong adherence to our public health measures, that even though if there is a surge of cases, we should be able to manage those people who are hospitalized and in ICU within our existing capacity within the health system.

As I said yesterday, that would stretch us, because there’s still a lot of other health care needs that need to be managed. We have trauma that’s going to happen. We have people with cancer or necessary and other urgent surgeries that need care.

We have to watch — we have a few more weeks before we can confidently say that we have hit our peak and start to go down. So it is something that needs to be looked at as part of — we talked a lot about how we start to relax some of the public health measures, but along with that is the folks in the health care system who are in charge of delivering health care, how do we slowly start to return to normal. But we need to make sure we don’t do that prematurely and put us in a situation where we start to open up the health care system and all of a sudden we have a surge of COVID-19.

So it’s a bit premature to start doing that, but it’s not premature to start thinking about it.

Nursing homes

Dr. Robert Strang, Nova Scotia’s chief medical officer of health, at the daily COVID-19 briefing, Friday, April 17, 2020. Photo: Communications Nova Scotia.

The Department of Health today released updated figures for COVID-19 infections in eight long-term care facilities — 98 people associated with the homes have tested positive. That figure includes 55 residents and 43 staff.

That’s a 50% increase over yesterday’s figure of 65 infected (42 residents and 23 staff).

The long-term care numbers are not directly correlated with the daily totals issued by the Department (cited at the beginning of this article), as the reporting periods are different. So it’s confusing that 33 new cases were reported in nursing homes today, but only 27 new cases were reported province-wide, including in nursing homes. Strang said that health authorities are working at developing a more consistent reporting system.

Still, there’s no doubt that nursing homes are a significant concern — reporting issues aside, somewhere between 15 and 20% of all cases are in nursing homes, and that percentage is increasing daily.

My colleague Jennifer Henderson is doing more in-depth reporting on nursing homes, but while I had the opportunity, I wanted to ask Strang or Premier Stephen McNeil about the movement of continuing care assistants (CCA) between facilities. The concern is that a CAA will unwittingly bring COVID-19 from one facility to the next. Our exchange:

Bousquet: It seems the major concern right now and the weeks coming forward concerns the long-term care facilities. British Columbia and Ontario have prevented workers from going between facilities, but I’ve noted that Dr. Strang’s order from April 11 (see here, page 9) allows, and in fact says it’s necessary in order to fully staff some of these facilities.

It occurs to me, and talking to folks that work at some of these facilities, that the workers simply — they’re working in different places because they can’t afford, or they aren’t offered the opportunity to work in one place. So my question is: Is this crisis in some way aggravated right now because our long-term care facilities have been going on the cheap for so many years, in not fully employing people and giving them well-paying jobs, and as a result they’ve had to work in multiple facilities?

Strang: It’s a complex staffing issue. I can’t speak to some of the long-term pieces.

I do know that as we work in this current situation, clearly, the more we can keep staff working in one facility, the better. And that is one of our objectives. But we do know that if we are not in a position to be completely directive on that like some other provinces because it’s always in finding the balance. We need people to be in facilities to provide the necessary care.

But one of the key things we have done is that when there’s an outbreak in long-term care, it always creates staffing challenges, we’ve said staff that are identified as close contacts, that they can come back and work if they test negative, they wear masks, their temperature is taken every day, there’s strict protocols for them. That is simply a way to make sure that as much as possible, people who work in those facilities can continue to work in those facilities, minimizing the need to bring people from other facilities.

Because we recognize that people moving across facilities is always a chance to spread the virus. So we’re doing what we can do within some of the limitations of our HR issues in the long-term care sector, to keep people in one facility.

That might’ve been a good answer to someone else’s question, but not to mine.

Oh, by the way, Northwood is hiring. As of yesterday, at the Halifax complex, 42 residents and 26 staff have tested positive.

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Tim Bousquet is the editor and publisher of the Halifax Examiner. Twitter @Tim_Bousquet Mastodon

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  1. Thanks very much for raising this issue with Strang Tim. The question in your headline and the one you asked NS’s public health officer are excellent ones and very much appreciated. And they point to the root of the problem. I think the answer, which Strang was unwilling or unable to provide, is: “Yes, that is a significant factor.” In fact, they don’t pay these health care workers nearly enough, and that is part of the reason many have more than one job in more than one facility. It’s also one of the reasons it’s been so difficult for facilities across the province, even prior to this pandemic, to attract new staff and to keep existing staff. But it’s only one piece of the puzzle. Another important one is that these relatively low-paying jobs carry enormous responsibilities and are extremely difficult, both physically and emotionally demanding. Part of the daily stress experienced by CCAs (certified care assistants) comes from the fact that there are never enough of them to do what needs to be done. The dirty little secret that neither Strang nor McNeil will ever admit is that crisis-levels of understaffing are baked into the formula of these institutions: that the government-set ratio of care-workers to resident is simply an obscenity and can’t fail to result in needless suffering on the part of the residents and needless duress on the part of those who care for them. The ratio has minimal relation to the actual needs of the residents or the facilities and is not remotely consistent with decent levels of care, the welfare of the workers, or the human dignity of the residents. When I questioned the Premier and his former Health Minister Leo Glavine on how this ratio was arrived at, mentioning – as one example of its many flaws – that as residents aged their care needs increased while the ratio remained constant, I was met with this deluge of bullshit: “Before establishing the current staffing ratios for the nursing homes that opened recently, the Department of Health and Wellness carried out extensive research and comparing practices across Canada. Not only were staffing ratios examined but alternate models of care were explored as well. A 2010 cross-jurisdictional review of staffing ratios revealed the current staffing ratios in nursing homes in Nova Scotia on par with the rest of Canada. We continue to monitor the effectiveness of the current staffing ratios and the models of care as we strive to ensure the care provided is the best it can be.”

    In other words, “none of your goddam business”. The reason they won’t answer this question, and why the mountain of evidence of chronically inadequate care across Nova Scotia in these facilities is irrelevant to them, gets to the heart of the catastrophe that is care for the elderly in this country, and indeed of our whole political and economic system. They won’t tell you because those ratios have nothing to do with keeping residents of nursing homes healthy and happy and well-nourished and letting them live out their days with a modicum of contentment and dignity. Rather they have to do with the state religion of neoliberalism, an ideology which says that the real goal of government is not protecting the democratic rights and serving the interests of its citizens, but promoting (among other things) profits for and expansion of the private sector, letting the “market” decide, whatever the human costs. Care for the elderly has been largely contracted out in the service of this hegemonic social pathology, and for those in the business, profits are inconsistent with decent standards of care. It’s as simple and as horrifying as that. So those standards – like the wages of the health care staff – are set at minimal levels, basically to permanent crisis mode, in order that this branch of health care can be shoehorned in to the market’s procrustean bed where it never belonged, does not belong, and never will belong. What the votaries of this religion like Stephen McNeil are saying is this: If our elders need to die of bedsores, die of boredom and despair, die of a broken hip after being pushed over by another demented resident while unsupervised, be crowded four to a room, have their privacy and dignity and peace of mind trampled on, or even be left to drown in their own excrement during a pandemic as happened in Quebec, well so much the worse for our elders. The market has spoken and its victims need to accept the sacrifice.

    Of course neither Stephen McNeil nor his provincial counterparts across the country can say that; that would give the game away. Instead he’ll assure us of how he wants to wrap his benevolent arms around all Nova Scotians during this crisis and that it’s no time to raise “labour beefs” or whatever tf he said when the issue of CCA pay was raised.

    Sadly the staffing shortages that have resulted from the neoliberal model for elderly care and that have been exacerbated by the pandemic probably can’t be solved overnight, despite the immediate and urgent need. Raising the pay of CCAs and other employees in long term care facilities immediately – something that would have to be covered by government – would probably help in the short term and should be implemented immediately. In the longer term, the model has to be discarded as the moral obscenity that it is, and replaced with a fully-funded public system with a completely different set of standards for care, one based more on a Scandinavian and less on a US model from which the profit-motive has been removed completely.

    1. Hear, hear! Well said. Not much to add other than the neoliberal model is on display at its most egregious in the long term sector, but it is also applied to the health sector in general. The job of management types is to control budgets and staff. At the hospital I work at as a nurse, the IWK, our vision statement is “the best care”. This is utter bullshit and pandering to the public wanting to believe that the executives who run the place and the government that funds it actually care about the health of women and children. Their job ,first and foremost, is to ensure that the least amount of money possible is spent to provide the minimum level of care that will prevent too much of a public outcry. Hence good work still takes place there but this is despite management and government, not because of it. We do our best everyday to help the women and children who need our care, but the government and employer do things like make ambulatory patients pay for their medications, outsource as many ambulatory clinic patients to private clinics as they possibly can so as to keep staffing costs to a minimum (the clinic sees the most complex and challenging patients only because the private clinics just want to skim off the easy ones who don’t have complex social situations or difficult IV access etc…), outsources cleaning services to private for profit companies so the “heroes” cleaning our hospital aren’t even employees of the IWK, but of Crothall (again to keep costs down).
      And all of this is in the service of a neoliberal agenda so that government can keep costs down and thus blather on about zero deficits and balanced budgets and fiscal responsibility and living within our means. The job of the coordinator class, like management at the IWK, is to serve the interests of governments more interested in tax cuts for the wealthy and corporations, that in the health and welfare of the population it is supposed to serve.

      1. Agree completely epiong. The pandemic is a crisis on top of a crisis and is laying bare the moral bankruptcy of both neoliberalism and the captured governments that implement it, especially as it/they affect all aspects of health care. It’s been pretty clear for a while that the neoliberal playbook – first render public institutions dysfunctional as a justification for increasing privatization which is carried out on the sly – is being faithfully implemented by the NS government and its proxies in the NSHA.