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How the coronavirus took North Vancouver’s Lynn Valley Care Centre – The Globe and Mail

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The Lynn Valley Care Centre is pictured in Lynn Valley in North Vancouver, on March 16, 2020. All but five of Canada’s 13 coronavirus deaths as of Friday afternoon can be traced to Lynn Valley.

JONATHAN HAYWARD/The Canadian Press

Ruth was outraged when the colleague she was driving to work told her rumours were flying that a nurse at their North Vancouver care home had tested positive for COVID-19.

“I said, ‘What? They have coronavirus here? Why didn’t they let us know? What are we going to do now?’”

Ruth, an aide at the facility, recalls her conversation as they pulled into the facility for the graveyard shift on the night of Thursday, March 5.

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Ruth immediately asked her supervisor of the wing of the Lynn Valley Care Centre known as “the lodge” about the concerning rumour. Ruth says she received no special instructions for the next eight hours.

As the sun rose on Friday, March 6, a half dozen concerned aides and nurses waited around after their shift to press the director of care about whether COVID-19 had arrived at the North Vancouver nursing home.

The director confirmed that, the day before, their co-worker had tested positive. The staff, almost all middle-aged Filipina-Canadians, were shocked and then angered.

“’The only thing you need to do is wash your hands – wash your hands,’” is what Ruth recalls the director telling everyone. Ruth seethed.

“Why didn’t you let us know?” she asked.

To mitigate any potential spread of the virus, staff cut out the communal breakfast on the second floor of the lodge and began “tray service,” delivering meals to rooms there, according to Ruth, a staff member who would later test positive for the virus, told The Globe. She spoke on the condition of using a pseudonym because she was worried about losing her job and ashamed of the stigma associated with the virus.

As panic set in among staff at the 200-bed facility, nurses scrambled to swab three residents showing symptoms of the virus that day and sent the samples off to be tested, according to other staff members who spoke with The Globe. After the morning shift was done around 2 p.m., the director of care held a more formal meeting and told a larger group of employees that their co-worker, whose last day at Lynn Valley was a week earlier on Feb. 29, had just tested positive.

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Anyone with flu-like symptoms needed to stop working and get tested, she added.

Two days after receiving word that the virus had reached the care home, British Columbia’s Provincial Health Officer Bonnie Henry stood before a scrum of reporters on March 7 to declare an outbreak at the facility due to the novel coronavirus. Two residents and one health-care worker had tested positive for COVID-19.

“This is one of the scenarios that we have been, of course, most concerned about,” Dr. Henry said.

The next day, March 8, one of the residents would die, becoming the first person in Canada to succumb to COVID-19. In the ensuing two weeks, another seven would die, and 36 residents of the facility and 18 health-care workers linked to it would be infected by the virus.​

All but five of Canada’s 13 coronavirus deaths as of Friday afternoon can be traced to Lynn Valley, where the average age of residents is roughly 87 years old.

The fatal outbreak marked a grim turning point in the country’s battle against COVID-19. The province reacted by prohibiting all but essential visits to long-term care homes while acknowledging that the increased isolation could damage the delicate mental health of many seniors.

The local health authority, which has direct oversight of the provincially funded facility, is still piecing together how and when the virus was introduced into Lynn Valley and why it spread so quickly.

To understand what was happening there in the days before Canada’s deadliest outbreak, The Globe reached out to workers and families of people either killed by the virus or still living at Lynn Valley. Five workers spoke to The Globe, but all of them, like Ruth, did so on the condition of using a pseudonym. Their accounts offer a glimpse into how easily the highly contagious virus can devastate a nursing home, the form of housing in Canada that appears most vulnerable in this global pandemic.

The local Sherkat family has long owned the nursing home, and their company North Shore Private Hospital Ltd. was incorporated in 1985 to run the facility.

In a full-page letter sent from the nursing home’s e-mail account, an unnamed representative detailed how heartbroken everyone at the facility is at the mounting death toll.

“We are deeply thankful to each and every member of our staff, and their families, for their tireless and continued efforts to keep residents safe, and ensure we get through this difficult time together,” the letter stated. “The Lynn Valley Care Centre has been in operation since 1963, and under the same ownership since the mid 1980s.

“Our residents, their families, our staff, and their families feel like part of our family.”

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The letter stated the centre is meeting daily with local health officials and is concentrating all its efforts on stopping the current outbreak and minimizing its harms. Once the world is “on the other side of the COVID-19 emergency,” the centre said it is committed to commissioning an independent review into how events unfolded on its property and sharing as much as possible of the resulting report into the outbreak.

The crisis in North Vancouver has revealed the devastating toll that the virus is having on the elderly, as well as those who care for them. The precarious nature of employment in many private nursing homes may have also contributed to the spread of the coronavirus.

Many employees in the sector supplement their low wages by working at multiple facilities – an arrangement that has already led to one Lynn Valley employee being suspected of spreading the virus to a second long-term care home in nearby West Vancouver. This week, the province announced the virus has also infected a resident at a third nursing home, Haro Park Centre in Vancouver.

The workers who spoke with The Globe worry that the weak initial response by management and the health authority will inflate the ultimate death toll.


Lynn Valley Care Centre sits midway up the striking North Shore, nestled in between Grouse and Seymour mountains, which attract hikers, mountain bikers and skiers throughout the year.

The private facility houses 139 government-subsidized beds and 65 private pay rooms and suites in a wood-framed lodge and a newer and much larger concrete tower called “the manor.” The outbreak has so far been contained to the lodge, which contains roughly half the units at Lynn Valley.

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The Sherkat family has had no recent complaints or outbreaks of any kind, according to an October, 2019, report from the province’s seniors advocate, whose role is to monitor seniors services and make recommendations to government and service providers to address systemic issues.

Two-thirds of Lynn Valley’s residents live with some degree of dementia and about 58 per cent receive medication for depression, which is 10 per cent higher than the B.C. average, according to the 2018-19 annual report from the independent provincial watchdog.

A third of B.C.’s 27,000 provincially funded nursing-home units are owned and operated by the various health authorities in the province. The rest are run by non-profit organizations and for-profit companies contracted by these health authorities.

The wages and working conditions in the sector vary greatly between the different homes.

Long-time workers at Lynn Valley say they once were unionized, but over the past decade or so have been rehired by subcontractors that offered less money and rolled back benefits for the people who clean the facility, prep and bus meals in the communal dining room, and feed and bathe residents.

Nurses in the province’s long-term care homes have stayed unionized over the past 20 years, as stipulated under provincial legislation that opened up the possibility of privatizing those services.

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Lena, a long-time aide at Lynn Valley, says management there ditched an agreement with her union several years ago and the private firm that rehired her to do the same job paid her $2 less an hour and cut the number of sick days she was allowed each year from 10 to three. Vacation days – a potential buffer for sickness – were also cut from 22 days a year to 10, according to Lena.

The chief executive of her Vancouver-based employer, Carecorp Seniors Services, deferred any comment to Vancouver Coastal Health (VCH), the Lower Mainland health authority.

She has three sick days a year, which is why, when she finished her shift on Feb. 29 and felt a cold coming on strong, she decided to take just two days off before returning to work.

“We don’t have enough sick time,” Lena said. “Even if people are sick, we are still working, and that’s the truth.”

Lena (not her real name) poses for a photograph in her apartment window. Lena is a medical worker at the Lynn Valley Care Home, the centre of B.C.’s first COVID-19 outbreak. She asked that her real name not be used because she fears being fired for speaking out about how the care home managed the outbreak.

Jesse Winter/The Globe and Mail

After working the first day with a stubborn fever, Lena visited a North Vancouver walk-in clinic, where a doctor checked her lungs, ears, throat and temperature before diagnosing her with the flu.

Lena, who regularly remits money back to her family in the Philippines, continued working, but her illness kept getting worse. Her fever was paired with a dry, nagging cough and a troubling shortness of breath.

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It was apparent residents were sick as well: Those on the second floor of the lodge were asked to stay in their rooms on the evening of Thursday, March 5, according to several workers.

There were whispers among them that the coronavirus had reached Lynn Valley, but Lena wasn’t notified formally until the Friday afternoon meeting with the director of care.

Lena’s heart sank. She suspected she had been infected, too. The following day, she went to a hospital close to her home, where she explained her situation and was given a nasopharyngeal test – an uncomfortable swab of the nose and upper throat – for the coronavirus. At that point, the virus was confirmed to have infected around 20 people in B.C.

“Deep inside my heart, I knew I was positive because I had pneumonia and pneumonia is one of the serious symptoms,” said Lena, whose test later proved her hunch correct.

She was afraid for her friends and co-workers, some of whom she carpooled with. When Lena called in sick that weekend, she was joined by several other colleagues now self-isolating with symptoms consistent with COVID-19.

On Saturday, Dr. Henry, the province’s top health official, declared an outbreak at the Lynn Valley Care Centre. Two residents and one health-care worker had tested positive.

“This is one of the scenarios that we have been, of course, most concerned about,” Dr. Henry said.

Short-staffed, some subcontractors offered double wages to entice people to come back to work, but there were few takers and the facility limped along without a full complement of workers that weekend, according to several staff members and relatives of residents who spoke with The Globe.

As signs were posted to the care home’s doors warning of an outbreak and a team from VCH arrived on site to assess everyone on Saturday, March 7, worried family members of residents helped frazzled health-care workers with feeding and other duties.

Signs posted to the doors of the Lynn Valley Care Centre warning of a coronavirus outbreak.

Jesse Winter/The Globe and Mail

VCH personnel helped the nursing home try to stop the spread of the virus by implementing an outbreak protocol that ended communal meals in the lodge’s dining room and suspended recreational exercises.

In a letter sent to residents and their families that day, VCH’s deputy medical health officer, Mark Lysyshyn, said those with COVID-19 had been isolated to their rooms. The facility would still accept visitors as long as they were not sick, restricted their visits to one room or resident and obeyed all infection-control signage posted around the facility.

Bold letters emphasized a promise: “Residents who develop symptoms will receive the care that they need.”

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At Dr. Henry’s news conference, it was revealed that the facility first appeared on health investigators’ radar two days earlier, after a woman with no recent travel history was confirmed to have COVID-19 – the first confirmed case of community spread in B.C. She had earlier visited her physician, complaining of flu-like symptoms, and was administered a COVID-19 test, which had recently been added to the province’s regular influenza surveillance in efforts to pro-actively detect cases of the new disease.

The health investigators then learned she was a health-care worker at Lynn Valley.


That Sunday, March 8, staff reported the situation getting increasingly dire.

Around 1 p.m., Janine, an aide, brought an egg salad sandwich into the room of an elderly woman and was startled to see a tray of toast and scrambled eggs laying untouched and out of reach. The bedridden woman beamed up at her with gratitude, but Janine couldn’t help bursting into tears as she began feeding her lunch.

After, in the dining room of the lodge, Janine and the two other workers on shift confronted their manager as to what the plan was for dealing with the nearly 50 residents on one floor of the building, some of whom hadn’t been fed or helped to the bathroom for many hours.

“I don’t know,” her boss said as she herself wept. She explained that their subcontracted company had not received any guidance from management. Janine thought that was strange, given that she had seen an official with the local health authority buzzing around earlier that Sunday with a public health nurse and the home’s director of care.

Another sign of the chaos, she noticed, was that a trio of relatives were pitching in to help feed the remaining guests of the lodge, despite VCH’s warning that any guests needed to restrict their visits to a single room or resident. Still, she was grateful for their help that Sunday because many of her co-workers stayed home battling symptoms of the virus.

That Sunday evening, a resident of the facility, an 83-year-old liked by everyone, became the first in Canada to die of COVID-19.

His daughter Kelly, who asked that her real name not be used to protect her deceased father’s wish for privacy, said her dad loved nothing more than gardening in the acidic soil of North Vancouver or strolling through the local mountain paths with their family dog. Though he was frail and often battling one ailment or another, he was lucid enough to understand what was going on around him.

“He was very weak, but he still said ‘please’ and ‘thank you,’ ” Kelly told The Globe last week in a phone interview.

Her mother knew something was wrong at the nursing home when she went to visit her husband that Friday and was told now may not be the best time.

On Saturday, someone at VCH called Kelly, her dad’s second family contact, to tell them he had tested positive.

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By Sunday afternoon, his condition had deteriorated rapidly. When Kelly and her brother donned full protective gear to enter his room, they saw him connected to a ventilator struggling to breathe, hours away from death.

She said the exhausted staff on site at the lodge that Sunday were incredible in their attempts to help the residents, but the understaffing gave the building the feeling of a ghost town.

“If you’re trying to serve more people than they really can and every time they have to go into that particular room and another you’ve got to suit all up to give them some water – it’s just not happening,” Kelly said of the overwhelmed facility.

For a while, she had known the next common cold could fell their father, so his death at the hands of the coronavirus was not inconceivable.

“The saddest part, given his age, given his frailty, is just thinking there was any fear or discomfort that was unnecessary because of the lack of levels of care,” Kelly said. “But maybe he can be the one contribution to improving the level of care in these homes. … [Staff] are run off their feet, there’s not enough of them.”

The next day, Monday, March 10, Dr. Lysyshyn of VCH issued another letter to families of residents at the centre’s lodge, expressing sadness over the death.

“As a family member to one of the residents at the lodge, we understand that this is concerning information,” he wrote.

He explained that the lodge was under outbreak precautions and that a medical health officer was working with staff to ensure appropriate infection-control precautions were in place.

By that point, health officials had revealed that two more residents and an additional health-care worker at the facility had tested positive. Friends and family of the nurse who first tested positive also were notified that they had the virus. Medical officials are working to determine how the virus was introduced into the care home.

Cleaning staff outside the Lynn Valley Care Centre on Monday, March 16, 2020.

JONATHAN HAYWARD/The Canadian Press

When word that a Lynn Valley staffer had tested positive began circulating in the community, people began speculating about how it happened, said Christine Sorensen, president of the BC Nurses’ Union, which represents several licensed practical nurses at the care home.

“There were some criticisms from members of the public about whether the nurse had brought it in, or if they were bringing it out into the community,” she said.

“Some of [the nurses] couldn’t get rides to work. Taxis wouldn’t pick them up to go to Lynn Valley, or come to pick them up from Lynn Valley to go home. Some members had difficulty finding child care because once they were known that they worked at Lynn Valley, then their children were asked to be excluded from child care.”

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On March 12, Dr. Henry delivered further bad news. “Most concerning for us is we do now have a second long-term care home that has an outbreak that is involved with COVID-19,” she said.

A resident of the Hollyburn House Retirement Residence in West Vancouver, a man in his 90s, had tested positive for the disease, she said. A health-care worker who worked shifts at both facilities had accidentally spread the virus.

The day after the first resident died, Gordo Bone pulled his anxious 85-year-old mother out of Lynn Valley after a short stint recuperating from a bad fall. He brought her back to his home in Pender Harbour on B.C.’s Sunshine Coast, where she is isolating now without symptoms. His dad is also asymptomatic, but the 87-year-old remains in the care home, where he has been staying on a more long-term basis.

Both were living in the newer and larger manor building.

Mr. Bone said that when he visited his parents at the outset of the outbreak, the centre seemed short-staffed with care providers working double shifts, but that has since improved. Additional safety protocols have been put in place – visitors are restricted and meals are taken to all residents’ rooms to avoid communal dining, he said.

And the front-line staff – or “heroes” as he calls them – are doing their best to stop the potential spread of the virus among the remaining residents. But that is hard because many residents are suffering dementia and other debilitating conditions, he said.

An elderly woman sits in a room at the Lynn Valley Care Centre on Saturday, March 14, 2020.

DARRYL DYCK/The Canadian Press

Roger Wong, a clinical professor in geriatric medicine at the University of British Columbia, said seniors are more vulnerable to developing infections in part because immune function declines with age. As well, underlying health conditions may predispose them to developing infections more easily.

“Seniors who live in seniors homes are intrinsically more at risk,” Dr. Wong said.


The outbreak at Lynn Valley had one other impact on the health-care workers. A directive, confirmed by Dr. Henry, to only work at one facility – a measure aimed at mitigating the spread of the virus – meant that those who worked casual shifts in more than one setting suddenly had their income slashed.

“We’re looking at the impacts at that,” said Ms. Sorensen, of the nurses’ union, “not only on staffing numbers – because if you don’t get to work in the other facility, that reduces the number of nurses in that other facility, which could compromise patient care – but also the financial impacts if nurses aren’t able to work in both of their facilities.”

For Lena, the Lynn Valley staffer still battling the virus while quarantined in her own home, this crisis shows how urgently the sector needs to be reformed to improve wages and benefits such as sick days and vacation time. That would cut down on workers travelling to multiple facilities in a day, she said.

“This is the right time for us to come together so the government will see the situation of the health-care workers who are the front-liners who work hard,” she said.

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Carecorp Seniors Services, a dietary aide subcontractor, directed all media queries to Vancouver Coastal Health. Pro Vita Care Management Inc., a care aide subcontractor, and WestCana Services Inc., the company contracted for housekeeping duties at Lynn Valley, did not respond to interview requests.

In a statement to The Globe, VCH said Lynn Valley is operating “very near target staffing levels” and that the health authority is working with the operator to add additional staff as needed. “We recognize the stepped-up outbreak response precautions delayed the delivery of some services, including meals,” the statement said. “We’re committed to providing residents the care they need and we thank the families for their patience, kindness and understanding.”

JONATHAN HAYWARD/The Canadian Press

Janine, an aide at Lynn Valley, said she has more pressing concerns than whether her pay will one day increase.

Her husband also has tested positive for COVID-19 and the couple is now trying their best to stop their seven-year-old son from contracting the virus while isolating him to a separate room of their two-bedroom basement suite.

“No one is helping my son,” she wrote in a text message exchange Wednesday. “I’m still preparing his food. I just washed my hand and don’t talk without mask on.

“I’m just thankful my son has a good immune system.”


A timeline of the COVID-19 outbreak at Lynn Valley Care Centre

February 29: Nurse who would later test positive works her last shift at the North Vancouver facility known as Lynn Valley Care Centre.

March 5: Provincial Health Officer Bonnie Henry announces that a woman in her 50s with no recent travel history or known links to confirmed cases has tested positive for the new coronavirus. This makes her the first confirmed case of community transmission in B.C. – and evidence that the virus is spreading undetected. That evening, rumours swirl among staff at Lynn Valley that the virus had arrived at the facility.

March 6: A half-dozen concerned aides and nurses at Lynn Valley confront the centre’s director of care at the end of the graveyard shift. The director confirms that one of their co-workers had tested positive. The others are shocked and angered to learn the news this way. A more formal meeting is held that afternoon.

March 7: Dr. Henry announces an outbreak at Lynn Valley Care Centre. Health officials tracing the contacts of the woman who tested positive two days earlier had learned she was a health-care worker at the centre. There, they find two residents are also positive for the virus. The local health authority dispatches a team to assess people on site and implement outbreak protocol.

March 8: One of those residents, an 83-year-old man, dies. He is the first person in Canada to die of COVID-19.

March 9: Dr. Henry announces the man’s death at a news conference. Another health-care worker at Lynn Valley tests positive, as well as two close contacts of the initial health-care worker.

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March 10: Two more health-care workers at Lynn Valley test positive: a woman in her 40s, and a woman in her 50s.

March 11: Another two health-workers are confirmed to have the virus. They are a man in his 20s and a woman in her 50s.

March 12: An outbreak is declared at Hollyburn House Retirement Residence in West Vancouver, where one resident and one health-care worker have tested positive. Health officials confirm it is linked to the outbreak at Lynn Valley.

March 13: An outbreak is declared at Lions Gate Hospital in North Vancouver, where three administrative staff tested positive for the virus. They have no known link to Lynn Valley, and had no regular contact with patients. Another close contact of a Lynn Valley worker tests positive.

March 14: Five more cases linked to Lynn Valley are confirmed. By now, four residents and a dozen staff members have been infected. Due to a soaring number of cases in the province, the B.C. government has stopped providing details of individual cases.

March 16: Three more residents of Lynn Valley die. Lions Gate Hospital escalates its outbreak response and accepts only emergency patients.

March 17: Two more Lynn Valley residents die.

March 18: A resident of Haro Park Centre, an independent housing, assisted living and long-term care centre in downtown Vancouver, tests positive.

March 19: Another Lynn Valley resident dies.

March 20: Asked about cases at the care home, Dr. Henry said 36 residents had tested positive to date, and eight had died. As well, 18 health-care workers at Lynn Valley had tested positive but all of those cases were mild. A new outbreak was declared at the Dufferin Care Centre in Coquitlam, where a staff member tested positive.

If you have further information about this story, please email mhager@globeandmail.com and andreawoo@globeandmail.com.

With research from Stephanie Chambers and Rick Cash

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COVID-19 likely to kill thousands in Canada even with tough measures – Ottawa Sun

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TORONTO — Amid crippling job losses across the country due to COVID-19, the federal government on Thursday warned the number of Canadians killed by the novel coronavirus would likely double over the next week and could reach thousands over the course of the pandemic.

If stringent measures remained in place, the country’s top public health officer predicted the virus could cost at least 4,400 lives over its course. Had such controls not been implemented, models indicate as many as 80 per cent of the population could have been infected, with as many as 350,000 deaths.

“These stark numbers tell us we must do everything we can now to remain in that best-case scenario,” Dr. Theresa Tam said in a sombre presentation. “We must minimize the population infected … in order to keep deaths, ICU admissions and hospitalizations as low as possible.”

In response to the projections, Prime Minister Justin Trudeau said it would take months of determined effort to temper the worst outcomes. Canada, he said, was at a crossroad, and how scrupulously people observed isolation measures would determine what happens.

“We are going to continue to lose people across this country in the coming weeks,” said Trudeau, who noted normal was still a long way away. “We will not be coming back to our former normal situation; we can’t do that until we have developed a vaccine and that could take 12 to 18 months.”

Tam said the spread of the virus appeared to be moderating somewhat and that Canada could bring the epidemic under control by the end of summer if social distancing and other measures were strictly adhered to. With spotty controls, she said, we could still be battling the tail end of the pandemic a year from now.

The number of Canadians infected with the flu-like virus passed the 20,000 level on Thursday, with 504 deaths. Quebec, with almost 11,000 cases, reported 41 new deaths, 216 in all. Ontario said the virus has killed 200 people so far — an increase of 26. The new total of infections in the province is 5,759 others. One death was a worker at a hospital in Brampton, Ont.

Globally, the flu-like pandemic has infected more than 1.5 million people, about 93,000 fatally, according to latest international data. The U.S. appeared to become the country with the highest number of known COVID deaths in the world — more than 15,000 — with New York State alone having more cases than any country excepting the U.S. itself.

Given the bleak American situation, Tam said keeping the common border closed to all but essential traffic was critical.

“We are different from what is happening in the United States in terms of their epidemiology,” Tam said. “We want to be able to stay within that epidemic control curve that I presented today, so we’ll be doing everything that we can.”

Experts say frequent hand-washing and keeping at least two metres from others is the most effective way to curb the pandemic and ease the burden on the health-care system.

The isolation measures — governments and health authorities have either urged or ordered people to stay home and non-essential businesses to close — have brought commercial life to its knees.

Just how deep the restrictions cut was seen when Statistics Canada reported on Thursday that more than one million people lost their jobs in March. The result was a 40 per cent jump in the monthly national unemployment rate to 7.8 per cent, up from 5.6 per cent at the end of February — a “punch in the gut,” as Ontario Premier Doug Ford put it.

People aged 15 to 24 took the biggest brunt, with unemployment jumping to 16.8 per cent — a 63 per cent increase.

The spike was the worst showing in 40 years of data gathering and the April situation was expected to be even worse, economists warned.

The federal government said more than five million people had applied for the government’s emergency jobless benefit.

One glimmer of light did emerge job-wise: WestJet said it would put 6,400 employees bank on payroll with help from Ottawa’s wage subsidies. Air Canada had similarly said 16,500 of its laid-off employees were taking advantage of the program.

The latest numbers on COVID-19 in Canada

The latest numbers of confirmed and presumptive COVID-19 cases in Canada as of 6:20 p.m. ET on April 9, 2020:

There are 20,765 confirmed and presumptive cases in Canada.

— Quebec: 10,912 confirmed (including 216 deaths, 1,112 resolved)

— Ontario: 5,759 confirmed (including 200 deaths, 2,305 resolved)

— Alberta: 1,451 confirmed (including 32 deaths, 592 resolved)

— British Columbia: 1,370 confirmed (including 50 deaths, 858 resolved)

— Nova Scotia: 373 confirmed (including 2 deaths, 82 resolved)

— Saskatchewan: 278 confirmed (including 3 deaths, 88 resolved)

— Newfoundland and Labrador: 236 confirmed (including 3 deaths, 96 resolved)

— Manitoba: 207 confirmed (including 3 deaths, 69 resolved), 17 presumptive

— New Brunswick: 111 confirmed (including 50 resolved)

— Prince Edward Island: 25 confirmed (including 17 resolved)

— Repatriated Canadians: 13 confirmed

— Yukon: 8 confirmed (including 4 resolved)

— Northwest Territories: 5 confirmed (including 1 resolved)

— Nunavut: No confirmed cases

— Total: 20,765 (17 presumptive, 20,748 confirmed including 509 deaths, 5,254 resolved)

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'Different than anything we've seen': ICU doctors question use of ventilators on some COVID-19 patients – Simcoe Reformer

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Some are now asking, can we stave off ventilating some patients, and increase the chances of people being discharged from hospital alive?

It started in New York City, in the trenches in the battle against COVID-19. Stressed doctors began worrying that the breathing tubes and pressures being used to open up the tiny air sacs in the lungs of the critically sick could be causing worse harm.

Some are now asking, can we stave off ventilating some patients, and increase the chances of people being discharged from hospital alive?

“In many ways, it’s different than anything we have seen before,” Dr. James Downar, a specialist in critical care and palliative care said Thursday from inside an ICU at The Ottawa Hospital dedicated to critically ill COVID-19 patients. On Thursday, the unit was full.

The pandemic virus seems not only to affect the lungs, making them stiff and inflamed, but other parts of the body as well, including the heart. It’s not clear if it’s a direct effect of the virus on the heart that’s causing heart failure in some cases, or if it’s because the virus is playing with the body’s coagulation system, increasing the risk of blood clots.

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It’s different in another way, too: In a phenomenon reported in the U.S., as well as Italy, and, now, Canada, some patients with severe COVID-19 are arriving in hospital with such low blood oxygen levels they should be gasping for breath, unable to speak in full sentences, disoriented and barely conscious.

Except they’re not in any sort of distress, or very little distress, compared to the burden of illness. They’re talking. They’re lucid. It’s not the classic acute respiratory distress syndrome doctors are used to seeing, and that most guidelines recommend doctors treat as such. One Brooklyn critical care doctor has likened it to high altitude sickness and is urging his colleagues to be cautious about who is being ventilated, and how. The concern is that the pressure may be harming lungs, and that some patients could be more safely treated with less invasive means such as high-flow nasal oxygen.

“To think that we understand this infection, I think is very naive,” Dr. Ashika Jain, an associate professor in trauma critical care and emergency ultrasound at New York University/Bellevue Hospital Center said on a recent  REBEL Cast podcast. “There are so many different theories about how this is behaving. There’s no one cohesive picture. We don’t really understand how to really treat this, because it’s a four-month old virus that we just don’t understand how it’s already running when it didn’t really learn how to walk yet.”

With some Ottawa patients, “we’re giving them all the oxygen we can give them without putting them on a breathing machine, and they’re wide awake and talking,” Downar said. In some situations, people are being flipped onto their stomachs, into the prone position, to improve gas exchanges.

High-flow nasal oxygen, where little plastic tubes are placed in the nostrils, can deliver up to six times the amount of oxygen. “And those high flows actually generate a little bit of positive pressure within the patient’s upper airway, which helps keep the lungs open and improve the oxygen levels in the blood,” said Dr. Claudio Martin, a critical care physician and medical director of critical care at London Health Sciences Centre and Western University.

“The problem with that is, when you’re giving oxygen with such high flows, there is a high possibility the viral particles in the airways are being aerosolized, so you can increase the possibility of spread of the virus in the environment,” Martin said. “Which is why if we do use that it has to be in a negative pressure environment, so that you contain the air in the room. You basically try to contain any virus particles that are aerosolized.” It also means any staff  looking after the patient need to be wearing N95 masks.

It’s not the classic acute respiratory distress syndrome doctors are used to seeing

While the vast majority, some 80 per cent of infections, are mild, the COVID-19 virus can cause pneumonia, which interferes with the ability of oxygen to get in through the lungs, and into the bloodstream. Currently, about six per cent of confirmed cases in Canada have required admission to an ICU.

A ventilator does two things: it provides oxygen as well as pressure to open up the alveoli, the little lung units, to allow the lungs to get oxygen in, and carbon dioxide out. While potentially life saving, it can worsen lung injury.

The strategy, for now, is not to rush to intubate, said Downar, who led the drafting of an Ontario “triage protocol” if hospitals are forced to ration ICU beds and ventilators. “Unless somebody seems to be failing, or their oxygen level is truly at this critical life-changing level, we can maybe hesitate,” Downar said. Even when the decision is made to ventilate, in some cases, “you almost end up having to talk them into it, which is a very unusual situation.”

“But let me be explicitly clear here: These are still the exceptions. The majority are failing … They need to have a tube put down (their throats) and put on a breathing machine to help them breathe.”

It’s not clear what proportion will be discharged alive.


A tube from a ventilator on a sedated patient infected with COVID-19 at the intensive care unit of the Peupliers private hospital in Paris, April 7, 2020.

Thomas Coex/AFP via Getty Images

A study published this week in the Journal of the American Medical Association involved 1,591 people infected with the pandemic virus admitted to ICUs in the Lombardy region of Italy between Feb. 20 and March 18. A high proportion — 88 per cent — required mechanical ventilation. As of March 25, 26 per cent of the ICU patients had died, 16 per cent had been discharged, and 58 per cent were still in the ICU. The median age was 62; 82 per cent were men.

British Prime Minister Boris Johnson remained in an ICU Thursday, where his condition reportedly continues to improve. The 55-year-old is not on a ventilator; according to a spokesman, he’s receiving standard oxygen therapy.

People who have been ventilated have described the experience as awful beyond belief.

The person is sedated, so that they’re calm. “Sometimes you have to relax the breathing muscles so they’re able to open their mouth and accept the tube being inserted,” said Dr. John Granton, head of the division of respirology at Toronto’s University Health Network- Sinai Health System. “If they’re incredibly sick we need to take over their breathing completely, and so we fully sedate them,” meaning a medically induced coma.

“We don’t allow them to wake up from that anaesthetic until their lungs have healed. And then once they’ve healed, or if they’re not that sick, we can allow them to be reasonably aware,” Granton said.

If this ever happened to me, this is what I would not want to look like at the end

With a tube down their throat, however, they can’t speak. They have to communicate by using a board, or moving their lips. “We’ve become expert lip readers in the intensive care unit,” Granton said.

From the experience with H1N1 and SARS, it can sometimes take several weeks, or a month or more for people to recover to the point they can be “liberated” from the machines. For some with a significant underlying condition, like chronic obstructive pulmonary disease, there’s a risk they may never come off.

If nothing else, the pandemic should be encouraging discussions about what people value in life, Granton said, including conversations such as, “If this ever happened to me, this is what I would not want to look like at the end.”

With hospitals in COVID-19 lockdown, families aren’t allowed inside the ICU. Normally, they’re at the bedside. “We’re trying to update them by phone, we’re trying to do Facetime,” Downar said. “To have to see a critically ill family member through a video call and have your questions answered by somebody wearing a face mask … it’s not the way we like to do things. But it’s better than nothing.”

“We’re tired, but this is our job,” Downar said. “People are sending us food. People are honking their horns and putting up signs … It’s really touching.

“We’re going to do our best, and we’re pretty damn good. This is a really strong team. I wouldn’t want to be anywhere else while this is going on than where I am right now.”

(This story has been updated with comments from Dr. Claudio Martin of Western University.)

• Email: skirkey@postmedia.com | Twitter:

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'Different than anything we've seen': ICU doctors question use of ventilators on some COVID-19 patients – Timmins Press

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Some are now asking, can we stave off ventilating some patients, and increase the chances of people being discharged from hospital alive?

It started in New York City, in the trenches in the battle against COVID-19. Stressed doctors began worrying that the breathing tubes and pressures being used to open up the tiny air sacs in the lungs of the critically sick could be causing worse harm.

Some are now asking, can we stave off ventilating some patients, and increase the chances of people being discharged from hospital alive?

“In many ways, it’s different than anything we have seen before,” Dr. James Downar, a specialist in critical care and palliative care said Thursday from inside an ICU at The Ottawa Hospital dedicated to critically ill COVID-19 patients. On Thursday, the unit was full.

The pandemic virus seems not only to affect the lungs, making them stiff and inflamed, but other parts of the body as well, including the heart. It’s not clear if it’s a direct effect of the virus on the heart that’s causing heart failure in some cases, or if it’s because the virus is playing with the body’s coagulation system, increasing the risk of blood clots.

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It’s different in another way, too: In a phenomenon reported in the U.S., as well as Italy, and, now, Canada, some patients with severe COVID-19 are arriving in hospital with such low blood oxygen levels they should be gasping for breath, unable to speak in full sentences, disoriented and barely conscious.

Except they’re not in any sort of distress, or very little distress, compared to the burden of illness. They’re talking. They’re lucid. It’s not the classic acute respiratory distress syndrome doctors are used to seeing, and that most guidelines recommend doctors treat as such. One Brooklyn critical care doctor has likened it to high altitude sickness and is urging his colleagues to be cautious about who is being ventilated, and how. The concern is that the pressure may be harming lungs, and that some patients could be more safely treated with less invasive means such as high-flow nasal oxygen.

“To think that we understand this infection, I think is very naive,” Dr. Ashika Jain, an associate professor in trauma critical care and emergency ultrasound at New York University/Bellevue Hospital Center said on a recent  REBEL Cast podcast. “There are so many different theories about how this is behaving. There’s no one cohesive picture. We don’t really understand how to really treat this, because it’s a four-month old virus that we just don’t understand how it’s already running when it didn’t really learn how to walk yet.”

With some Ottawa patients, “we’re giving them all the oxygen we can give them without putting them on a breathing machine, and they’re wide awake and talking,” Downar said. In some situations, people are being flipped onto their stomachs, into the prone position, to improve gas exchanges.

High-flow nasal oxygen, where little plastic tubes are placed in the nostrils, can deliver up to six times the amount of oxygen. “And those high flows actually generate a little bit of positive pressure within the patient’s upper airway, which helps keep the lungs open and improve the oxygen levels in the blood,” said Dr. Claudio Martin, a critical care physician and medical director of critical care at London Health Sciences Centre and Western University.

“The problem with that is, when you’re giving oxygen with such high flows, there is a high possibility the viral particles in the airways are being aerosolized, so you can increase the possibility of spread of the virus in the environment,” Martin said. “Which is why if we do use that it has to be in a negative pressure environment, so that you contain the air in the room. You basically try to contain any virus particles that are aerosolized.” It also means any staff  looking after the patient need to be wearing N95 masks.

It’s not the classic acute respiratory distress syndrome doctors are used to seeing

While the vast majority, some 80 per cent of infections, are mild, the COVID-19 virus can cause pneumonia, which interferes with the ability of oxygen to get in through the lungs, and into the bloodstream. Currently, about six per cent of confirmed cases in Canada have required admission to an ICU.

A ventilator does two things: it provides oxygen as well as pressure to open up the alveoli, the little lung units, to allow the lungs to get oxygen in, and carbon dioxide out. While potentially life saving, it can worsen lung injury.

The strategy, for now, is not to rush to intubate, said Downar, who led the drafting of an Ontario “triage protocol” if hospitals are forced to ration ICU beds and ventilators. “Unless somebody seems to be failing, or their oxygen level is truly at this critical life-changing level, we can maybe hesitate,” Downar said. Even when the decision is made to ventilate, in some cases, “you almost end up having to talk them into it, which is a very unusual situation.”

“But let me be explicitly clear here: These are still the exceptions. The majority are failing … They need to have a tube put down (their throats) and put on a breathing machine to help them breathe.”

It’s not clear what proportion will be discharged alive.


A tube from a ventilator on a sedated patient infected with COVID-19 at the intensive care unit of the Peupliers private hospital in Paris, April 7, 2020.

Thomas Coex/AFP via Getty Images

A study published this week in the Journal of the American Medical Association involved 1,591 people infected with the pandemic virus admitted to ICUs in the Lombardy region of Italy between Feb. 20 and March 18. A high proportion — 88 per cent — required mechanical ventilation. As of March 25, 26 per cent of the ICU patients had died, 16 per cent had been discharged, and 58 per cent were still in the ICU. The median age was 62; 82 per cent were men.

British Prime Minister Boris Johnson remained in an ICU Thursday, where his condition reportedly continues to improve. The 55-year-old is not on a ventilator; according to a spokesman, he’s receiving standard oxygen therapy.

People who have been ventilated have described the experience as awful beyond belief.

The person is sedated, so that they’re calm. “Sometimes you have to relax the breathing muscles so they’re able to open their mouth and accept the tube being inserted,” said Dr. John Granton, head of the division of respirology at Toronto’s University Health Network- Sinai Health System. “If they’re incredibly sick we need to take over their breathing completely, and so we fully sedate them,” meaning a medically induced coma.

“We don’t allow them to wake up from that anaesthetic until their lungs have healed. And then once they’ve healed, or if they’re not that sick, we can allow them to be reasonably aware,” Granton said.

If this ever happened to me, this is what I would not want to look like at the end

With a tube down their throat, however, they can’t speak. They have to communicate by using a board, or moving their lips. “We’ve become expert lip readers in the intensive care unit,” Granton said.

From the experience with H1N1 and SARS, it can sometimes take several weeks, or a month or more for people to recover to the point they can be “liberated” from the machines. For some with a significant underlying condition, like chronic obstructive pulmonary disease, there’s a risk they may never come off.

If nothing else, the pandemic should be encouraging discussions about what people value in life, Granton said, including conversations such as, “If this ever happened to me, this is what I would not want to look like at the end.”

With hospitals in COVID-19 lockdown, families aren’t allowed inside the ICU. Normally, they’re at the bedside. “We’re trying to update them by phone, we’re trying to do Facetime,” Downar said. “To have to see a critically ill family member through a video call and have your questions answered by somebody wearing a face mask … it’s not the way we like to do things. But it’s better than nothing.”

“We’re tired, but this is our job,” Downar said. “People are sending us food. People are honking their horns and putting up signs … It’s really touching.

“We’re going to do our best, and we’re pretty damn good. This is a really strong team. I wouldn’t want to be anywhere else while this is going on than where I am right now.”

(This story has been updated with comments from Dr. Claudio Martin of Western University.)

• Email: skirkey@postmedia.com | Twitter:

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