April 23, 2020 CBC article features timeline related to long term care in Ontario

Everybody is doing the best they can in difficult circumstances in Ontario as elsewhere.

The current post concerns one aspect of the ongoing pandemic – namely, the distinction between rhetoric and reality. When times are difficult as at other times, the closer rhetoric matches reality, the better off we are.

Previous posts refer to variability in COVID-19 testing

Click here for previous posts about COVID-19 >

Some previous posts have focused on testing:

March 18, 2020 Intensive testing has vastly reduced infections in South Korean, Taiwan, and Singapore; in Canada the focus is now on minimizing the quickness of the ‘forest fire’ as it burns, yet testing still remains a key requirement

March 19, 2020 Intensive testing for COVID-19 is recommended by WHO; in Canada, public health messaging appears to emphasize restrictions on testing

April 5, 2020 South Korea and Germany are doing extensive COVID-19 testing; Province of Ontario has not been doing much testing at all

April 8, 2020 COVID-19 testing is an absolute priority – including of asymptomatic individuals; not much testing is happening in Ontario right now

April 8, 2020 Battle is breaking out in southwestern Ontario between three long-term care facilities and local public health, with health officials refusing to test elderly asymptomatic patients for COVID-19

April 9, 2020 Canada doesn’t have enough COVID-19 testing capacity, and might never get it

Some general comments based on news reports from reliable sources come to mind:

  1. Some jurisdictions around the world have responded with a high level of effectiveness to the pandemic by adopting measures including quick lockdowns and extensive testing, tracing, and isolation. In such cases, rhetoric from public health sources has closely matched the reality of what is happening on the ground.
  2. Some jurisdictions have responded with a moderate level of effectiveness. In such cases, rhetoric from public health sources has in some but not all cases matched the reality of what is happening on the ground.
  3. Some jurisdictions have responded with a low level of effectiveness. In such cases, public health sources are unable to provide accurate information related to the reality on the ground.

These are thoughts that occur to me as I read about the situation in Ontario where I live.

April 23, 2020 CBC article features timeline related to long term care in Ontario

An April 23, 2020 CBC article is entitled: “From ‘risk is low’ to calling in the army: 2 months of Ontario’s COVID-19 response in long-term care: Province was ‘taking all the necessary precautions’ to protect long-term care, ministers said on March 16.”

An excerpt reads:

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.”

April 20, 2020 Foreign Affairs article outlines COVID-19 decision making in the United States

An April 20, 2020 Foreign Affairs article is entitled: “How America’s Urban-Rural Divide Has Shaped the Pandemic: The High Cost of Geographic Political Polarization.”

The article helps to contextualize a slow and divided American response to COVID-19.

An excerpt reads:

However, the long incubation period and lack of testing outside of metro areas meant that some holdout officials may have waited too long, including some in places with extremely vulnerable populations and an underdeveloped health infrastructure.

April 23, 2020 New York Times article highlights limited U.S. testing capability

An April 23, 2020 New York Times article is entitled: “Hidden Outbreaks Spread Through U.S. Cities Far Earlier Than Americans Knew, Estimates Say.”

The article highlights how a response was delayed in a particular city namely New York; links in the following excerpts refer to delay along with initial reluctance to close schools and restaurants:

Unseen carriers of the disease, many of them with mild symptoms or none at all, can still spread the virus. For that reason, by the time leaders in many cities and states took action, it was already too late to slow the initial spread.

A few cities with early outbreaks, notably Seattle, are believed to have avoided enormous growth later by heeding the models available at the time and taking action well ahead of the rest of the country.

“We knew the numbers we saw were just the tip of the iceberg, and that there were much greater numbers below the surface,” said Jenny A. Durkan, the mayor of Seattle, in an interview. “We had to act.”

City and state officials in New York acted more slowly, waiting until known cases were at a higher level to shut down schools and issue a stay-at-home order. Mayor Bill de Blasio was reluctant to embrace shutdowns until mid-March, citing the impact they would have on vulnerable New Yorkers.

“Even while we learn new things about this virus almost daily, one thing remains consistent: New Yorkers were put at risk by the federal government’s total failure to provide us with adequate testing capability,” said the mayor’s press secretary, Freddi Goldstein.

April 24, 2020 New York Times article advocates random testing

An April 24, 2020 New York Times article is entitled: “We Need Coronavirus Tests for Everyone. This Is the Next Best Thing.: Random sampling is the quickest, most feasible and most effective means of assessing the U.S. population.”

An excerpt reads:

The recent Nobel in economic science went to Abhijit Banerjee, Esther Duflo and Michael Kremer, researchers using random control trials, the mainstay of scientific medicine. Their work dramatizes how misleading it can be, for example, to measure disease prevalence by reference to those who seek treatment at rural health clinics, omitting the multitudes who have no access.

Local random tests should be undertaken immediately. University researchers, working with local governments or operating independently, could conduct simple randomization, testing perhaps 5,000 or 10,000 individuals. We would quickly learn whether total cases were five times or 50 times current estimates in those areas.

April 24, 2020 New York Times article highlights quick response in Australia and New Zealand

An April 24, 2020 New York Times article is entitled: “Vanquish the Virus? Australia and New Zealand Aim to Show the Way: The two countries, led by ideological opposites, are converging on an extraordinary goal: eliminating the virus. Their nonpolitical approach is restoring trust in democracy.”

An excerpt reads:

It all started with scientists. In Australia, as soon as China released the genetic code for the coronavirus in early January, pathologists in public health laboratories started sharing plans for tests. In every state and territory, they jumped ahead of politicians.

“It meant we could have a test up and running quickly that was reasonably comparable everywhere,” Dr. Collignon said.

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