“There are political penalties for overreacting, but fatal consequences for underacting. For overconfident leaders, the true enemy may not be the virus, but their own hubris…”
A timely quote from a mid November Macleans column serves as todays blog headline, this brief line is small, but speaks largely to where we are in BC right now..and where we may be headed if we aren’t careful. Ironically, Horgan was noted in this piece for winning a majority, not for the ongoing death toll in long term care other leaders have faced questions over: https://www.macleans.ca/politics/before-2020-we-believed-that-in-a-crisis-leaders-will-lead-we-were-wrong/
That column came to mind immediately last night after a friend brought my attention to the story by Ian Young in SCMP yesterday, detailing the painful details of how yet another LTC outbreak evolved so tragically. https://www.scmp.com/news/china/article/3116863/vancouver-coronavirus-disaster-infected-staff-tried-push-through-their
Dr Michael Schwandt, a medical health officer with the Vancouver Coastal Health (VCH) authority, sounded almost upbeat on the Zoom call, which was leaked to the South China Morning Post. He expressed confidence that anti-infection protocols would succeed; after all, a previous outbreak at Little Mountain Place in March had been swiftly stamped out.
Precautions were being strictly followed, he assured listeners. Staff were ready. Measures would be “airtight”.
It didn’t turn out that way. Soon, the outbreak at Little Mountain Place was spiralling out of control.
Dozens more residents and staff soon became infected, in a catastrophic cascade that overwhelmed the home’s frail residents.
Now, at least 41 out of Little Mountain Place’s 114 residents are dead of Covid-19, according to an update delivered to relatives on Tuesday. Ninety-nine of the elderly had been infected. And 70 staff had also tested positive. It is British Columbia’s deadliest Covid-19 outbreak, by a wide margin.
How did anti-infection protocols collapse so badly?
It fell on VCH infection investigator Dr Andrew Hurlburt to explain, in another leaked Zoom call, on December 29.
He described how multiple infected staff – either asymptomatic or having failed to recognise and report their symptoms – interacted with numerous residents, as well as other staff.
“There were a lot of people who were exposed. And that was both in terms of residents, and in terms of staff causing transmission to other staff. This really led to a perfect storm”:Vancouver Coastal Health officer Dr Andrew Hurlburt
And when workers began falling irrefutably ill with Covid-19, creating staff shortages, their newly infected colleagues dismissed or downplayed their own symptoms – because they did not want to worsen the escalating staff shortages.
The phenomenon, described by Hurlburt as “presenteeism”, is founded on good intentions. But it would have tragic consequences.
“We had people who are pushing through things and probably explaining away things, in an attempt to really help the site out, and it turns out that unfortunately these people did have symptoms that were probably indicative of ongoing transmission for days,” Hurlburt said.
I can’t even imagine these kinds of numbers of elders dying in such a short time. And what makes it even more incredibly tragic… no… outrageous…is that this has occurred again, and again and again since early spring when the first outbreak happened in a North Vancouver care home.
Yesterday the province finally agreed to release information relating to all deaths and cases in long term care yesterday, a move health authorities have not taken proactively on their own, with Vancouver Coastal Health being the most opaque. The first weekly report is grim reading as the death toll in care homes mounts. http://www.bccdc.ca/Health-Info-Site/Documents/COVID_sitrep/LTC_AL_COVID-19_Outbreak_Report_0106_2021.pdf
I’ve already seen the blaming and shaming of staff online from those who routinely deflect from this governments handling of the second wave of the pandemic, and I think its terribly misplaced. I hadn’t heard of the term ” presenteeism” before reading Ian’s story, and looked it up. https://wmhp.cmhaontario.ca/workplace-mental-health-core-concepts-issues/issues-in-the-workplace-that-affect-employee-mental-health/presenteeism#:~:text=Presenteeism%20is%20the%20action%20of,%2Doptimal%20conditions.%5B1%5D
From that link:
Presenteeism is the action of employees coming to work despite having a sickness that justifies an absence and as a consequence, they are performing their work under sub-optimal conditions.
When employees come to work not mentally present due to an illness, extreme family/life pressures or stress, they are not giving themselves adequate time to get better. While they are at work their performance can deteriorate. Presenteeism can affect an organization just as sickness or absence can in terms of productivity and performance.
Stressful life events have been directly linked to health problems, absenteeism and presenteeism. The cause of the event determines whether an employee is more likely to contribute to absenteeism or presenteeism. Individuals who have undergone treatment for a physical illness, such as a heart condition, have a higher correlation with absenteeism than presenteeism. Where as individuals who have sought psychological help or undergone counselling have a higher correlation with presenteeism than absenteeism.
Presenteeism is most common in people with children, lower waged workers, employees with poor health status and those who have difficulties setting limits when confronted with excessive demands.
Some of the reasons employees have for presenteeism include:
*cannot afford to take the day off;
*there is no back-up plan for tasks the individual is responsible for;
*when they returned to work, there would be even more to do;
*committed to personally attending meetings or events;
*concerned about job insecurity related to downsizing or restructuring.
This…explains so much. Staff are already living in trauma and stress, holding hands of elders dying and while some may have a hard time understanding why anyone would risk going to work in a situation like this,there are a few things to understand here. Much of this should have been preventable and/or mitigatable:
- Dr. Henry has repeatedly squashed every suggestion of the use of preventative rapid testing since early on with a variety of excuses. Critics have been saying for some time ( as I have too, as regular readers of this blog know) that if she doesn’t feel rapid testing is effective enough for catching asymptomatic carriers, why not use standard PCR swab testing routinely? Even performed every 2-3 days, it would catch asymptomatic staff early enough to potentially mitigate a large transmission event. But when asked before Christmas in a post report call in scrum, she said its uncomfortable to be swabbed up the nose and we want to be mindful of this. ( paraphrase, you can go back and watch the pressers online to see exact wording )
- Many of us have been calling for UBI – income tested – since the spring, foreseeing the inability for many to stay home with every minor sniffle because they simply can’t afford to. The federal sick benefit currently in place, can take weeks to be approved and verified…and by that time anyone who is sick is back at work. It’s also just a one time only benefit. The reality is, while health officials and politicians tell us not to work when sick, they have refused to acknowledge the privilege inherent to that statement, that is far removed from the reality of most peoples lives. At this point in the pandemic, many middle income earners have used their credit up, if they had it, and most low income earners don’t even have credit cards. Its almost like these politicians and health officials live in a world where this reality does not exist. Or maybe they just don’t care? Even a sick benefit that is made immediately available when sick, and able to be accessed more than once would be a tremendous benefit for workers, especially those with kids who are forced to stay home anytime their child is symptomatic as well. If you want people to stay home,.make it possiblrle to do so. This goes back to the premature self confidence felt this spring and summer, that may have been the undoing of our fall and winter second wave.
Politicians are their own worst enemies at times, as are the bureaucrats that bolster them. They are quick to the podium when things go well, but rarely to be seen when they don’t. ( Horgan is largely unseen) I recognize this is an unprecedented challenge but the hubris displayed truly is astounding and inappropriate. It astounds me that Trudeau even dares mention possibly going to an election while many provinces are seriously in the thick of it, considering how the one we had in BC gave social license to so many to let loose in Fraser Health.
We were left without an education or health minister while the government continued in caretaker mode, albeit in the competent hands of Carole James. And while it was clear by the data on the BC CDC website that cases were already well on the rise in September – something Dr.Henry has publicly acknowledged being surprised by – the public was repeatedly and endlessly told that it was very safe to have an election right now. ” The best time, before our second wave” was commonly heard. But by the October 8th presser and dataset, it was clear we were moving into a more rapid increase, and yet…nothing more than mild admonishment by Dr. Henry and a reminder we needed to pull back our activities. The wave had already started.
By then, Dr. Henry had shut down banquet halls, and larger facilities, but as a result many events moved to peoples homes, well documented by south of the Fraser media. But not helping anyone take the pandemic seriously, were ongoing campaign events( held outside but still in groups) and in person appearances continued, covered in person by media daily.
We were still being told we have to learn to live with this virus and carry on safely and yet by the last 2 weeks of the election it was very clear we were in trouble (anyone can go to the BC CDC website and view all the old stats and graphs to confirm this ) but still no restrictions were issued.
Worse yet, we continued to hear assertions of “Its SAFE!!” from everyone supporting Horgan. In effect,this messaging during the election, inadvertently gave social license to many to continue their activities since there was no restriction ordering them to. Did this messaging and lack of action by Dr. Henry until the day immediately after the election contribute to the disaster in Fraser Health? Absolutely. Like the long overdue mask mandate, the in home gathering restriction was also delayed too long.
Fraser Health communities are where much of Metro Vancouvers workforce lives, in a densely populated region where secondary suites and shared accomodations where distancing isn’t possible are innumerable. Where those workers go, the virus goes. Even the late August graphs showed a high degree of unknown transmission and workplace spread in lunchrooms. When restrictions finally did come it, it was far too late for all these care homes. ( people who watch the post report scrum feeds, and read the graphs know this)
With cases rapidly multiplying now that school is back in session, and very low testing over the holidays, health care workers and teachers are both feeling the concern in hotspot areas of BC. It was long overdue for the BC CDC to finally acknowledge airborne transmission this week, months after the federal health authority, the WHO, and many other respected epidemiologists.
But herein lies the problem.
We have been told continuously decisions are based in science, and that keeping community transmission low is key, which is commonsense. But government fails to acknowledge when that science changes, and acts too late time and time again. This is now a key factor moving through the remaining winter months.
We failed to mandate simple things that we know there is concrete evidence of working, like testing proactively for long term care staff early on. (using standard pcr tests )
We failed to enact a mask mandate after reducing the distancing requirement for many workplaces and schools.
We still hear reasons why masks are not needed in secondary school classrooms where distancing cannot happen, despite knowing this helps and is mandatory in many jurisdictions already.
And now we have two new variants, months of winter and spring ahead… and even longer before people are widely vaccinated. ( I’m not even going to get into this issue below …)
But hey, we have hockey now……everyone applaud and be distracted from my next question.
Please tell me why, as this article makes clear, it was ultimately the province that approved the return of NHL hockey to BC, using the NHL protocal of a daily PCR ( swab) test daily on every member (https://media.nhl.com/site/asset/public/ext/2020-21/2020-21PositiveTestProtocol.pdf) ….
… yet they have chosen for months not to use PCR testing proactively to prevent the death of hundreds of elders in long term care? It works to keep hockey players safe, but not seniors? It works for movie sets, but not long term care in hot zones? What gives, seriously?
Dr, Henry has mentioned staffing concerns as a reason not to test. But I would say it is better to deal with having to replacing a few positive staff caught early and prevent a massive outbreak, than have to replace all staff, lose hundreds of elders and have long lasting trauma and PTSD to deal with for all involved.
We cannot waste time hesitating for the remainder of this winter. An ounce of prevention is worth far more than a pound of cure in this pandemic, just as it was in SARS. Dr.Henry knows this personally. But 9 months later, we still aren’t applying lessons learned in the SARS inquiry. And I think we need to ask why.
*Update 3:18 pm Friday January 8th*
*update Jan 8th, 8 pm.
Prior to Christmas break, Dr. Henry promised they would separate public,.msp paid for testing numbers from the privately paid for, industry numbers. The BC CDC dashboard number still combines the two, which skews positivity.
Below us the BC CDC testing number reported screenshot and the Govt of Canada’s daily BC testing number…the different is 4847, which the number of private industry tests.
We are testing so far below average in BC, and hospital numbers tend to be a lagging indicator. Now that school and work is back in session many anticipated a spike coming.