Ontario nurse explains how COVID-19 enters nursing homes, then hits health care workers

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As weeks passed in March and cases of COVID-19 in Canada continued to escalate, Pamella began to worry about residents who came and went from the long-term care facility where she worked.

The Licensed Practical Nurse has cared for elderly residents of the 126-bed Rekai Center at Sherbourne Place in Toronto for 16 years, administered their medications, hooked them up to dialysis machines and answered calls from loved ones.

It was common for these clients to leave for therapy sessions or medical appointments. In the midst of a pandemic, Pamella feared that constant back and forth would endanger everyone.

In mid-March, the 54-year-old naïve – whose CBC News identity protects her because of job security concerns – began warning fellow COVID-19 workers that she was clearly spreading through the city. She felt that the home should cancel outside dates for a while and stop taking new admissions as well.

Instead, Pamella says a resident has been sent downtown for his regular therapy appointment at the Center for Addiction and Mental Health – an establishment that has since reported several outbreaks.

The man started coughing on March 19. Just over a week later, the test results showed that he had the virus.

“In the back of my head, I think, ‘Oh my God,’ recalls Pamella.

Married and the mother of three, she didn’t want to risk catching the life-threatening illness and bringing it home – but it was already too late. The man had mingled with his fellow citizens in the Rekai center for days before his cough started, and the staff members were not wearing full protective gear while caring for him until what he manifests symptoms.

As Pamella says: “We were already exposed. “

Shortly after the resident’s results returned, Pamella started to experience a fever, with a bit of a headache. Maybe it was nothing, she thought. She also started to sneeze.

On the last Sunday in March, she went to downtown St. Michael’s Hospital in downtown Toronto for testing.

Four days later, the results came back positive. Pamella had COVID-19.

More than 2,700 healthcare workers infected

We are now at the beginning of May and the COVID-19 crisis in Canada is still in full swing. Here in Ontario, approximately 18,000 people have become ill and 1,300 have died, while others may be infected without even knowing it.

Health care advocates warned that frontline workers were among the most at risk at the start of the pandemic, amid concerns over shortages of personal protective equipment and memories of the staggering number of hospital workers at the hospital. the SARS epidemic in 2003.

The predictions turn out to be correct. Although it is not known where every healthcare worker is infected, the number of positive cases continues to increase – reaching 2,761 confirmed cases by May 4, according to the province.

So far, at least five of these infected front-line workers have died, and front-line workers increasingly constitute a larger part of the grand total.

In early April, about 10% of cases in Ontario were people working in health care, including doctors, nurses and personal support workers, as CBC News first reported times on April 2 (the province did not start reporting this detail in its daily epidemiological summary until April 5).

Today, a month later, health workers account for 15.4% of all cases.

The nurse felt “head to toe”

After joining the growing number of workers tested positive, Pamella remained isolated, avoiding contact with her husband and her youngest adolescent son, who still lives at the couple’s home in Whitby.

Alone in a room as March turns into April, Pamella faced headaches and the occasional cough as her mind filled with all the reports she had seen on patients dying from the disease.

She also noticed that her mild, cold symptoms were evolving into something stranger.

There was a bitter taste in his mouth. And his appetite is gone. As a diabetic, Pamella continued to drink juice while staying in bed, hoping to make sure her sugar did not drop as she did not eat regularly.

The scariest symptom, she says, was a devouring dizziness.

Around the clock, Pamella had to stand on her bed, otherwise it would feel like the room was spinning around her.

“All I thought was,” My god. I think I’m too young to die. I have my kids, “she recalls.

Additional support has been provided to some long-term care homes experiencing COVID-19 outbreaks. David Common chats with staff and health workers who are brought in for support to hear what’s going on inside. 3:18

During these moments of private misery, she also learned dark news from parents in New York, where hospitals were overrun with COVID-19 patients. An older family member in Brooklyn had battled the disease and survived, Pamella discovered. A second parent, only in his thirties, found himself under ventilator in intensive care and died later.

Pamella kept remembering to stay strong, take a sip of juice, or eat a small snack if her body felt weak – all to maintain some control over the virus that made her feel “headache” at the feet “.

Her husband also took time off to keep an eye on her and found that he could not sleep while she was locked in another room. Most nights, he told her later, he quietly opened her door while she slept just to make sure their worst fears hadn’t been realized.

“Sometimes I would turn and look,” said Pamella, “and he would just ask,” Are you okay? “”

17 residents died at Rekai Center

While Pamella was sick at home, the situation at the Rekai Center in Sherbourne Place deteriorated rapidly.

The new coronavirus has spread throughout the downtown facility, infecting at least nine staff and 52 residents in just over a month, according to data from Rekai and Toronto Public Health.

To date, 17 of these clients have died, including the first ill resident who tested positive on March 27.

Sue Graham-Nutter, CEO of Rekai Centers, said the first resident who showed symptoms of COVID-19 was immediately placed in isolation, tested and “monitored 24 hours a day”.

In a statement to CBC News, she also said that all staff wear full personal protective equipment while caring for residents who test positive.

Since mid-March, adds Graham-Nutter, “only one resident” has left the facility and this trip was for “critical medical appointments.”

To date, 17 residents of the Rekai Center at Sherbourne Place have died from COVID-19 since the first ill resident tested positive on March 27. (Jon Castell / CBC News)

When asked if the province could have done it sooner to protect frontline workers, amid concerns over back and forth problems between establishments, Chief Medical Officer of Health Dr. David Williams , said residents would return to a home wearing COVID-19 is “an interesting statement”.

If long-term care residents have health concerns, doctors on site may need to order tests that cannot be found in the facility, he noted.

Others point out that there are many interconnected issues that go far beyond a single policy or facility, given the hundreds of epidemics reported in long-term care homes and hospitals across the province.

Planning for a pandemic is not “adopted quickly enough”

“The principles of pandemic planning and infection control have not been adopted quickly enough,” said Vicki McKenna, provincial president of the Ontario Nurses ‘Association.

Some front-line workers in various hospitals have been asked to ration and reuse personal protective equipment, while others working in long-term care have experienced extreme staff shortages.

In contrast, McKenna notes, front-line staff at many nursing homes without the outbreaks have documented some common approaches. Most prevented visitors from entering early and checked whether residents should leave for outside meetings. Many also ordered additional supplies, making sure they had a supply of personal protective equipment if things went wrong.

At a broader level, and particularly in the case of private homes, she says it is crucial that the province begins to step up inspections to protect not only residents, but staff who find it difficult to care for. them safely.

A staff member in an Ontario long-term care home wears full personal protective equipment in the midst of an epidemic among residents. (Evan Mitsui / CBC)

As CBC News recently reported, only nine of 626 households in Ontario underwent annual proactive quality inspections in 2019 – down from just over half of the province’s households. previous year, and most of them in previous years.

These full inspections should take place in addition to the complaint-based checks, McKenna said, adding, “I don’t think they should be notified in advance. “

In the midst of the ongoing pandemic, other advocates say that provincial officials must make universal testing protocols mandatory for healthcare workers and their caregivers in order to detect cases earlier.

“Remove long-term care residents with COVID. Take them to the hospital. Protect people who don’t have one in these establishments. Test like crazy to make sure other residents and staff are free from the disease, “said Michael Hurley, President of the Ontario Council of Hospital Unions.

“All healthcare workers in hospitals, long-term care, retirement homes, community care must be tested,” echoed Natalie Mehra, director of the Ontario Health Coalition, an advocacy group. representing dozens of community organizations in support of the public. Health care.

Currently, health care workers have priority at COVID-19 testing sites, and the province is pursuing “proactive surveillance testing” in long-term care homes, including testing for residents and staff without symptoms – although this directive was not sent by the ministry of health until April 21.

To date, more than 31,900 cumulative tests have been done in long-term care homes, and nearly 38% of the resident population has been tested, according to the Ministry of Long-Term Care.

“Some people really hurt”

As officials from the outside world prepared for new epidemics and an increase in the number of cases, Pamella slowly began to feel like her again.

The dizziness subsided and his appetite returned. She even started to experience unusual cravings, such as a sudden desire to snack on pickles.

“If you’re pregnant, it’s not mine! Joked her husband, a moment of lightness that the couple had not known for weeks.

Full recovery from COVID-19 took approximately one month in Pamella. Meanwhile, many of his infected colleagues are still experiencing the terrifying spectrum of symptoms.

“Many of the staff I have been in contact with – some people are really struggling,” she said. “Some people can’t hold anything back. Vomiting. Body pain. “

Pamella, whose CBC News identity has agreed to hide, says in the future, all healthcare facilities and long-term care homes must store lots of personal protective equipment, quickly isolate infected residents and put stronger infection control plans in place. (Evan Mitsui / CBC)

Standing on the wraparound porch of her house, the space where she had come to take a few minutes of fresh air while tolerating isolation at home, Pamella announces with a broad smile that she is officially one of those who “Conquered” COVID-19, after having recently tested negative twice in a row.

She is now looking forward to returning to work in the long term care sector, despite the risks. But she maintains that her employer did not protect front-line workers like her by allowing residents to come and go during the pandemic, which could potentially bring back the virus which has since infected dozens of residents and staff. foyer.

“From the moment this pandemic started … we should have stopped all meetings. They are not urgent. They are not necessary, ”she says.

In the future, all health care facilities and long-term care homes will need to store a lot of personal protective equipment, quickly isolate infected residents and put in place stronger infection control plans, either for this ongoing pandemic or the next flu season, a few months later, says Pamella.

“I want to be a nurse,” she says. “But I didn’t sign up to become a nurse. “

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