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Health-care system’s history with Black community is affecting attitudes around COVID-19 vaccine

Before Brayana Taylor went into labour with her now 16-month-old daughter, she read up and carefully planned for the day. While much of it was a blur, she says she remembers her time at the hospital as traumatic, and that her concerns and feelings were dismissed.

“I just feel like, during the most vulnerable and crucial moments of my entire life, my care was mishandled.”

She rarely talks about what happened to her in detail, but after speaking to another Black mother, Taylor soon found out that she wasn’t alone in her experience. It’s something that she says has hurt her trust in the health-care system, and it has also affected how Taylor feels about the COVID-19 vaccine.

While health professionals are stressing to Canadians that the approved COVID-19 vaccines are safe, Taylor is one of those who attribute their vaccine hesitancy to eroded trust in the health-care system as a whole for its treatment of Black and Indigenous people.

Taylor runs an Instagram page called Black Motherhood Collective. In response to pushback she and others have received for being vaccine-hesitant, she put out a post outlining statistics about Black maternal health as an answer to why some Black women feel skeptical about the medical system.

One of them is an alarming stat from the U.S. National Center for Health Statistics that reveals 84 per cent of pregnancy-related deaths in the United States in 2018 were Black women. There’s limited race-based medical research data available in Canada, but a 2015 McGill study found that Black women have significantly higher preterm births than white women.

“I think to a lot of people, it’s just hard to imagine why somebody wouldn’t want a vaccine, you know, because the pandemic has been around for what seems like forever at this point,” Taylor said.

“But in practice, we have to understand that there [are] a lot of kinks in our institutions and in our systems that really do obstruct a lot of progress when it comes to our communities.”

Brayana Taylor runs an Instagram account called Black Motherhood Collective. She says it was important to her that the skepticism she and other Black women feel about the COVID-19 vaccine and the health care system be taken seriously. (Ousama Farag/CBC)

Black people have also been disproportionately affected by the COVID-19 pandemic. Despite making up 9 per cent of Toronto’s population, a quarter of patients hospitalized with COVID-19 are Black.

It’s something Cheryl Prescod, the executive director of the Black Creek Community Health Centre in North York, Ont., is working hard to address as part of the effort to vaccinate all Canadians and stop the spread of the virus.

Prescod notes that the predominantly Black and brown neighbourhood is home to many essential workers living in precarious conditions. Social distancing is made harder when they shuttle to work in crowded buses and come home to densely populated, high-rise apartment buildings.

“This has been a hotspot since the beginning of COVID. We have a high number of positive cases, and we also have a low testing rate,” Prescod said.

Of the top 10 COVID-19 hot spots in Toronto last month, eight were in the city’s north-west end.

Prescod adds that while the vaccine isn’t yet available to most of the general public, the work to address their questions and inform them about it needs to happen now.

Cheryl Prescod, executive director of the Black Creek Community Health Centre, says she sees first-hand how Black and other racialized Torontonians have been disproportionately affected by the COVID-19 pandemic. (Ousama Farag/CBC)

In a recent virtual information session, the Black Creek Community Health Centre put together a panel of health professionals and community members to take questions about the COVID-19 vaccine.

Attendees weighed in with questions ranging from how the COVID-19 vaccine works differently than the flu vaccine, to whether or not there was a microchip in it being used to track people, particularly low-income people of colour. Prescod has heard a lot of it before.

“Can we trust that substance? Can we trust what’s happening? There’s still that mistrust around that science, around the development of the vaccine, around the fact that certain populations might be used as guinea pigs,” Prescod said.

One of the historical examples Prescod hears patients refer to is the Tuskegee Syphilis Study, where 600 Black men in Alabama were experimented on without being told what for. In Canada, Indigenous children in residential schools were also experimented on to learn about the effects of malnutrition.

The Tuskegee Syphilis Study, conducted in Alabama from the 1930s to the 1970s, took blood samples from Black men for an experiment they didn’t know they were participating in. The unethical study is often cited by experts when systemic racism in health care is discussed. (National Archives and Records Administration)

Dr. Upton Allen, head of infectious diseases at Sick Kids Hospital, has been meeting with the Ontario government, urging it to factor the need to repair relationships with vulnerable communities into the province’s vaccine rollout plan.

“It’s really important to ensure that the Black community is engaged in discussions and decision-making, and that the community can feel that they are part of the process,” Dr. Allen said.

“It’s important to ensure that the messaging relating to vaccine prioritization is appropriate, and is very transparent and very clear, so that there’s no misinterpretation of intent.”

Dr. Allen says he received his first dose of the vaccine a few weeks ago, and that he is confident recommending it to others in the Black community.

He also emphasizes the importance of Black people being involved and considered at every level of health care. Dr. Allen leads a team of researchers at Sick Kids looking at the rates of COVID-19 infection among Black Canadians and the factors behind them, as well as pushing for their participation in antibody testing. He says the lack of diversity in medical research can contribute to inequities in the system.

“One needs to make sure that all the major groups are included so that one can generalize across several groups, not just in terms of racial groups, but also in terms of age groups,” Dr. Allen said. “And so moving forward, it’s important that vaccine related studies — and there will be more — will include Black representatives, Black participants.”

Health professionals are stressing to Canadians that the approved COVID-19 vaccines are safe, but some say their trust in the system has been eroded due to its past treatment of vulnerable communities. (Jon Cherry/Getty Images)

In a statement to CBC News, Nosa Ero-Brown, Assistant Deputy Minister of Ontario’s Anti-Racism Directorate, says that the province is talking to community health groups about how these concerns can be addressed through the Communities at Risk COVID-19 Vaccine Task Force Sub-Group.

“We will be working with partners to develop culturally relevant and responsive outreach strategies for each community as part of our Vaccine Distribution Plan, so that all Ontarians can access and understand the facts they need to make an informed decision on getting vaccinated,” the statement said.

The Ministry of Health says it is allocating $ 12.5 million in funding towards community health agencies in 15 high-risk communities for community outreach and increased testing. It adds that at-risk areas will be prioritized in Phase 2 of the vaccine roll-out.

This week, the City of Toronto announced a new Black Community COVID-19 Response Plan, allocating $ 6.8 million in funding towards 12 Black-led and Black-serving organizations to provide additional support, from food delivery to vaccine education.

The Black Health Alliance has been advocating for investment in grassroots organizations that are trusted in the communities they serve.

The government is not going to be able to build trust with the Black community overnight.– Paul Bailey, Black Health Alliance

“The government is not going to be able to build trust with the Black community overnight,” said Paul Bailey, executive director of the Black Health Alliance. “The agencies or the organizations that have to engage with certain parts of the population will be able to build trust over time.”

It’s the kind of commitment Taylor says she’s been looking for from those in power.

“Make the effort and let us know that this is something that you’re very serious about, and you’re adamant about repairing the relationship, and making sure that there is a level of trust between the Black community and health-care professionals so that we can have confidence moving forward,” Taylor said.

Dr. Allen remains cautiously optimistic that the advocacy work he and others are doing is leading to change.

“I think that the issues are being heard, steps are being taken, but it’s early in the game to see whether or not these steps are going to be sustainable and appropriately resourced.”

Watch full episodes of The National on CBC Gem, the CBC’s streaming service.

For more stories about the experiences of Black Canadians — from anti-Black racism to success stories within the Black community — check out Being Black in Canada, a CBC project Black Canadians can be proud of. You can read more stories here.


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CBC | Health News

Health-care workers, nursing home residents should get vaccine first, U.S. government panel advises

Health-care workers and nursing home residents should be at the front of the line when the first coronavirus vaccine shots become available in the U.S., an influential government advisory panel said Tuesday.

The U.S. Advisory Committee on Immunization Practices voted 13-1 to recommend those groups get priority in the first days of any coming vaccination program, when doses are expected to be very limited. The two groups encompass about 24 million people out of a U.S. population of about 330 million.

Later this month, the Food and Drug Administration will consider authorizing emergency use of two vaccines made by Pfizer and Moderna. Current estimates project that no more than 20 million doses of each vaccine will be available by the end of 2020. Also, each product requires two doses. As a result, the shots will be rationed in the early stages.

Tuesday’s action merely designated who should get shots first if a safe and effective vaccine becomes available. The panel did not endorse any particular vaccine. Panel members are waiting to hear the FDA’s evaluation and to see more safety and efficacy data before endorsing any particular product.

Experts say the vaccine will probably not become widely available in the U.S. until the spring.

The panel of outside scientific experts, created in 1964, makes recommendations to the director of the Centers for Disease Control and Prevention, who almost always approves them. It normally has 15 voting members, but one seat is currently vacant.

The recommendations are not binding, but for decades they have been widely heeded by doctors, and they have determined the scope and funding of U.S. vaccination programs.

In Canada, the National Advisory Committee on Immunization, or NACI, has released preliminary recommendations that prioritize the elderly and others at severe risk of illness, including health-care workers, front-line staff and those with lower access to health care, such as Indigenous populations. 

In the U.S., it will be up to state authorities whether to follow the guidance. It will also be left to them to make further, more detailed decisions if necessary — for example, whether to put emergency room doctors and nurses ahead of other health-care workers if vaccine supplies are low.

Devastating toll in homes

The outbreak in the U.S. has killed nearly 270,000 people and caused more than 13.5 million confirmed infections, with deaths, hospitalizations and cases rocketing in recent weeks.

As the virtual meeting got underway, panel member Dr. Beth Bell of the University of Washington noted that on average, one person is dying of COVID-19 per minute in the U.S. right now, “so I guess we are acting none too soon.”

Nursing home residents and the staff members who care for them have accounted for six per cent of U.S. coronavirus cases and a staggering 39 per cent of deaths, say officials with the Centres for Disease Control and Prevention. (Ben Garver/The Berkshire Eagle/AP)

About three million people in the U.S. live in nursing homes, long-term chronic care hospitals and other long-term care facilities. Those patients and the staff members who care for them have accounted for six per cent of the nation’s coronavirus cases and a staggering 39 per cent of deaths, CDC officials say.

Despite the heavy toll, some board members at Tuesday’s meeting said they hesitated to include such patients in the first group getting shots.

Dr. Richard Zimmerman, a University of Pittsburgh flu vaccine researcher who watched the hearing online, said he thought it was “premature” to include nursing home residents as a priority group. “[The panel’s] vote seems to assume that these people will respond well to the vaccine. … I don’t think we know that,” said Zimmerman, a former ACIP member.

Committee members were unanimous in voicing support for vaccinating health-care workers, according to CDC officials.

That broad category of an estimated 21 million in the U.S. includes medical staff who care for — or come in contact with — patients in hospitals, nursing homes, clinics and doctor’s offices. It also includes home health-care workers and paramedics. Depending on how state officials apply the panel’s recommendations, it could also encompass janitorial staff, food service employees and medical records clerks.

Trump cabinet members say governors should make the call

The government estimates people working in health care account for 12 per cent of U.S. COVID-19 cases but only about 0.5 per cent of deaths. Experts say it’s imperative to keep health-care workers on their feet so they can administer the shots and tend to the booming number of infected Americans.

For months, members of the immunization panel had said they wouldn’t take a vote until the FDA approved a vaccine, as is customary. But late last week, the group scheduled an emergency meeting.

WATCH l Canadian vaccine committee member speaks to challenges:

As Canada prepares to distribute millions of doses of COVID-19 vaccines in January, Chair of the National Advisory Committee on Immunization Dr. Caroline Quach-Thanh and David Levine, who managed the H1N1 vaccine rollout for Montreal, say this vaccination campaign won’t be without challenges. 3:56

The panel’s chairman, Dr. Jose Romero, said the decision stemmed from a realization that the states are facing a Friday deadline to place initial orders for the Pfizer vaccine and determine where they should be delivered. The committee decided to meet now to give state and local officials guidance, he said.

But some panel members and other experts had also grown concerned by comments from Trump administration officials that suggested differing vaccine priorities.

Dr. Deborah Birx of the White House coronavirus task force said in a meeting with CDC officials last month that people 65 and older should go to the head of the line, according to a federal official who was not authorized to discuss the matter and spoke to The Associated Press on condition of anonymity.

Then last week, U.S. Health and Human Services Secretary Alex Azar stressed that ultimately governors will decide who in their states gets the shots. Vice-President Mike Pence echoed that view.

Asked whether Azar’s comment played a role in the scheduling of the meeting, Romero said, “We don’t live in a bubble. We know what he said. But that wasn’t the primary reason this is being done.”

Jason Schwartz, a professor of health policy at the Yale School of Public Health, said it makes sense for the panel to take the unusual step of getting its recommendation out first.

“Without that formal recommendation, it does create a void from which states could go off in all sorts of different directions,” said Schwartz, who is not on the panel.

The panel will meet again at some point to decide who should be next in line. Among the possibilities: teachers, police, firefighters and workers in other essential fields, such as food production and transportation; the elderly; and people with underlying medical conditions.

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CBC | World News

Investigation finds widespread racism and discrimination against Indigenous peoples in B.C. health-care system

Racism, stereotyping and discrimination against Indigenous peoples in the B.C. health-care system are widespread and can be deadly, according to the findings of an independent investigative report. 

The investigation was led by former judge Mary Ellen Turpel-Lafond, who released her report, titled In Plain Sight, on Monday. 

“We have a major problem with Indigenous-specific racism and prejudice in B.C. health care,” she said. 

The report weaves first-hand accounts from patients, witnesses and health-care workers through 11 key findings, followed by two dozen recommendations for change. 

Nearly 9,000 people participated in the investigation. 

Eighty-four per cent of Indigenous people who participated reported experiencing some form of discrimination in health care. More than half of the Indigenous health-care workers who participated said they had personally experienced racism at work. 

“I am afraid to go to any hospital. When I do have to, I dress up like I’m going to church,” states a young Indigenous woman quoted in the report. 

An Indigenous doctor is quoted as saying: “I have been asked to look after my ‘drunk relatives’ in the ER or have had Indigenous patients [who were considered difficult patients] reassigned to me on the wards when I was a resident.”

The report also sheds light on how current efforts in education and training are inadequate and why more Indigenous peoples are needed in health leadership and decision-making positions. 

Specific allegations 

Turpel-Lafond was asked to lead the investigation after it was revealed that hospital emergency staff were allegedly playing a “game” where they would guess the blood-alcohol content of Indigenous patients.

She was asked to look into those allegations but also to report more broadly on the range and extent of Indigenous-specific racism in the provincial health-care system.

The investigative team was not able to substantiate allegations about the “game” being played in emergency rooms.

They did find, however, “extensive profiling of Indigenous patients based on stereotypes about addictions.” 

Assumptions about substance use were among the many stereotypes the report found were commonly ascribed to Indigenous patients. The investigation then linked how stereotypes can lead to discriminatory care and how this can harm one’s health. 

‘Stereotypes kill,’ nurse practitioner says 

“Those stereotypes kill,” said Tania Dick, a nurse practitioner and member of the First Nations Health Council. 

She recounted the death of her aunt as one such example.

Tania Dick is a nurse practitioner from the Dzawada’enuxw First Nation and a member of the First Nations Health Council. (Kwantlen Polytechnic University)

She said her aunt was taken to an emergency room after falling and hitting her head. But when she arrived, Dick said health-care staff assumed she was intoxicated.

By the time they realized something serious was going on, Dick said it was too late. She said her aunt — who was experiencing a brain bleed — died while being transferred to a major regional hospital. 

Dick said she knows her aunt’s experience isn’t an isolated incident. 

“Almost every community I go to has that same sort of story,” she said. “It just breaks my heart.” 

She said it’s emotional seeing Turpel-Lafond’s report and to see top government officials “shining a light on what we’re living on a day-to-day basis.”

Indigenous people participated in the investigation by sharing directly with investigators by phone, email and via an online survey. Nearly 2,800 people filled out the Indigenous Peoples’ survey. 

Health-care workers were also encouraged to participate through an online survey and by making direct contact with the investigative team. More than 5,000 health care workers filled out the online survey. 

Health minister apologizes

B.C. health minister Adrian Dix called the work of Turpel-Lafond’s team “extraordinary.” 

“Racism has made B.C.’s health-care system an unsafe place for many Indigenous peoples to access services and the care they need,” he said Monday. 

WATCH | Adrian Dix apologizes after report finds widespread racism in health-care system:

Health Minister Adrian Dix has apologized and promised action on the recommendations from an independent investigation into anti-Indigenous racism in the health-care system. 0:55

He promised action and apologized.

“I want to make an unequivocal apology as the minister of health to those who’ve experienced racism in accessing health-care services in British Columbia now and in the past,” he said. 

Dix said he will appoint an associate deputy minister to lead a task force responsible for implementing the recommendations, which include legislative, policy and structural changes focused on changing systems, behaviours and beliefs. 

Action needed, Indigenous leaders say

Indigenous leaders were quick to respond to the report on Monday — emphasizing the need for action on the recommendations. 

We have known for years that the healthcare system in this province treats First Nations people with disrespect and discrimination,” wrote Terry Teegee, B.C. regional chief of the Assembly of First Nations, in a news release. 

“Now, thanks to Mary Ellen Turpel-Lafond and her team, we have the proof of this deep seated, systemic and horrific racism within the health-care system.” 

The Association of Nurses and Nurse Practitioners of BC also responded to the report on Monday. In a news release the association thanked Turpel-Lafond for her investigation, acknowledged the findings and committed to responding directly to the recommendations.

“It is our responsibility to work to eradicate the conditions that perpetuate systemic racism,” the association wrote. 

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CBC | Health News

Quebec promises diversity training for health-care workers in wake of Joyce Echaquan’s death

A little less than a month after taking over as Quebec’s Indigenous affairs minister, Ian Lafrenière has announced a $ 15-million plan to teach health-care workers how to better provide services to members of Indigenous communities — with an emphasis on cultural safety.

That means providing care in accordance with Indigenous norms and traditions.

The announcement is a direct response to the death this fall of a 37-year-old Atikamekw woman at a hospital in Joliette, Que., a town about an hour north of Montreal.

In late September, Joyce Echaquan did a Facebook live of her treament in her hospital room shortly before her death. Viewers could hear her pleas and the staff’s response: degrading and racist insults.

The exact cause of her death is still not known.

Lafrenière was accompanied by Health Minister Christian Dubé as he told reporters the government wants to remove barriers for Indigenous communities in the health and social services network. 

“We would like to regain trust from different nations,” Lafrenière said.

Echaquan’s death sparked protests, a public inquiry and a public apology from Quebec Premier François Legault at the National Assembly.

WATCH | Lafrenière says Quebec’s efforts are not just about ‘image making’:

Ian Lafrenière, Quebec’s new minister of Indigenous affairs, says the province is “talking about facts” and not just concerned with “image making.” 0:49

Cultural safety was a key component in the Viens Commission’s 142 recommendations, which documented the discrimination Indigenous people face when receiving public services.

The cultural-safety training is expected to be rolled out gradually, starting with hospitals that take in more Indigenous patients — such as Joliette Hospital where Echaquan died  — before eventually being implemented across the province.

A team at l’Université du Québec en Abitibi-Témiscamingue developed the training guide, and Indigenous community leaders will have a chance to weigh in on its contents.

“There are many subtleties that we need to have in the training and this is the reason we want to involve them,” Dubé said.

The province will also hire liaison agents and health-care “navigators” who will serve as go-betweens for hospitals and members of Indigenous communities, with the navigators expected to come from Indigenous communities.

“Today, this is not image making, this is facts,” said Lafrenière. “We’re not telling you it’s going to be done within a week. It’s going to be a long process.”

Joyce Echaquan’s mother is seen at a vigil after hear death at the Joliette, Que., hospital. (Ivanoh Demers/Radio-Canada)

‘This is one announcement, this is not the last one’

The $ 15-million investment is part of a $ 200-million envelope set aside by the CAQ government in its latest budget.

It’s also Lafrenière’s first major move since replacing Sylvie D’Amours as the Indigenous affairs minister.

“This is one announcement, this is not the last one,” he said. “Let’s hope for the future, work for the future.”

His appointment last month raised eyebrows and drew criticism, due to his history as a high-ranking Montreal police officer. Indigenous communities have said their relationship with Montreal police is a tense one.

Lafrenière promised swift action, and claimed his experience with the SPVM was an asset in his new role, not a liability.

Following Echaquan’s death, voices calling for the CAQ government to recognize systemic racism grew louder, but Legault and Lafrenière, have both denied it exists in the province.

WATCH | Legault apologizes following Joyce Echaquan’s death

François Legault said the Quebec government has a duty to treat everyone with dignity and respect. He said Quebec failed that duty by allowing Joyce Echaquan to die amid racist taunts. 1:05

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CBC | Health News

COVID-19 surge pushing Manitoba’s health-care capacity to brink, microbiologist says

Manitoba’s health-care system is at the tipping point of a breakdown if the surge in COVID-19 cases isn’t immediately curtailed, a Winnipeg doctor says.

“There’s basically a perfect storm of situations that is making things extremely difficult,” said Philippe Lagacé-Wiens, a medical microbiologist and physician at St. Boniface Hospital.

There’s an increase in COVID-19 cases with no known transmission lines, along with a growing number of hospital outbreaks, and those are on a collision course with an ever-reduced capacity to deal with them, he said.

When hospital staff are exposed, they are removed from the pool of workers who can treat the deluge of patients, Lagacé-Wiens said Monday morning.

“So what I’m really imploring people to do is to really step up to reduce transmission.”

Dr. Philippe Lagacé-Wiens urges people to drastically reduce the number of contacts they have in order to bring down the spike in COVID-19 cases. (Philippe Lagace-Wiens/Facebook)

He and his colleagues are worried Manitoba could get to a situation that could be similar “to those the horror stories that you heard coming out of Europe back in April and May,” Lagacé-Wiens said.

“I don’t think it’s there yet. I think there’s still capacity, but it has the potential of becoming very concerning pretty quickly. There’s still an opportunity to turn this around. It’s just that we’re getting to the point where it might be a tipping point.”

Manitoba is experiencing record hospitalizations of COVID-19 patients, with 77 reported Sunday. Of those, 15 are in intensive care.

More than 300 new cases were added over the weekend, and six deaths were reported.

On Saturday, Lagacé-Wiens took to Facebook to express his alarm about the situation.

“Resources are getting strained. ICUs are full. We are on the brink,” he wrote. “This is what happens when we let our guard down, have too many contacts, relax and go out with too many people.

“The recent explosion of hospital cases and ICU cases are all caused by the disease we didn’t prevent two to three weeks ago. Without a turnaround, we are within days of being at the limit of ICU capacity.”

‘We’re the wild card’

From the beginning, the concept of flattening the curve was really about protecting the health-care system, which is already pretty lean in terms of vacancy without the pressure from COVID-19, said Cynthia Carr, Winnipeg-based epidemiologist and founder of EPI Research Inc.

She echoes Lagacé-Wiens’ call for people to go back to basics and keep their distance.

“My concern is, with more and more cases, there’s more chance to spread,” she said. “We’re a highly-interconnected society.”

If a community has a reproduction rate of two — so one person can infect two other people — and doesn’t get that under control immediately, 100 cases will become 3,200 cases just 40 days later, Carr explained.

“That’s how quickly and exponentially this can spread,” she said.

Bringing the reproduction rate down to less than one, say 0.7, those 100 cases on Day 1 would fall to just 17 by Day 40.

“So this exponential increase can become an exponential decrease with the right strategies,” Carr said.

But as of right now, “we are pushing our system and our public health leadership, such as Dr. [Brent] Roussin [the province’s chief provincial public health officer] into a situation where he might be running out of options for targeted approaches” and have to resort to another full shutdown like Manitoba had in spring.

“It’s up to us to stop it. We’re the wild card. The infection can’t get into the health-care system or into a personal care home or into a school if it’s not in the community,” Carr said. “We bring it there.”

Beyond exhaustion

Pretty well everyone in the field of medicine and nursing is exhausted, Lagacé-Wiens said.

“But they are strong people and they will continue to do their jobs as best as they possibly can to the point of beyond exhaustion. I don’t want them to get there, but they will eventually, if this demand on their time and ability continues,” he said.

“They are heroes and will keep working very hard for us.”‘

In the meantime, everyone else can do their part to reduce the strain. The solution is clear, Lagacé-Wiens said: no more social outings, work from home if you can, distance from others outside your household — even loved ones — wash your hands and wear a mask indoors.

“It’s in all our hands.”

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CBC | Health News

SARS was ‘dress rehearsal for COVID-19’ yet Canada failed health-care workers, report author says

Canada put health-care workers at risk of contracting COVID-19 and taking it home to their families because it failed to learn lessons from Severe Acute Respiratory Syndrome in 2003, a new report says.

Mario Possamai, who authored the report and was senior adviser to a two-year commission on SARS, outlines multiple shortcomings by the Public Health Agency of Canada (PHAC).

The agency was established to respond to emerging infectious diseases after an early recommendation by the commission investigating how the SARS epidemic that killed 44 people arrived in Canada and spread, mostly in Ontario.

Hundreds of people died of SARS elsewhere, including in China and Taiwan. However, Possamai says in the report released Monday that unlike Canada, those countries heeded the warnings from SARS, which he calls “a dress rehearsal for COVID-19.”

“In COVID-19, Canada is witnessing a systemic, preventable failure to learn from the 2003 SARS outbreak,” he said. “It is a failure to both adequately prepare and to urgently respond in a manner that is commensurate with the gravest public health emergency in a century.”

Possamai says in the report, titled A Time of Fear: How Canada Failed Our Health-Care Workers and Mismanaged COVID-19, that the safety of workers, from those in long-term care homes to respiratory technicians and nurses and doctors in hospitals, has been ignored.

It says union sources suggest 16 workers died in the pandemic, though official reports put the number at 12 deaths.

Unseen workers called a systemic problem

Canada’s infection rate among health-care workers is four times that of China, the report says.

While other countries, including the United States, have fared worse than Canada in containing COVID-19, they managed to escape SARS and did not have the opportunity to learn from it, Possamai says in the report, which was commissioned by the Canadian Federation of Nurses’ Unions to evaluate the first wave of the pandemic.

WATCH | Calls for more accountability in long-term care homes:

A family who believes neglect by a long-term care home killed their loved one says they hope the federal government’s promise to amend the criminal code to target anyone who neglects a senior in their care will also apply to long-term care homes. 2:04

“A significant systemic problem during COVID-19, as it was during SARS, is that health-care workers and unions were not seen by governments and public health agencies as collaborative partners in setting safety guidelines and procedures,” Possamai says, adding that is still the case as parts of Canada enter a second wave of the disease.

Corinna Heieie is a nurse who works in a long-term care home in Winnipeg. She fears what another wave of COVID-19 could bring for herself and those under her care. 

“The truth is, is that if I go out into the community and I get COVID, I’m going to go to work and I’m going to kill people that I love,” Heieie said. “The stress is real and it is heartbreaking.”

Dr. Theresa Tam, Canada’s chief public health officer, says while both the PHAC and her position were created because of SARS, she agrees pandemic preparedness needs to encompass more. 

“We need to broaden pandemic preparedness going forward so it’s not just public health and maybe hospitals,” Tam said. “It has to extend to long-term care,” as well as home care workers and those employed in seniors’ residences.

Possamai says precious time was wasted as infections among health-care workers rose and the so-called precautionary principle, which aims to reduce risk of infection without waiting for scientific certainty, was not adopted as a lesson from the SARS commission.

WATCH | What to keep in mind about communicating with a mask on:

CBC News asked two experts what’s lost from the human experience when one of our biggest tools of communication is eclipsed and muffled by cloth. 5:30

Questions about whether COVID-19 was airborne resulted in some health-care workers being denied N95 respirators in place of surgical masks, and other personal protective equipment has also been lacking. The report says that was not the case in China, Hong Kong and Taiwan, which also endured SARS.

Possamai makes several recommendations, including that:

  • Federal, provincial and territorial governments pass legislation requiring their chief medical health officers to report annually on the state of their jurisdiction’s public health emergency preparedness.
  • Top doctors in each jurisdiction be empowered to make recommendations addressing any shortcomings.
  • Occupational hygienists and safety and aerosol experts be added to the PHAC and for provincial health and for provincial labour ministries to act independently from health ministries to enforce workplace health and safety measures.

Linda Silas, president of the Canadian Federation of Nurses Unions, said it was only after pressure from nurses and doctors and ultimately from federal Health Minister Patti Hadju in February that the public health agency began weekly calls with the health sector, including psychologists and dentists, on guidelines.

However, she said unions are still not involved in developing those guidelines and how they should be used in practice. “That’s the gist of the mistake,” Silas said.

Health sector unions are still not involved in developing workplace health and safety guidelines, said Linda Silas, president of the Canadian Federation of Nurses Unions. (CBC)

“It is always a joint responsibility between the employer and the union,” she said of occupational health and safety issues.

Dr. Sandy Buchman, past president of the Canadian Medical Association who finished his one-year term in August, said he worked as a family doctor in Mississauga, Ont., during the SARS outbreak and remembers lining up to get into a hospital before being screened and wearing personal protective equipment when seeing patients.

The level of anxiety among health-care workers now is no comparison to that outbreak, Buchman said, adding he was shocked to learn Canada did not have enough personal protective equipment for a pandemic after the SARS commission recommended to stockpile it.

“What can I say? It’s still kind of incomprehensible to me that we weren’t prepared for a pandemic when it was … such a thorough report,” he said of the commission’s findings, which were released in 2007.

“My sense was, and it still is, that somehow the government expected front-line workers to put themselves in harm’s way, without having adequate PPE. It’s like expecting a firefighter to go into a burning building without the proper equipment to protect them.”

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CBC | Health News

Why err on the side of caution as COVID-19 looms in health-care workplaces

Hospitals, long-term care homes and other workplaces in Canada need to err on the side of caution or risk being paralyzed in the face of uncertainty from COVID-19, some doctors say.

Six months after the country’s first presumed case, more than 8,900 devastating deaths have occurred mainly among elders and 98,000 others have recovered. Restrictions to everyday routines curbed transmission and avoided overwhelming health-care systems, but public health officials warn people still need to protect themselves to keep case numbers low.

COVID-19 is a tricky disease. Its symptoms can be absent or vague, its course remains unpredictable to physicians and its exact methods and timing of transmission haven’t been nailed down.

Those lingering uncertainties are on Dr. Lauren Crosby’s mind as Calgary ramps up day and elective surgeries.

“When you’re working in the context of scientific uncertainty, especially in the case of an impending and serious threat to health, it’s unreasonable to clarify, to wait for the answers to all your questions before you take action to avert the threat,” said Crosby, an anesthesia resident in Calgary.

Reassurance of higher-level precautions

That’s why Crosby and her father, Dr. Edward Crosby, an anesthesiologist at Ottawa Hospital, wrote an opinion piece last week in the Canadian Journal of Anesthesiology titled “Applying the precautionary principle to personal protective equipment (PPE) guidance during the COVID-19 pandemic: did we learn the lessons of SARS?”

“If we can’t be certain then we should be safe,” she said.

For the Crosbys, one of the lessons from the 44 deaths from SARS in Toronto in 2003 is that when health-care workers are asked to put themselves at risk of infection to care for others, PPE like masks, gowns and gloves should be provided. It’s an application of the precautionary principle — the idea of erring on the side of caution to protect public health.

Justice Horace Krever first recommended the precautionary principle during the Commission of Inquiry on the Blood System in Canada in 1997.

Justice Archie Campbell’s 2006 SARS Commission also called for the health concerns of health-care workers to be taken seriously so they feel safe, even if that requires higher levels of precautions, Crosby said.

Friends and family members of residents at Extendicare Guildwood Long-Term Care home, in Toronto, hold a rally on June 12. They say including long-term care in the Canada Health Act could better protect residents. (Evan Mitsui/CBC)

If health-care workers become sick with COVID-19, they pose a “triple threat” as vectors for more disease transmission, reduced capacity in the health-care system and by becoming patients.

“Scarcity is not a valid reason to limit protective equipment and to limit access to that equipment,” Crosby said.

Instead, she said, to prepare for a second wave, PPE should be used as efficiently as possible, including decontaminating and repurposing it and using other barriers during procedures that spray infectious aerosols.

Fostering public trust

People working in any industry need to feel involved in decision making and have their concerns addressed, Crosby said. Otherwise, there can be a loss of public trust, low morale, anxiety and confusion. In health-care settings, the stress can lead to burnout of workers who are particularly in demand during the pandemic.

WATCH | Lives remembered in Quebec:

Staff and family laid 101 flowers — one for each of the seniors who lost their lives at CHSLD Sainte-Dorothée in Laval, the Quebec long-term care home hit hardest by COVID-19. 1:17

Dr. Roger Wong, a clinical professor of geriatric medicine at the University of British Columbia, called the idea of applying the precautionary principle an important and timely conversation because COVID-19 has already hit long-term care homes and other shared living facilities hard.

“We have an opportunity, a very narrow window,” Wong said in an interview. “We should take action now.”

How? Wong told a COVID-19 guidance for long-term care homes.

Be transparent as evidence evolves

Tim Caulfield, Canada research chair in health law and policy, supports applying the precautionary principle.

He said it has an intuitive appeal. During COVID-19, it’s been raised in the context of wearing masks and weighing the use of pharmaceutical treatments like hydroxychloroquine.

“If you’re going to do that, then you have to take extra care to ensure that you’re being transparent about the information that you’re using, the evidence you’re using to make the decision,” Caulfield said. “You want to make sure that you are open to change as the evidence evolves.”

He pointed to an association between jurisdictions around the world, such as Australia and regions of France, which have been the most successful in containing the disease so far, and public trust in key institutions and decision makers.

“In the face of uncertainty, we still have to march forward and we have to do it in a manner that benefits the most, and I think that we can’t allow uncertainty to paralyze us,” Caulfield said.

(CBC News)

Dr. Timothy Paul Hanna, a clinician and scientist at Queen’s University Cancer Research Institute, applied the precautionary principle to help guide Ontario’s prioritization plans for cancer care during COVID-19.

Potential risks to patients include:

  • Infection risk by leaving their homes to come for treatment.
  • Possible side-effects of treatment, such as radiation for lung cancer that further diminishes lung function after getting COVID-19.
  • Treatment and diagnostic delays associated with rationing care when hospitals scale back.

“We’re really fortunate across Canada,” Hanna said. ‘We weren’t left as single institutions or single physicians to proceed based on our own opinion when resources became limited. I think that that’s a real plus of our universal health-care system.”

Provincial prioritization frameworks weighed factors he wrote about such as the magnitude of benefit from treatment, if the treatment is meant to be curative or palliative, patient considerations such as age, comorbidity, and preferences as well as the availability of human resources and equipment to treat cancers.

Canada has a narrow window of opportunity to better protect its most vulnerable, says Dr. Roger Wong. (Submitted by UBC)

“Regardless of how we discover how well we might have done, I think the mental health effects and social stress, the impacts on patients and their families having to wait or having to experience care in maybe a different way, like through telemedicine or other virtual means, I’m sure we’ll find has been hard on patients.”

Canadians are touched not only as patients, but as employees and citizens, too.

Soma Ray-Ellis, chair of the employment group at Gardiner Roberts LLP in Toronto, said that as non-essential employees return to work and social gatherings occur, more direction is needed on applying precautionary principles together with human rights, occupational health and safety and privacy legislations.

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CBC | Health News

Nurses, truckers in Ontario denied health-care services over COVID-19 risk

Some essential workers in Ontario say they’ve been denied health-care services because their jobs put them at risk of contracting COVID-19.

Hinda Hassan, an ICU nurse at Grand River Hospital in Kitchener, Ont., said it happened to her during a scheduled massage therapy and chiropractic appointment last week.

She was given a COVID-19 screening questionnaire at a Waterloo, Ont., clinic that asked if she had come into contact with confirmed cases of the novel coronavirus.

Hassan checked yes and clarified that this contact was due to her job at the hospital, where she’s required to wear personal protective equipment. 

She said she was told to come back after being tested for COVID-19. 

The Ontario Ministry of Health released a COVID-19 patient screening guidance document in June to ensure that “all health providers are following the same screening protocol” and to “help ensure consistency when dealing with suspected or confirmed cases of COVID-19.”

A ministry spokesperson said in a statement that the document is only for risk assessment and that it’s up to individual regulatory colleges to decide how to proceed if a patient screens positive.

Anyone who feels they have been denied service unfairly should take it up with their relevant regulatory college, the spokesperson said.

Hassan said there is no practical way for her to take time off work while she awaits a result. And, she said, it was tough news to hear given that she has put her own health and safety on the line during the pandemic.

“If you need my service, I can’t say, ‘Hey, you’re high risk. I’m sorry. I can’t take care of you.’ But then here you are — you’re denying me those rights,” she said. “It felt a little frustrating.”

Clinic apologized for denying service

The College of Massage Therapists of Ontario said someone like Hassan shouldn’t have had problems, based on the province’s current screening guidelines.

“An ICU nurse who works with COVID-19 patients (wearing appropriate personal protective equipment) should absolutely be able to receive massage therapy treatment, assuming they are not showing symptoms of COVID-19,” a spokesperson said.

A spokesperson for the College of Chiropractors of Ontario declined to comment on individual situations but said its professionals follow Ministry of Health screening guidelines. 

The clinic has since called Hassan back, apologized and updated its policies. She said she’s happy it made the change, and she plans to make another appointment.

Vicky MacLean, an ICU nurse in Waterloo Region, tried to book a speech therapy appointment for her toddler but was unable to because of her contact with COVID-19 patients. (Submitted by Vicky MacLean)

Vicky MacLean, a fellow ICU nurse in Waterloo Region, in southern Ontario, said a similar situation happened in her family.

At the beginning of June, MacLean said, she tried to book a speech therapy appointment for her toddler but was screened out because of her contact with COVID-19 patients.

MacLean said she was offered a virtual appointment, but she felt her two-year-old wouldn’t be able to focus during an online session.

After reaching out again last week, MacLean learned that the clinic had updated its screening policies based on provincial guidance, and she booked an in-person appointment.

She said she was “overwhelmed with joy” at the news but wishes she had managed to get an appointment sooner.

“We’re doing everything we can at home, but … she would be much further along if she’d had speech therapy,” MacLean said of her daughter.

Vicki McKenna, president of the Ontario Nurses’ Association, said she hasn’t heard of similar problems from other nurses. But she said she’s sorry to hear that such incidents are happening.

“Nurses, they’ve been under incredible stress over the last number of weeks, as many people have,” she said. “They deserve services as well — and certainly their families.”    

‘I don’t see why my wife is punished’

It isn’t just nurses who’ve been denied service, said Bob Heans, of Fergus, Ont.

He’s a long-haul truck driver and often drives through the United States.

Heans said his wife recently made an appointment for a dental checkup, but when she mentioned his work as a long-haul driver, she was told she had to isolate from him for 14 days before she could be treated.

Heans said he doesn’t think that was fair to either of them.

“Being a truck driver, we’re probably all scared senseless for our family enough,” he said.

“I probably wash my hands 100 times a day, probably go through two bottles of hand sanitizer in like two or three days,” he said.

“I don’t see why my wife has to be punished for this because I’m a long-haul truck driver.”    

Trucker Bob Heans, who often drives through the United States, says his wife was told she needed to isolate away from him for 14 days before she could get a dental checkup. (Submitted by Bob Heans)

Stephen Laskowski, head of the Ontario Trucking Association, said the industry has worked hard to protect drivers from COVID-19 and doesn’t think they’re at an elevated risk because they travel south of the border.

“Long-haul truck drivers spend a lot of their time alone inside their trucks. Trucks are sterilized before drivers get in, when they come out,” he said.

“We’re very proud as an industry of how proactive we’ve been.”

Laskowski said he’s heard other reports of drivers being turned away from health-care services, and that’s a concern because they need to have periodic medical exams to renew their licences.

The association is currently trying to find out how widespread the issue is, he said.

Dental college seeking clarity

Heans’s situation demonstrates a “long-standing issue” with current provincial screening guidance, said Kevin Marsh, a spokesperson for the Royal College of Dental Surgeons of Ontario.

Marsh said dentists — like massage therapists and other health-care providers — also use the province’s screening template, which includes a question about whether a patient has travelled outside of Canada in the last 14 days.

“Long-haul truck drivers who travel into the U.S.A. will always screen positive to this question. So will many pilots,” Marsh said in an email.

“As a result, their family members will always come into question, as they have close contact with someone who screens positive.”

The dental college has asked the provincial government for more clarity regarding people in these categories, but it has not yet received a response, Marsh said.

Skipping the dentist

For now, Marsh said dentists can provide emergency dental care to patients who screen positive for COVID-19, but for non-essential appointments, patients still have to either get tested or isolate for 14 days.

Heans said that means he and his wife will simply skip the dentist for the foreseeable future.

“I guess we have to,” he said.

As for Hassan, she said she’s happy with how her situation was resolved but hopes it will shed light on a situation that other essential workers may be going through. Essential workers who find themselves in a situation like hers shouldn’t be afraid to push back, she said.

“I think just have a discussion around it,” Hassan said.  

“In some cases, it’s going to take some navigation, and that’s how a decision is going to be made.”

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CBC | Health News

COVID-19 in Quebec: ‘We need you,’ says Legault of 9,500 workers absent from health-care network

The latest:

  • Quebec has 21,838 confirmed cases of COVID-19, and 1,243 people have died. The majority were residents of long-term care institutions and other seniors’ homes.
  • There are 1,411 people in hospital, including 207 in intensive care. Here’s a guide to the numbers.
  • Quebec will release details on how it will ease restrictions next week. The process is expected to start May 4.
  • The Jewish General Hospital has lifted its ban on allowing partners in the maternity ward delivery room.
  • A patients’ rights group is filing a human rights complaint for how long-term care homes have handled the spread of COVID-19. 
  • Director of public health Dr. Horacio Arruda says guidelines on wearing masks are coming later this week. 

Quebec Premier François Legault says there are 9,500 workers absent from Quebec’s health-care network, as the number of COVID-19 cases continue to rise.

In the last 24 hours alone, 800 more people have not shown up to work, bringing the total number of absences to 9,500, he said. This labour shortage is especially felt in the province’s long-term care homes.

Among those absent, 4,000 workers are infected with COVID-19. In his daily update on the situation in Quebec on Thursday, Legault issued a plea to healthy workers who have finished their 14-day quarantine period, but are still at home.

“We need you,” he said. “We are not taking any risks with your safety.”

He said the province has the necessary protective equipment, such as masks and gloves. The supply of gowns was running low, but Quebec companies are now stepping up to make more.

On Thursday, the premier announced 109 more deaths related to COVID-19, bringing the total to 1,243. There are 873 more cases in the province, for a total of  21,838. 

Eight more people are in intensive care, bringing the total to 207, and 1,411 people are currently hospitalized.

A health-care worker wears protective equipment at the Pierre Boucher Hospital in Longueuil, Que., on Wednesday. (Ivanoh Demers/Radio-Canada)

Legault has described the pandemic in Quebec as existing in two worlds: the beleaguered long-term care homes, known in French as centres d’hébergement de soins de longue durée (CHSLDs), and seniors’ homes, and the rest of the population where community transmission is decreasing. 

The rising death toll among seniors in care puts the province on pace to surpass the most optimistic scenario presented by public health experts earlier this month: 1,263 deaths by April 30.

About 80 per cent of those who have died were in long-term care homes or seniors’ homes, and 97 per cent were over the age of 70.

To help control the spread of the virus, public health director Dr. Horacio Arruda is asking Quebecers to wear masks when it is not possible to leave one to two metres of space between people.

He said it is a “strong recommendation” but not obligatory, and that the government will be posting videos explaining how to make a mask at home and how to safely wear it.

Seniors arriving at hospital underfed, dehydrated: doctor

A doctor at Montreal’s Jewish General Hospital says patients from long-term care homes are arriving in need of urgent care, not necessarily because of COVID-19, but because they are underfed and dehydrated.

WATCH | Health impact of Quebec’s long-term care crisis goes beyond coronavirus:

The long-term care crisis in Quebec is having an impact on seniors’ health even if they don’t have COVID-19. Doctors are seeing elderly patients coming to hospital with signs some basic needs aren’t being met. 2:04

“These are patients who are required to be fed by someone else. They need to be given water by someone else,” Vinh-Kim Nguyen, an emergency physician, told CBC Montreal’s Daybreak. “They’re not, and so they’re coming with quite serious health consequences as a result.”

Nguyen, who is also vice-president of Doctors Without Borders Switzerland, where he lives part of the time, said what is happening in long-term care homes is a “humanitarian crisis.” 

Nguyen said Jewish General Hospital is increasingly getting patients from CHSLDs that have not been provided the most basic level of care.

“What we are seeing is that some of these facilities are so overwhelmed that they are sending us patients for basic nursing care that they are no longer able to offer,” he said. 

In many cases, Nguyen said staff immediately set up an IV (intravenous) line to give them fluids and restore their electrolyte balance. He said the hospital has newly purchased iPads, which allow patients to speak with their family and lift their spirits.

“If a patient isn’t motivated, there’s not much we can do,” he said.

On Wednesday, Legault requested another 1,000 members of the Canadian Armed Forces to assist with the crisis. 

Prime Minister Justin Trudeau said Thursday that 350 members are currently in the province and that more military support is coming.

Lack of care a human rights issue, advocacy group says

A patients’ rights group has filed a complaint against the province’s long-term care homes for their treatment of residents amid the COVID-19 pandemic. 

Paul Brunet, president of the Quebec Council for the Protection of Patients, says residents have faced discrimination and exploitation in the lack of care provided by the homes. 

“Some seniors are not getting minimum health-care services, which is required by virtue of our Constitution and Charter of Rights,” Brunet said.

“They are not treated humanely. They’re not respected. They are infringed in their right to integrity, security and dignity.”

Watch | How does COVID-19 spread?

You play a role in how effectively the virus moves from person to person, says family physician Dr. Peter Lin. 0:48

In 2018, the same group launched a class-action lawsuit targeting all the government-run CHSLD care facilities in the province, which house around 37,000 people.

The lawsuit was approved in 2019, but still hasn’t been heard in Quebec Superior Court.

In light of the unfolding situation at the homes with the pandemic, Brunet says the group decided to make a complaint to Quebec’s Human Rights Commission. 

“We thought a complaint … would be the best, the fastest and certainly the most relevant way of telling and asking the commissioner for a statement and eventually for monetary compensation for patients,” Brunet said. 

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CBC | Health News

Gloria and Emilio Estefan Provide 500 Daily Meals to Healthcare Workers and First Responders

How Gloria and Emilio Estefan Are Giving Back Amid COVID-19 Pandemic | Entertainment Tonight

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