What went wrong at Bobcaygeon: How the COVID-19 pandemic killed 29 people in an ill-prepared nursing home

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The convoy arrived with hundreds of tugs, exploding horns and ringing bells. Passengers leaned out of the windows of passing vehicles, or stood in the beds of pickup trucks, or stuck their heads through their sunroofs. They greeted and shouted encouragement and offered gratitude and wiped tears as they drove slowly past the Pinecrest Nursing Home in Bobcaygeon, a town of approximately 3,500 residents, framed by Sturgeon and Pigeon Lake. Some vehicles have looped for a second pass.

Gathered at the front doors of the facility, the health and personal support workers present waved their hands. They wore blue gloves and yellow dresses that floated over their tired bodies. Passengers held signs over their heads as they passed. “Thanks to the health heroes. “Prayers for Pinecrest. “Bobcaygeon Strong,” the colors ignite in the warmth of the spring sun, one of the few familiar delights this season in a world turned upside down by the coronavirus pandemic.

Behind the nursing staff and inside the gates of Pinecrest, one of the country’s worst COVID-19 tragedies is still taking place. As of Thursday, the virus had killed 29 residents of the 65-bed facility and one volunteer. Pinecrest did not disclose the names of the victims, but according to the family, who had spoken to the media, the volunteer was Jean Pollock. Her husband, Ted, 92, a resident, died seven days after her. In his obituary, it was requested that commemorative donations be made to the Pinecrest nursing home.

Ted and Jean Pollock, Bobcaygeon residents who both died of COVID-19.


Handout

More deaths are expected at Pinecrest. The dire situation of this long-term care home – and others across the country – has drawn the attention of the nation and has left many wondering what is wrong.

Dr. Jeremy Jones, a cardiologist at Ross Memorial Hospital in Lindsay, about 30 kilometers from Bobcaygeon, saw it coming.

He posted a note on social media on March 21, warning the public that an epidemic was happening at Pinecrest. The Haliburton, Kawartha, and Pine Ridge district health unit confirmed three cases at the facility on March 20, but Jones thought the situation was much worse.

“What they did not reveal is that there are 20 other residents and eight nursing home workers who show symptoms but have not been tested. These 28 additional people are undoubtedly other cases of COVID19, “he wrote at the time. “It means there could be hundreds of cases in the community that go undetected.”

Community members drive and honk their horns to support the Pinecrest Nursing Home after the deaths of several residents and the deaths of dozens of employees with coronavirus (COVID-19) in Bobcaygeon, Ontario, Canada, March 30, 2020.


Carlos Osorio /

Reuters

What went wrong

Pinecrest, an aging private single storey building with up to four residents in one room, separated only by curtains, was particularly well placed to be devastated by the pandemic. Like most long-term care facilities in Ontario, there was a chronic shortage of staff before the crisis started. When the crisis finally hit, there was a lack of testing capacity, limited communication, and questions explaining why the public had not been made aware of the scale of the epidemic earlier. And why a doctor in a nearby town was the first to raise the alarm.

When Dr. Jones issued his warning on March 21, it was 10 days after the World Health Organization declared COVID-19 a global pandemic. Five days after the announcement, the first two deaths at Pinecrest have been confirmed. Another 33 residents were already showing symptoms. Then things started to get out of hand. Deaths began to occur in clusters. Seven a day. Four others. For six consecutive days in early April, not a day passed without a death. Almost half of the facility’s residents are now dead – all before the number of COVID-19 cases in the province peaked.

There are no simple answers to what didn’t work at Pinecrest, but a confluence of factors offers some perspective. Efforts to isolate residents were almost impossible, given the space constraints of the dated building. Unfortunately, it was only when residents started dying that additional rooms became available.

“Pinecrest plans and prioritizes infection control – whether it’s the flu or the common cold. Unfortunately, the severity of COVID-19 presented unique challenges for our staff and our facility, “wrote Pinecrest administrator Mary Carr in a statement released on April 7.” At the start of this epidemic, we followed the plans management of existing epidemics, including the isolation of symptomatic residents. However, due to the size of our home and the limited front line capacity, we were faced with unprecedented circumstances. “

City Councilor Kathartha Lakes Kathleen Seymour-Fagan asked why the community was not more alert to the speed of the escalation.

“There has been an epidemic. No one really said there was an epidemic, “she said, while trying to explain how the Pinecrest crisis unfolded. “Then the staff started to get sick and the tests didn’t come back. They were told to go home and isolate themselves, which meant that there were no staff because people were sick and then there was no one to care for people. No one. I’m serious, like … four people for more than 60 people. “

The workers

The lack of available workers has led family members of some Pinecrest employees to volunteer to enter the facility and help with tasks such as cleaning. The workers who remained, as well as those forced into solitary confinement, are devastated, says Seymour-Fagan. Sorry.

“The PSWs and the nurses I spoke to said there would be PTSD afterwards because it’s so stressful,” she said. “It was such a mess because there were no staff there. “

On March 23, the province attempted to shore up front-line workers by issuing a new ordinance, giving, among other measures, more freedom to long-term care homes in the deployment of staff. On March 28, the province continued with additional emergency measures, giving homes more flexibility to recruit additional workers. Building inspectors were also deployed to focus on supporting workers.

Family members mourn another Pinecrest victim from Covid-19 at Verulam Cemetery on the outskirts of Bobcaygeon; a city in crisis. Monday April 6, 2020.


Toronto Sun / Postmedia Network

The rules

Unions and patient advocates are concerned about the removal of measures to protect residents and staff, but Donna Duncan, CEO of the Ontario Long-Term Care Association, says the orders were necessary.

On March 30, the OLTCA, along with five other organizations, wrote an open letter outlining the conditions faced by long-term care workers.

“The Ontario Long-Term Care Homes Act contains 193 sections and the regulations include 330 sections, often with several paragraphs, each imposing detailed restrictions,” said the letter.

“These rigid requirements have the practical effect of prohibiting homes and employees from implementing certain measures in pandemic response plans – such as allowing non-caregivers to move a wheelchair to provide the required physical distance , or allow homes to reallocate space to isolate residents. with COVID-19 from others. “

Duncan says that one of the many lessons to be learned from this crisis is that, despite the best of intentions, the legislation is so prescriptive that it creates barriers to how employees can respond to emergencies. Duncan describes it as a level of micromanagement that infantilizes the sector.

“The government has tried to over-regulate and micromanage through legislation how to actually deliver care,” she said. “To the point where licensed practical nurses and even PSWs weren’t allowed to work within their full scope of practice for what they were actually trained to do, because the legislation would say you can do it, but only up to a point. “

A member of staff wearing personal protective equipment helps a resident return to the PineCrest nursing home.


Stan behal /

Toronto Sun

By the time the province announced the second round of emergency measures, the first two residents of Pinecrest had already died. Duncan says the OLTCA has been asking for flexibility around the regulatory framework for some time, saying the limitations “create a culture of failure.”

However, she said that the government intervened quickly. “I think the government was very quick to respond once we said, ‘This is coming quickly, you have to give it to us now. “”

Despite emergency measures, the situation at Pinecrest remains dire, says Seymour-Fagan. “There are still not enough people to work,” she said, explaining that Pinecrest employees fired 12-hour days and that most have not had a day off for weeks. . “It was horrible and they still don’t have enough staff,” she said. And there is no end in sight.

“No one knows when this could happen,” said the Kawartha Lakes adviser. “We told as many people as possible, but we weren’t getting direct responses from the house. We knew this to some extent, but we weren’t getting enough information. And the breakdown of the information is how it could have spread more in the community. It is still too early to say how serious the community spread is.

Seymour-Fagan cites the lack of Pinecrest staff for limited communication. She does not blame the workers. She describes Pinecrest as an intimate and united installation. “They are doing their best,” she says. “They care about these patients.” But she wonders why there has not been a stronger response from the facility or local public health units.

“There was really no communication between the home, the municipality or anyone, so we would know what is really going on there. The same goes for the Kawartha Pine Ridge health unit. They didn’t recognize anything either. “

Dr. Jones’ letter was one of the first communications about what was going on at home, but beyond being shared on Facebook, it was not accessible to the general public. “It should have been officially released at that time,” says Seymour-Fagan. “Someone should have done it, and nobody did it. “

The community

Meanwhile, Seymour-Fagan and a few local residents have launched a Bobcaygeon and Area COVID-19 relief fund. In less than a week, more than $ 70,000 was raised. Pinecrest employees also received gift cards for groceries and gas, she said. And community leaders are striving to bring more personal protective equipment to the facility, supplies that Seymour-Fagan said were initially limited. The fund will also be used to support mental wellness counseling for frontline staff and local residents.

Elsewhere in the community, people find different ways to help. Aaron Shaw is a local arborist who has lived in Bobcaygeon for 43 years. For almost three weeks, his work truck served a different purpose. He and half a dozen other locals have delivered free groceries to seniors in the area, making more than 30 deliveries a day.

When he is reached for comment shortly after 9 a.m., he is in his truck, after finishing a delivery, with three others on the way.

“It’s devastating,” he says, of the feeling that reigns in the city. “It is a small community. I’ve never seen anything like it. It’s sad. But the big thing I get out of it is how many people get together. That’s nice to look at. ”

Workers and resident greet cars passing by honking their horns to support Pinecrest Nursing Home after the deaths of several residents and the deaths of dozens of employees suffering from coronavirus (COVID-19) in Bobcaygeon, Ontario, Canada, March 30, 2020 .


Carlos Osorio /

Reuters

The community also gave tablets to other residents of Pinecrest so they could video call their families. Shaw was also behind the live event of the last Tragically Hip concert that aired in the city in the summer of 2016. Before the pandemic, most people, if they knew Bobcaygeon, knew it because of the song eponym .

“We are known as the hip city, but right now, we are known as the epidemic center of it all,” he says. “But we will be known again as the trendy city. Listen to me carefully. “

The downtown strip is empty now. Some residents are still afraid to leave their homes. Many do not know how far the virus has spread and how safe it can be.

Many local Bobcaygeon businesses are seasonal and depend entirely on the summer rush. Like everything else, we still do not know what impact the coronavirus will have on the usual tourist season.

“There is so much information coming in, so we work in a group and we find it helpful to support each other and share information and knowledge that we can then pass on to our local businesses,” said Denise Benning-Reid. , director of the Bobcaygeon Chamber of Commerce. “But there is so much community support and love that flows from it. It’s a very Canadian thing. “

The Pinecrest crisis has altered any sense of normalcy, and an investigation may take place in the coming months, but the determination of the community remains intact.

Last Sunday, The Tragically Hits, a local cover group, organized a community-wide concert. Shortly before 6 p.m., community doors began to open. People gathered on their porches, in their alleys, in the middle of barren streets, and their voices carried the eponymous song that the nation has come to know.

Just a few summers ago, the heart of downtown was packed with thousands of locals and cottage owners, all gathered to celebrate the hip and spirit of this small town. That evening, the Hip waited in the depths of their set to scrape these familiar chords. The summer sky had passed to the deep blue of the ocean, and the street was illuminated by the image of Gord Downie and alive with the sound of his voice. When he stopped singing, the crowd continued.

Their voices echoed throughout the night as the nation listened. One day they will echo again.

National Post

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