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There's no quick post-pandemic fix for Canada's long-term care facilities, say experts – CBC.ca

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This is the third in a series looking at lessons learned from the first months of the COVID-19 pandemic, and at how Canada moves forward.

Dini Cameron has watched Canada’s long-term care catastrophe unfold with a mounting sense of dread.

The 84-year-old recently spoke to CBC News from the home in Ashton, Ont. she shares with her 86-year-old husband Doug. He’s been in a wheelchair since suffering a stroke but the couple “managed for three months without help and did quite well,” she said.

“How we will be in the next few years we don’t know,” she added. “I’m already afraid. I will look for an [alternative] rather than go to one of those (long-term care homes) for both of us.

“Depending on how far gone I am and if my mind is clear, I think I would prefer euthanasia …”

Pandemics, like the viruses that drive them, attack weak points. The novel coronavirus exploited a weakness in Canadian society — this country’s tendency to warehouse its elderly in poorly supervised long-term care homes.

The result, say the experts, was completely predictable: as of May 25, long-term care residents made up 81 per cent of all reported COVID-19 deaths in Canada.

“This has been an issue and has caused older adults to die of infections prior to this, and this has just really put it in the limelight,” said immunologist Dawn Bowdish, who holds a Canada Research chair on aging at McMaster University. She said the poor infection control at long-term care facilities was well known before the pandemic struck.

“In fact, we know that we’ve had transfer of influenza — which is the next big infectious disease killer of older adults — between homes because people worked part-time, because they moved from home to home, because we don’t have the same infectious disease control that COVID has shown us that we so desperately need.”

Long-term care with long-term problems

The SARS outbreak of 2003 led to strong recommendations to improve the management of long-term care facilities, she said — recommendations that faded from view once the crisis passed.

“People cut a corner when you need to cut cost,” she said. “It’s easy to do because one hopes it never happens. But now we’re paying the price for that.”

Dr. Sandy Buchman, president of the Canadian Medical Association, said no one should assume that the shockingly high number of deaths in long-term care facilities is due entirely to the age and frailty of the people living there.

“It’s an absolute tragedy what happened to elders that lived in Canadian long term care facilities,” he said. The CMA has convened an advisory panel of experts to recommend preparations for the next pandemic.

“It’s not just about their biological vulnerability … If you were a senior at home with the same vulnerabilities, you were one hundred times less likely to die than you were if you were in a long-term care institution.

Anson Place Care Centre, in Hagersville, Ont., experienced a severe outbreak of COVID-19. (Evan Mitsui/CBC)

“So it was about the staffing issues. It was about the underfunding. It was about personal support workers having to travel between different long-term care homes. So there are system issues that need to be addressed.”

Michael Villeneuve, chief executive officer of the Canadian Nurses Association, will sit on that CMA expert panel. He said the early focus of politicians and policy experts on the pandemic’s threat to hospitals — the risk that an overwhelmed hospital system might collapse — led them to focus on that problem at the expense of long-term care.

“We had our eyes over here when there was a really critical problem over there,” he said. “And that’s got to have a very very close examination before round two comes — if it comes.”

No more ‘duct tape solutions’

People should start by understanding that the fix for long-term care won’t be quick or cheap, said Villeneuve.

“Long-term care needs a long term solution. It’s not going to get fixed overnight,” he said. “And our concern certainly now at the Canadian Nurses Association is it’ll be a sort of duct tape solution — throw a few more staff in and pay them a little bit more and it will be fine. And it won’t.

“There are fundamental issues that need to be tackled in long-term care. One is [that] the structure of the physical plant of many of these homes is really old.”

Villeneuve said the design of many long-term care facilities helped open the door to COVID-19.

“So you have people in rooms of four or two, or you have a single room with a Jack and Jill bathroom — all kinds of places for disease to move,” he said.

“It’s hard to to imagine but many of those places don’t have air conditioning. So one of the things that staff do to make residents more comfortable is they will congregate them in a lounge or in a hallway and put large fans on them to help them cool off. Well, that’s a recipe for disaster right there.”

Watch: Dini Cameron on why she is worried about moving into long-term care

Dini Cameron, 84, says she and her 86-year-old husband weathered the pandemic at home in Ashton, Ontario but are worried about the prospect of one day moving into long-term care. 0:41

Demolish and start over

Bowdish argues that, for some older and poorly designed homes, the solution may start with a wrecking ball.

“In Canada, it’s really expensive to heat our homes in the winter and it’s expensive to cool them in the summer,” she said. “So we really love to recycle our air and we know that this virus, because it can live in those itsy-bitsy little two-micron droplets, it can float around in that recycled air for a long time and infect people.”

Research shows that SARS-CoV-2, the virus that causes COVID-19, can travel through air ducts and remain suspended in the air for long periods of time. Researchers at the University of Alberta have found that, under certain conditions, airborne droplets carrying the virus can travel tens of metres.

“Air circulation is going to be increasingly important, and in fact this is one of the reasons we’re expecting a second wave” later in the year when the weather changes, Bowdish said.

“Because just like colds and flus, we go inside more, and we breathe more of that recycled air with more of these little droplets with some of the virus in it.”

The Ontario Long Term Care Association (OLTCA) has responded to the pandemic and to the dire reports out of some long-term care homes by acknowledging the sector needs help — and by pointing out that it has asked for help before now.

OLTCA CEO Donna Duncan said in a statement to CBC News that “nearly half of the province’s” long-term care homes “are older and in need of redevelopment.

“OLTCA has been advocating for a workable program to rebuild older homes for more than ten years.”

Trade-offs could hurt home care

British Columbia was able to stave off the disaster that befell Quebec and Ontario long-term care by acting quickly to seal off its homes and banning the practice of staff working in multiple locations.

The lesson seemed clear: pay long-term care workers enough to allow them to live off one salary, and you close off a potential disease vector.

But that risks pitting the long-term care sector’s needs against those of the personal care workers who are performing the home visits that allow many elderly Canadians to stay out of long-term care facilities.

Already in Quebec, workers are being lured away from the home care sector by hourly wages of $26 at long-term care homes — about double the rate paid for home visits.

“Pre-COVID, we used to be able to help 12,000 people on the island of Montreal,” said Judy Bambach, general manager of the non-profit home care agency Répit-Ressource de l’Est de Montréal. “In COVID, all of us together, I don’t even think we’re going to reach 750 by the end of this month.”

Experts say that if home care falters, more elderly people will end up in long-term care, further burdening the system.

The profit motive

The long-term care sector has many different kinds of players: provincial, private for-profit, not-for-profit and municipal homes all operate together.

Not all for-profit homes in Canada are the same. At one end of the spectrum are modern, comfortable and well-staffed homes that cost over a thousand dollars a week. At the other end are the kind of homes where Canadian soldiers found shocking examples of poor sanitation and neglect.

Bowdish said COVID has revealed a pattern, though.

“We see more deaths in private homes than we do in public homes. And I don’t know if we can ever get over the profit motive,” she said.

Canadian Armed Forces personnel arrive at the Villa Val des Arbes seniors residence, Monday, April 20, 2020 in Laval, Que. (Ryan Remiorz/The Canadian Press)

In Ontario, Doug Ford’s government moved to take over management of several privately operated homes that were called out in a scathing report by the Canadian military.

“All types of homes have been affected by COVID-19, and each has had a different experience with the disease,” said Duncan in her statement to CBC News. She said the OLTCA’s “preliminary analysis” indicates that the magnitude of an outbreak at a long-term care facility depends on a range of factors, including its staffing complement, whether it’s an older home with multiple beds per room, and whether it received “external support” when it needed it, such as staff and resident testing and personal protective equipment.

‘The one good thing’

Bowdish said she hopes this moment might be a catalyst for change.

“Maybe the one good thing that will come out of this whole episode is that we will understand how important it is to have these really basic health care and infectious disease control practices,” she said. “And we’ll also learn a lot about how to best train the people who work in these homes.”

But pandemic measures on their own won’t lead to lasting change unless Canadians themselves change the way they think about aging and elder care, she said.

“I think the public has to step up and agree that our elders are important to us,” she said. “They’re important to our families and our society. They paid their taxes. They worked hard. They deserve the best care in life. And unfortunately that’s going to come at a cost.”

Dini Cameron isn’t holding her breath.

“I don’t feel confident at all that the right choices will show up, and that they’ll get this under control,” she said. “I think those long-term care homes will always look like prisons to me.”

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Canada suspends extradition treaty with Hong Kong over new security law – CBC.ca

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Canada is suspending its extradition treaty with Hong Kong as part of a package of responses to the new security law China has imposed on the territory, Prime Minister Justin Trudeau said Friday. 

Canada will also treat sensitive goods being exported to Hong Kong as if they were being sent to mainland China. 

“Effective immediately, Canada will not permit the export of sensitive military items to Hong Kong,” Trudeau said in a news conference. 

China imposed strict new controls on Hong Kong this week, meant to give Beijing more power to police anti-government protests and other activities it considers the work of hostile foreign powers. 

Trudeau suggested the new law is a threat to the “one country, two systems” philosophy that was supposed to last 50 years after Britain returned Hong Kong to China in 1997. 

Canada’s relationship with Hong Kong, including freer trade and travel than is allowed between Canada and mainland China, depends on that principle, Foreign Affairs Minister Francois-Philippe Champagne said in a separate statement. 

“This process demonstrated disregard for Hong Kong’s basic law and the high degree of autonomy promised for Hong Kong under the ‘one country, two systems’ framework,” Champagne said.

“Hong Kong’s role as a global hub was built on that foundation. Without it, Canada is forced to reassess existing agreements.”

Other countries are considering offering asylum. About 300,000 Canadians live in Hong Kong.

“We will continue to support the many connections between Canada and Hong Kong while also standing up for its people,” Trudeau said. 

Watch: Trudeau says Canada is suspending the extradition treaty with Hong Kong:

Prime Minister Justin Trudeau spoke with reporters about the impact of Hong Kong’s new security legislation at a food bank in Gatineau, Quebec on Friday. 2:14

Canada’s moves follow measures taken by the United States earlier this week to tighten trade with Hong Kong and stop selling it military equipment. 

Britain announced that up to 2.6 million Hong Kong residents will be able to move to the United Kingdom for up to five years and ultimately seek citizenship.

Those are holders of special overseas British passports that have had much more limited rights attached to them until now. Trudeau hinted that something similar might be in the works in Canada. 

“In the days and weeks to come, we’re also looking at additional measures, including around immigration,” he said. 

The relationship between Canada and China remains extremely strained. China is holding two Canadians, Michael Kovrig and Michael Spavor, on national-security charges that Canada considers retaliation for the arrest of Huawei executive Meng Wanzhou in Vancouver in 2018 on a U.S. extradition warrant.

READ | Canada’s statement on Hong Kong’s new security law:

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Trudeau unsure about Washington trip, cites concern over tariffs

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OTTAWA (Reuters) – Canadian Prime Minister Justin Trudeau said on Friday he was still unsure whether he would go to Washington D.C. next week to mark a new North American trade treaty, citing concern about possible U.S. tariffs on aluminum.

Mexico’s President Andres Manuel Lopez Obrador, who is due to meet U.S. President Donald Trump next week, has said he would like Trudeau to attend.

(Reporting by Steve Scherer; Editing by Marguerita Choy)

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Today's coronavirus news: Wasaga Beach to close main beach area after huge Canada Day crowds; WE group to stop running federal volunteer program – Toronto Star

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KEY FACTS

  • 8:25 a.m.: Wasaga Beach to close main beach area after huge Canada Day crowds.

  • 5 a.m.: Atlantic provinces lifting travel restrictions within region today.

  • 4 a.m.: Farm shutdown escalates migrant fears over testing, group says.

The latest coronavirus news from Canada and around the world Friday. This file will be updated throughout the day. Web links to longer stories if available.

11 a.m.: When COVID-19 hit, Paintbox Bistro, a restaurant located in Regent Park, quickly transformed into a store. Why? The goal was to keep her staff employed and continue providing a resource to feed lower-income residents.

The Star’s Karon Liu has the full story.

10:20 a.m. (updated): Youth Minister Bardish Chagger says the WE organization won’t manage the federal government’s $900-million program to pay students and fresh graduates for volunteer work this summer.

In a statement this morning, Chagger says it’s a “mutually agreed upon decision.”

Since the charity founded by brothers Craig and Marc Kielburger was announced as the manager of the program last week, the sole-sourced deal has been criticized because of Prime Minister Justin Trudeau’s close relationship with the group.

Trudeau and Chagger have said repeatedly that the recommendation to use WE for the work came from the public service, not politicians.

10 a.m.: All those warnings from small cottage country mayors to stay away this spring haven’t discouraged Torontonians from hunting for vacation homes, realtors say. In fact, the pandemic is boosting those real estate numbers.

Read the full story from the Star’s Tess Kalinowski.

9 a.m.: Outdoor patios at restaurants and bars have been given the green light to grow, allowing more people to dine or have a drink in the open air as summer gets into full swing.

Premier Doug Ford said the government has amended emergency orders to cut red tape and allow municipalities to quickly pass temporary bylaws clearing the way during the COVID-19 pandemic.

The measure follows consultations with chief medical officer of health Dr. David Williams and a push from Progressive Conservative MPP Gila Martow (Thornhill), who proposed the idea in May to help restaurants and bars struggling to stay afloat selling take-away food, beer, wine and spirits.

Read the full story from the Star’s Rob Ferguson.

8:25 a.m.: The public’s “blatant disregard” for the rules of social distancing has resulted in Wasaga Beach laying out a plan to shut down the majority of the main beach area by July 9.

The only access permitted would be three walkways to reach the water, and so the public can access businesses along what was Beach Drive.

Anyone who chooses to flout the new rules by walking on the municipal portion of the beach will also face a hefty fine: $750.

The town’s emergency management co-ordinator and deputy fire chief, Craig Williams, called the disregard for social distancing and gathering recommendations on Canada Day, and the previous two weekends, “human behaviour at its worst.”

The beach area would be closed to the public by July 9 and “for the foreseeable future.”

The municipal lots would be reduced in capacity by half.

Mayor Nina Bifolchi said while the previous two weekends on the beach had been busy, the crowds on Canada Day “took it to a whole new level.”

7:18 a.m. The scale of coronavirus infections in English care homes was laid bare on Friday, adding to the pressure on Prime Minister Boris Johnson over his handling of the pandemic.

A survey of more than 9,000 institutions found that 56 per cent had at least one confirmed case of COVID-19 since the outbreak began, according to the Office for National Statistics. In total, 11 per cent of all care-home residents tested positive for the disease, almost double the rate in the community as a whole.

The government has come under fire for its failure to shield vulnerable people in care homes, with the ONS now estimating that over 19,000 residents in England and Wales died from the virus as of June 12. In the initial stages of the outbreak, some hospitalized residents were discharged into the facilities without a negative test to show they weren’t carrying the disease.

Speaking on LBC Radio on Friday, Johnson described the significant loss of life in care homes as “absolutely tragic” and promised a “proper examination.”

“Far too many lives were lost in care homes and we mourn for everyone,” he said. “I bitterly, bitterly regret every single loss of life that we’ve had. Whether an earlier lockdown would have made the crucial difference is something we will have to look at.”

Staff working arrangements also influenced levels of infection. Those that employed more workers from agencies, or had staff working across multiple sites, showed a greater spread of the virus. There was also evidence that care homes that provide sick pay had lower levels of infection, as staff were more likely to take time off work.

7 a.m.: The pandemic has dinged the auto sector, but one part of the industry is faring better than it was before the crisis: used cars.

Sales of used vehicles in the U.S. have roared back after dropping 38 per cent in April, when states were shut down and some dealerships were forced to close. In June, used-vehicle sales rose 17 per cent above the pre-pandemic forecasts, according to research firm J.D. Power.

A confluence of factors is drawing buyers to the used-car lot. Some have used federal stimulus checks on their purchases, dealers and analysts say. Interest rates have fallen during the pandemic, to about 4.73 per cent on average for a 36-month used-car loan, from about 5 per cent in early March, according to Bankrate.com.

Meanwhile, many dealers are having trouble getting new vehicles from the factory, after the health crisis forced auto makers to close their plants for nearly two months this spring. That has led salespeople to more readily redirect customers to the used-car lot, dealers say.

The used-vehicle market’s swift recovery is a relief for dealers and auto makers, which have seen other areas of their businesses upended by the pandemic.

6:10 a.m. North Korean leader Kim Jong Un urged officials to maintain alertness against the coronavirus, warning that complacency risked “unimaginable and irretrievable crisis,” state media said Friday.

Despite the warning, Kim reaffirmed North Korea’s claim to not have had a single case of COVID-19, telling a ruling party meeting Thursday that the country has “thoroughly prevented the inroad of the malignant virus” despite the worldwide health crisis.

Outsiders widely doubt North Korea escaped the pandemic entirely, given its poor health infrastructure and close trade and travel ties to China, where COVID-19 emerged late last year.

Describing its anti-virus efforts as a “matter of national existence,” North Korea earlier this year shut down nearly all cross-border traffic, banned tourists and mobilized health workers to quarantine anyone with similar symptoms to the disease.

Experts say the country’s self-imposed lockdown is hurting an economy already battered by stringent U.S.-led sanctions over its nuclear weapons and missile program.

The Korean Central News Agency said Kim during the politburo meeting of the Workers’ Party “stressed the need to maintain maximum alert without a slight self-complacence or relaxation” as the virus continues to spread in neighbouring countries.

The agency said Kim sharply criticized inattentiveness among officials and violations of emergency anti-virus rules and warned that a “hasty relief of anti-epidemic measures will result in unimaginable and irretrievable crisis.”

The North’s official Rodong Sinmun newspaper published several photos of Kim at the meeting, which were the first state media images of him in weeks. Neither Kim nor the ruling party officials who participated were wearing masks.

5:01 a.m.: Toronto’s northwest corner — which has been hardest hit by COVID-19 — is part of a larger hot spot of vulnerability that extends beyond the edges of the city, suggesting a broader regional cluster of high infection rates that defies boundaries and is exploiting socioeconomic inequalities, according to experts and public health data.

Officials are still trying to puzzle out why Toronto’s northwest corner has seen the city’s highest infection rates, and who, exactly, has been impacted most.

Recent reporting from the Star found that these neighbourhoods have some of the highest concentrations of residents who are low-income, racialized and living in cramped housing while working in higher-risk sectors like manufacturing. These findings were echoed Thursday by newly released data from Toronto Public Health showing that neighbourhoods with these characteristics were correlated with higher case counts.

Read more of the Star’s reporting here.

5 a.m.: The four Atlantic provinces are lifting travel restrictions within the region today, with an agreement that’s causing a mix of anxiety and excitement among people in the region.

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Residents of New Brunswick, Nova Scotia, Newfoundland and Labrador and Prince Edward Island can now travel to any of the other three provinces without self-isolating for 14 days after arriving.

The premiers of Newfoundland and Labrador and New Brunswick have hinted restrictions could soon be lifted for visitors from the rest of Canada if all goes well.

Some residents have criticized the so-called “Atlantic bubble” over fears the novel coronavirus could re-emerge in the region, but health officials are encouraging people to trust the science behind the decision and keep following health measures.

Read more of the Star’s reporting here

4:16 a.m.: South Africa’s reported coronavirus cases are surging.

Its hospitals are now bracing for an onslaught of patients, setting up temporary wards and hoping advances in treatment will help the country’s health facilities from becoming overwhelmed.

The spike comes as the country has allowed businesses to reopen in recent weeks to stave off economic disaster after a strict two-month stay-at-home order worsened already high unemployment and drastically increased hunger.

In Johannesburg, the largest city, health officials said they are considering reimposing some restrictions to try to slow the spread of the virus.

4 a.m.: A group representing greenhouse growers in Ontario’s Windsor-Essex region says a work stoppage at a local farm due to a COVID-19 outbreak has escalated fears about testing for the virus.

The Ontario Greenhouse Vegetable Growers says in a statement that the public health order has contributed to anxiety among both farmers and workers.

On Wednesday, the region’s medical officer of health issued an order that required an unnamed farmer whose greenhouse has an active outbreak involving 191 workers to isolate those employees and stop work.

The medical officer of health for Windsor-Essex issued the order after a rash of positive tests over the weekend.

The growers group says it is working with the sector and the provincial government to address those fears as on-farm testing continues.

Premier Doug Ford said Thursday the work stoppage will not encourage local farmers to participate in efforts to combat the virus.

6 p.m.: Interest payments were already draining the bottom line at Cirque du Soleil Holdings LP before the pandemic froze its revenues, according to a report by the monitor in its bankruptcy protection case.

Ernst & Young, the firm overseeing Cirque’s restructuring under the Companies’ Creditors Arrangement Act in Canada, said its net loss increased to $80 million last year from $10.2 million in 2017.

“During that period, the applicant’s financial position deteriorated as a result of the losses sustained and the increasingly debt heavy capital structure,” the monitor said in a report.

The pandemic hit the 36-year-old company just as it emerged from a string of acquisitions that helped it diversify from its original acrobat-based shows. The deals, which included Blue Man Productions Inc., help Cirque increase revenue to $1.04 billion last year from $882 million in 2017, but also put it deeper into debt.

As of March 31, Cirque owed its first lien creditors $901 million and its second lien creditors $154 million. It also owed $32 million to shareholder Caisse de Depot et Placement du Quebec and an equal amount to Fonds de solidarite des travailleurs du Quebec, the monitor’s report said.

Montreal-based Cirque filed for protection from creditors on Monday after the coronavirus forced it to close shows around the world. A creditors’ group has said a proposal by existing shareholders — TPG, the Caisse and China’s Fosun International Ltd. — to restructure the live performance company is “doomed to fail” and there is no chance they will accept it.

The shareholders’ group proposed refinancing the company with new capital and giving creditors a 45% equity stake in exchange for wiping out most of its debt. Now the company will go through a process to see if another investor can improve on that offer.

Cirque had $1.47 billion in liabilities at the end of 2019, about five times shareholders’ equity.

Thursday 5 p.m. Ontario’s regional health units are reporting a total of 37,389 confirmed and probable cases of COVID-19, including 2,728 deaths, up a total of 154 new cases since Wednesday evening, according to the Star’s latest count.

As has been the case in recent weeks, the vast majority of new cases reported Thursday came in a small handful of health units. Just Toronto (77 new cases), Peel Region (23 cases) and York Region (21 cases) reported increases in the double digits.

New infections are down sharply, even in these regions. In Toronto, for example, the long-term average rate of new infections has fallen from 196 per day in early June to just 53 daily as of Thursday.

Four more fatal cases were reported Thursday, all in Toronto.

The daily rate of deaths has also fallen sharply since peaking in early May when the health units reported as many as 94 deaths in a single day.

Earlier, the province reported the Canada Day holiday meant it had incomplete information on the number of Ontarians currently hospitalized with COVID-19. The most recent totals of patients hospitalized, in the ICU or ventilated in Ontario hospitals were near the lowest levels in records that were first made public in early April.

The province says its data is accurate to 4 p.m. the previous day. The province also cautions its latest count of total deaths, 2,680, may be incomplete or out of date due to delays in the reporting system. In the event of a discrepancy, “data reported by (the health units) should be considered the most up to date.”

The Star’s count includes some patients reported as “probable” COVID-19 cases. This means they have symptoms and contacts or travel history that indicate they very likely have the disease, but have not yet received a positive lab test.

Thursday 2:45 p.m.: More than three million Canadians either lost their jobs or had their hours significantly reduced due to COVID-19, according to Statistics Canada.

And now that economies across the country are reopening, some people are looking to change course, having realized their careers aren’t as viable as they may have been pre-pandemic.

Many are going back to school to pursue an entirely new profession — for example, Ryerson University’s Chang School of Continuing Education saw a 15 per cent jump in its spring enrolment, according to dean Gary Hepburn, even after the school’s in-person courses had to be cancelled.

Read the full story from the Star’s Rosa Saba.

Click here to read more of Thursday’s coverage.

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