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From ‘risk is low’ to calling in the army: 2 months of Ontario’s COVID-19 response in long-term care

Two months ago, Ontario had just four confirmed cases of COVID-19. Now there are more than 12,000, and at least 759 deaths. Two-thirds of the dead lived in the province’s long-term care homes.

This timeline shows what steps Ontario took — and failed to take — to protect the residents and staff of nursing homes as the coronavirus spread. 

Feb 23 

The number of deaths worldwide from COVID-19 surpasses 2,400. In Italy, police checkpoints seal off 11 towns and the Lombardy region closes schools and cinemas. Ontario reports one new positive test for the coronavirus. “Given the individual’s clinical assessment and history, there is a low risk that she was infectious,” says Ontario’s chief medical officer of health Dr. David Williams. “I want to assure the public that the risk to Ontarians remains low.”

March 2

Health Minister Christine Elliott announces the teams in charge of Ontario’s strategic response to the novel coronavirus. It’s led by a command table of senior officials. One of the members is the deputy minister of long-term care. 

March 8 

Canada’s first death from COVID-19 is reported. The victim is a resident of a long-term care home in North Vancouver, B.C. The number of confirmed cases in Ontario reaches 29. “At this time, the virus is not circulating locally,” Williams says in a news release

Chief medical officer of health Dr. David Williams said the province is now also doing COVID-19 testing on samples from long-term care homes where there is any respiratory outbreak. (CBC)

March 9 

In a memo, Ontario’s assistant deputy minister for long-term care instructs homes to screen visitors for symptoms of the illness “where possible over the phone.” The screening does not extend to staff until March 11, the day the World Health Organization declares COVID-19 a pandemic.

March 13 

The province confirms 20 new positive cases of the virus, bringing the total to 79. Williams “strongly recommends” that long-term care homes cease non-essential visits, but stops short of making it an order. 

March 16 

“Our government is taking all the necessary precautions to ensure loved ones in Ontario’s long-term care homes are safe and secure,” says Health Minister Christine Elliott and Minister of Long-Term Care Merrillee Fullerton in a statement. Ontario is yet to report any deaths from COVID-19. 

March 17 

Premier Doug Ford declares a state of emergency in Ontario. There have been 189 confirmed cases across the province. 

March 18 

An outbreak is declared at the Pinecrest Nursing Home in Bobcaygeon, Ont. Within three weeks, 28 of the home’s 64 residents will die. 

The Pinecrest Nursing Home in Bobcaygeon is among the first long-term care facilities in Ontario to be rocked by COVID-19. Nearly half its residents eventually die of the disease. (Fred Thornhill/Canadian Press)

March 19 

A woman in her 90s at the Hillsdale Terraces long-term care home in Oshawa shows symptoms of COVID-19. However, the public health unit does not receive her test results until March 23, the day she dies.

As the end of March Break nears, Williams recommends 14 days of self-isolation for health-care workers who have travelled internationally, but does not make it mandatory. The federal government waits until March 25 before ordering a quarantine.  

March 22 

Williams asks long-term care homes to limit the number of locations that employees are working at “wherever possible,” in an effort to reduce the risk of staff carrying the virus from home to home. This does not become a mandatory policy until a month later.

March 26 

The deaths in long-term care facilities begin to mount. Two at Seven Oaks in Scarborough. Two at Pinecrest in Bobcaygeon. One resident of the Heritage Green Nursing Home in Stoney Creek.

Still, the province continues to recommend against testing everyone in long-term care homes that see outbreaks. Ontario’s capacity to test for COVID-19 shows strains, as the number of people waiting for lab results soars above 10,000

March 27 

There are confirmed cases in at least 16 homes in Ontario, the Globe and Mail reveals, although the government is not providing a province-wide figure. 

The associate chief medical officer of health, Dr. Barbara Yaffe, is asked why the province does not order testing on all residents of long-term care homes where outbreaks are declared. “We don’t want to use up the limited lab resources to test everybody when we already know what the cause of the outbreak is,” she replies.  

March 28 

The outbreak at Pinecrest Nursing Home in Bobcaygeon is raging. Roughly half the staff are reported sick with symptoms of COVID-19. 

March 30 

With nine deaths reported at Pinecrest, Ford tells the daily news briefing: “We’re putting an iron ring of protection around our seniors. We must do everything we can to prevent further spread in these homes.” 

March 31 

More deaths and outbreaks hit homes, and Ottawa’s medical officer of health calls the long-term care sector her “top concern.”

“We’re doing everything we can to protect the most vulnerable,” Ford says in his daily news conference.  

CBC reporter Lisa Xing challenges Ford: “We’ve known for some time that this is a vulnerable population. Why did the province not act sooner to stop the virus from spreading in long-term care homes?” 

“I just wish I had a crystal ball a month ago, a month and a half ago to see where this was going,” Ford replies.  

WATCH: March 31 – Ontario Premier Doug Ford defends his government’s efforts to protect long-term care residents

“Why did the province not act sooner to stop the virus from spreading in long-term care homes?” CBC reporter Lisa Xing asked Ford on March 31. 1:26

April 1

Research by CBC News reveals 40 people have died at long-term care and retirement homes and counts declared outbreaks in at least 41 facilities, although the numbers of outbreaks and deaths given by provincial officials are far lower. 

“There’s more that we can do,” says Health Minister Christine Elliott. “We are very concerned about outbreaks in long-term-care homes,” she tells the daily news briefing. “That’s a very, very vulnerable group of people that we need to protect, absolutely.” 

WATCH: April 1 – Ontario Health Minister Christine Elliott responds to the worsening situation in long-term care homes 

Ontario Health Minister Christine Elliott acknowledged the government had more work to do protecting seniors in long-term care on April 1. 0:59

April 2 

“If my mom was in long-term care, I would pull her out. Now,” says Dr. Samir Sinha, a geriatrics specialist with Sinai Health System in Toronto and a top provincial adviser on senior care. 

In a separate interview with CBC News, Sinha urges Ontario to test every resident and staff member in any long-term care home that discovers an outbreak, pointing to evidence from the U.S. of confirmed cases among nursing home residents without symptoms. 

April 3 

Ontario reveals modelling that forecasts up to 15,000 deaths in the province, and lengthens its list of non-essential businesses, but announces no new measures regarding long-term care homes.  

April 6

Nearly 40 per cent of the residents of Anson Place Care Centre in Hagersville, Ont. (south of Hamilton) have tested positive, along with 22 staff. Five residents are dead, and within two weeks the death toll reaches 24.   

April 7

The province is reporting 78 deaths in long-term care and outbreaks in at least 58 homes. Meanwhile, Ontario’s daily number of tests completed barely exceeds 2,500, lower than its daily rate of testing in mid-March. 

April 8 

Williams issues a new directive to long-term care homes. It requires all long-term staff to wear masks at all times for the duration of their shifts and increases the frequency of screening for symptoms to twice a day. 

WATCH: April 8 – Premier Doug Ford says he wants testing done at ‘every single long-term care facility’ in Ontario 

Doug Ford says his patience has ‘run thin’ over the unacceptably low number of tests being done in Ontario. 1:44

April 10 

The impact of COVID-19 on Ontario’s long-term care homes hits two grim milestones: the number of cases among residents and staff surpasses 1,000 and the number of deaths surpasses 100. Those are the official numbers from Public Health Ontario. 

Ontario’s releases new testing guidelines, which continue to recommend against testing all residents of long-term care homes, even when there’s an outbreak. Provincial officials tell reporters in a not-for-attribution briefing that such testing is of limited value.

April 12

At the Anson Place Care Centre in Hagersville, south of Hamilton, 13 people are dead and more than half the home’s residents have tested positive for COVID-19, along with 30 staff.  

April 13 

News emerges that 25 residents of the Eatonville Care Centre in Etobicoke are dead. 

Facing questions about the province’s actions so far, Ford insists he and his government “are doing absolutely everything we possibly can” to protect long-term care residents.  “We could look backwards and point out every single little item. I’m sure there’s areas in this whole pandemic that are, ‘Could’ve, should’ve, would’ve.’ I feel we’re doing everything we can right now.” 

April 15 

Ford announces what he calls Ontario’s “action plan” for long-term care. “Today, we’re throwing everything we’ve got at our long term care homes,” he says. “We’re mobilizing every available resource.”  

The plan promises wider (but still not universal) testing in homes and offers help from hospital teams specializing in preventing and controlling infections. One of its provisions — a ban on employees working at more than one facility  — does not kick in for another week. 

It’s also been five weeks since the WHO declared the pandemic. Since then, according to Ontario’s official figures: 

•162 long-term care residents have died.

•933 residents are infected.

•530 staff are infected.

April 17

Nearly 2,000 residents and staff of long-term care homes have been infected with COVID-19, and the death toll surpasses 200. A personal support worker at a home in Scarborough dies. “It’s heartbreaking to hear of these tragedies and we’re doing everything we possibly can, as we’ve said, to put an iron ring around these homes,” says Ford. 

April 20 

The province releases new projections modelling the spread of infections in Ontario. While officials say this wave of COVID-19 has peaked in the border community, the spread of the virus is still accelerating in long-term care. The data show 367 people have died in long-term care homes. 

April 22

Ford announces he has asked for the Canadian Forces to help at five long-term care homes, which the federal government approves a day later.

The death toll from long-term care surpasses 400. There are outbreaks in 125 homes and more than 2,800 residents and staff have tested positive for the virus 

April 23

Ontario updates its reporting system for COVID-19 deaths, and the official death toll in long-term care surges to 516. Given all those deaths, Ford is asked if the province failed. “The system needs to be changed, and we’re changing the system,” he replies. “But right now our main focus is to make sure that we protect the people inside these long-term care homes.”

Ford’s voice quakes with emotion during the news conference. Afterward, an official confirms that Ford’s mother-in-law has tested positive for COVID-19. She is a resident at Toronto’s West Park Long-Term Care home, where at least 13 people have died. 

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Microplastics in drinking water are ‘low risk’ to human health: WHO

Microplastics contained in drinking water pose a “low” risk to human health at current levels, but more research is needed to reassure consumers, the World Health Organization (WHO) said on Thursday.

Studies over the past year on plastic particles detected in tap and bottled water have sparked public concerns but the limited data appears reassuring, the UN agency said its first report on potential health risks associated with ingestion.

Microplastics enter drinking water sources mainly through run-off and wastewater effluent, the WHO said. Evidence shows that microplastics found in some bottled water seem to be at least partly due to the bottling process and/or packaging such as plastic caps, it said.

“The headline message is to reassure drinking water consumers around the world, that based on this assessment, our assessment of the risk is that it is low,” Bruce Gordon of the WHO’s department of public health, environmental and social determinants of health, told a briefing.

The WHO did not recommended routine monitoring for microplastics in drinking water. But research should focus on issues including what happens to chemical additives in the particles once they enter the gastrointestinal tract, it said.

There are no data available to show that microplastics pose a hazard to human health, however this does not necessarily mean that they are harmless.– Alice Horton, National Oceanography Centre

The majority of plastic particles in water are larger than 150 micrometres in diameter and are excreted from the body, while “smaller particles are more likely to cross the gut wall and reach other tissues,” it said.

Health concerns have centred around smaller particles, said Jennifer De France, a WHO technical expert and one of the report’s authors.

“For these smallest size particles, where there is really limited evidence, we need know more about what is being absorbed, the distribution and their impacts,” she said.

More research is needed into risks from microplastics exposure throughout the environment — “in our drinking water, air and food,” she added.

Alice Horton, a microplastics researcher at Britain’s National Oceanography Centre, said in a statement on the WHO’s findings: “There are no data available to show that microplastics pose a hazard to human health, however this does not necessarily mean that they are harmless.

“It is important to put concerns about exposure to microplastics from drinking water into context: we are widely exposed to microplastics in our daily lives via a wide number of sources, of which drinking water is just one.”

Plastic pollution is so widespread in the environment that you may be ingesting five grams a week, the equivalent of eating a credit card, a study commissioned by the environmental charity WWF International said in June. That study said the largest source of plastic ingestion was drinking water, but another major source was shellfish.

Scientists say drinking water is just one source of microplastics. Another major source is shellfish. (Narikan/Shutterstock)

The biggest overall health threat in water is from microbial pathogens — including from human and livestock waste entering water sources — that cause deadly diarrhoeal disease, especially in poor countries lacking water treatment systems, the WHO said.

Some two billion people drink water contaminated with feces, causing nearly one million deaths annually, Gordon said, adding: “That has got to be the focus of regulators around the world.”

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