VANCOUVER — Canada’s first death from the novel coronavirus has highlighted the urgent and often ignored need for better staffing at long-term care facilities where elderly residents are especially vulnerable to the disease, says the head of the Canadian Federation of Nurses Unions.
Linda Silas said the need has become “top of mind” following the death on Sunday of a man in his 80s at a care home in North Vancouver, where another patient is infected with COVID-19. One of four care aides who contracted the illness there is in hospital and two relatives of another have also been sickened.
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Discussions about preparedness were focused on emergency rooms, critical care and public health units, she said.
“A week ago we were talking about ‘Is the acute-care sector ready?’ ” Silas said.
“Everyone’s now talking about, ‘What about long-term care?’ “
More infections of health-care workers leading to 14 days of quarantine would mean greater staff shortages that could leave frail patients, who often have chronic illnesses, at higher risk, Silas said, adding staffing levels are already affected by outbreaks of seasonal influenza.
“When it hits a long-term care facility it’s always more of a crisis than if it hits even your community or hospital. We’ve always known it’s a fragile population with any kind of illness and this (COVID-19) is one of those where we have to pay particular attention,” she said.
Silas said the federation has recommended 4 1/2 hours of care by registered and licensed practical nurses per day, per resident in long-term care facilities across the country.
The actual level of nursing is about three hours, with some provinces, including Ontario and New Brunswick, among the worst as few nurses choose to work in long-term care jobs, she said.
As well, there are shortages of care aides, also called personal support workers, which adds more stress to a challenging work environment, said Silas.
“The working conditions are very difficult. You’re working short all the time, you’re never guaranteed registered nurses and often your only option is to send your patient to the hospital when often it’s not what they need and what’s best for them,” she said.
“And your personal care workers are not often permanent employees. They work casual or part time and they work in different facilities so there’s always a turnover.”
Doris Grinspun, CEO of the Registered Nurses Association of Ontario, said less than 50 per cent of staff in long-term care homes work in just one facility and support workers are also employed in multiple facilities.
“Some of them work in three places,” she said, adding a government directive during the SARS crisis in 2003 required nurses to work in only one facility to reduce the risk of the virus spreading.
Dr. Bonnie Henry, British Columbia’s provincial health officer, said after announcing the death this week that an infected care aide from the same facility is believed to have worked at two other facilities.
“It’s a challenge with our system, with care homes,” she said. “We know that whether it’s care workers or nurses, even physicians, we work in many different health authorities, many different facilities sometimes. That is part of the ongoing investigation at the Lynn Valley care home, to find out exactly where everybody worked and make sure that the other facilities are investigated.”
Silas said a big concern is the lack of employment insurance sick leave benefits for some support workers compared with nurses.
Business and other labour groups have urged the federal government to ease access to such benefits, which the government appears open to doing, along with tax credits and other breaks as part of the federal response.
Finance Minister Bill Morneau has said the government was “looking at taking some initiatives this week” to help affected workers and the health-care system.
Government sources who were not authorized to discuss the plans publicly said Prime Minister Justin Trudeau is expected to announce federal funding on Wednesday to help provincial health-care systems cope with the new coronavirus.
Jennifer Whiteside, spokeswoman for the Hospital Employees’ Union, said care aides in British Columbia work in a “fragmented” system, with some in part-time and casual jobs at various facilities run by either private contractors or health authorities.
Sick leave benefits may be as few as five to seven sick days a year versus 18 days offered by health authorities, Whiteside said, adding aides having to go into quarantine could face financial hardship because of their lower pay levels.
“Their sick leave will be wiped out. They won’t even have enough to cover one period of self isolation should that become necessary and certainly not enough to cover them should they actually become sick with (COVID-19),” she said.
“If a large number get sick then we’ll be having some challenges. There’s no question that a situation like this does really bring into sharp relief some of the challenges we have in the system around how we manage the care-aide labour force.”
Isobel Mackenzie, advocate for seniors in British Columbia, said the job of care aides has long been undervalued and the novel coronavirus may create awareness about the need for change.
“I think what this is going to highlight, and this is a conversation for after we’ve dealt with the crisis, is the different ways in which these care homes are staffed. We need all licensed care homes to be doing things exactly the same under the direction of the officer of the public health officer,” she said.
“How are we going to deal with the fact that some people are going to get paid while they’re off sick and some people aren’t? How are we going to handle the fact that they are working potentially for multiple employers?”
The issue of care aides who travel to various private homes must also be considered for the safety of the wider community, Mackenzie said.
“That’s where we’re going to have to be ever vigilant around monitoring and managing the situation,” she said. “(They) may be providing (seniors) with their medications that they absolutely need and if we don’t go there they aren’t going to get their medications.”
This report by The Canadian Press was first published March 11, 2020.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
