The Avoidable Tragedy: How Canadian Public Health Failed to Curb the Carnage of COVID-19

Doris Grinspun was meeting with Ontario’s ministers of long-term care and health to talk about inadequate staffing in the province’s care homes, when she glanced at her Twitter feed and saw that the World Health Organization had declared a pandemic. It was March 11. By then the novel coronavirus had spread to 100,000 people in 114 countries, including 117 people in Canada.

Grinspun, the CEO of the Registered Nurses’ Association of Ontario, immediately gathered her things and walked out of the room, leaving behind her director of policy. The staffing issues facing long-term care homes were well known. This wasn’t the first time she had brought them to the government’s attention, and just the previous summer a public inquiry sparked by a serial killer nurse had also urged the province to address the longstanding shortage of registered nurses. Grinspun figured her time would be better spent planning for the impact of the pandemic, which was sure to make everything worse.

For weeks, she’d been talking about the coronavirus with colleagues in Spain and Italy. Hospitals were overrun. Doctors and nurses were dying, both from the virus and by suicide. In Canada, public-health officials were still reassuring citizens that the risk the virus posed to Canadians was low, but Grinspun worried about the coming storm.

At more than 7,000 deaths, Canada now has the 11th highest COVID-19 death toll in the world; a dubious distinction for a country of only 37 million people. But a close look at the details show that there was nothing inevitable about the devastation COVID-19 brought to Canada’s care homes, which have borne more than four fifths of the disaster. Had warnings been heeded and decisions made earlier, countless lives might have been spared. Instead,  what unfolded was a public-health failure on a grand scale.

Graphic by Dash Dixon

Grinspun knew care homes were uniquely vulnerable to infectious disease. Many operate out of older buildings that lack enough space to isolate the sick. Residents share living and dining areas, and often bedrooms and bathrooms as well.

Worst of all, the system suffers from chronic understaffing. It relies on low-paid workers who often take part-time jobs in more than one facility to make ends meet and who don’t have paid sick leave. Workers could easily carry the coronavirus with them to multiple homes, and their daily tasks—dressing, feeding, showering, and otherwise caring for elderly residents—make physical distancing impossible.

Despite the systemic vulnerabilities of long-term care and the frailty of those who need it, Grinspun saw ways to mitigate the risk to residents and staff. Her association quickly called on government and public-health officials to implement widespread testing, as well as a simple but important protective measure to reduce the risk of asymptomatic healthcare workers spreading the virus: Masking. “We started to say we need universal masking—and it needs to start in nursing homes,” Grinspun told The Capital.

About 8% of Canada’s seniors live in long-term care. “The only way to save their lives, in our view, was to keep the virus out,” she said.

That didn’t happen. The virus swept through Canada’s long-term care homes with ferocity. By the end of May, it had hit 18 percent of the country’s care homes, infecting 26,600 residents and staff and killing more than 5,500, accounting for 81 percent of Canada’s COVID-19 deaths.

“It’s a policy-made tragedy,” said Grinspun.

For the most part, the disaster in Canada's care homes has gone unseen. Visitors have been barred since March, and despite many of the hardest-hit facilities being located in the centre of residential neighbourhoods, to the average passerby the only change has been a few more white vans than usual pulling up to their loading bays. This week, however, Canada got its first unfiltered look at the horror within.

After soldiers were dispatched to shore up staffing at a series of Ontario care homes, the Canadian Armed Forces published a report containing nightmarish scenes; residents abandoned in their beds for weeks on end or force-fed until they choked. Residents with dementia allowed to wander at will through buildings rampant with the virus. At a facility just north of Toronto, residents were "crying for help" for as long as two hours before receiving assistance. Some had not been bathed for weeks, and "significant gross fecal contamination" was the norm in patient rooms. "Respecting dignity of patients not always a priority," wrote observers of a facility in Pickering, Ontario.

A Canadian Armed Forces member during deployment to a Quebec care home (Department of Defence)

Canada can’t say it didn’t have plenty of warning about the threat to its care homes. A report in mid-February by the Chinese Center for Disease Control and Prevention put the mortality rate for people 80 and older at 14.8%—significantly higher than the 1.3% mortality rate for those in their 50s. In late February, an outbreak in a US nursing home in Washington State sickened 129 people and killed 35. Horrific stories of outbreaks in European nursing homes followed. Soldiers deployed to disinfect nursing homes in Madrid discovered dozens of residents dead in their beds. By late March, 65% of the dead in Spain and 50% in Italy were 80 and older. “We knew it was coming, and there was no proactive strategy to protect seniors in long-term care,” said Marissa Lennox, chief policy officer for Canadian Association for Retired Persons.

Few areas of the world have been able to keep themselves completely free of COVID-19, but the example of Asian countries shows that it can be contained. Countries that were spared large numbers of coronavirus deaths (Taiwan had 7; South Korea, 269) acted quickly to stop community spread. “The countries that have been successful do mass testing, and then they contact trace, and they isolate, and then they quarantine,” said Kulvinder Gill, president of the Concerned Ontario Doctors, a non-profit organization of frontline doctors that advocates for a patient-centred healthcare system. "And that's the only way to contain the virus.” In Canada, she said, “we haven't had any part of that equation done correctly.”

The Public Health Agency of Canada “didn’t diagnose fast enough that this particular bug could not be tracked or traced like a normal virus,” said a family doctor who’s working shifts  in a Montréal nursing home and has asked not to be named. “You had an invisible trail of mild and asymptomatic cases that never came to medical attention, and it was public health's job to see that early. And it was very clear early—like in January, when China shut down Chinese New Year—that test results were the tip of a very large iceberg.”

Even so, as COVID-19 ripped through Europe and Central Asia, Canadian authorities were telling the public not to worry. In early-March, the country’s top public-health officer, Theresa Tam, described the new coronavirus’s risk to Canadians as low. Meanwhile, the virus was already surging unchecked through the country. “We suspect that there was rapid asymptomatic community spread happening as early as February,” said Gill.

Case reports as early as January and February suggested that the virus could be spread through asymptomatic carriers. But Canada’s border policy ignored these early findings, and instead opted to treat COVID-19 as a conventional disease where only the visibly sick were a risk to others. Much of Canada’s anti-COVID-19 strategy in the early days of the pandemic was focused on catching arrivals with symptoms and those who’d come from hotspots such as China and Iran, even at a time when Europe was already far outpacing every other region in the number of new cases per day. Between March 11 and March 17, the number of new cases in Europe nearly tripled, jumping from  3,235 to more than 10, 505.

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But it wasn’t until March 18 that the federal government began restricting international travellers, March 21 when it closed its border with the US for non-essential travel, and March 25 when it began requiring mandatory 14-day quarantine for returning Canadians.

While the response may seem slow in retrospect, enacting extraordinary measures requires public buy-in, according to Mel Krajden, medical director of the BC Centre for Disease Control’s public health laboratory—and that complicates the decision-making process for public health officials. “If you try to do these things too early you’ll get a backlash,” he said. “When you think about it, could you ever have imagined that we would close the border with the US? It is really difficult to envisage implementing that unless people felt really threatened.’”

But even after the threat to the public was clear, government and public- health officials were slow to enact measures that might have saved lives in long-term care homes. The Public Health Agency didn’t issue federal guidelines for long-term care homes until April 8—more than a month after the country’s first care-home outbreak.

Some relatively easy measures that could have curbed the virus’s spread include mass testing and extensive use of personal protective equipment, according to Gill, of Concerned Ontario Doctors. But shortages of PPE and the chemical reagents for testing, as well as the nasopharyngeal swabs used to collect test samples—which were imported from pandemic-battered Italy—left the country unprepared on either front.

That shouldn’t have been the case, said Gill—as this isn’t our first pandemic. Only 17 years ago, Canada had similarly faced down the spectre of an incredibly contagious respiratory coronavirus that had emerged without warning from China.

After SARS hit the Toronto area in 2003, killing 44 and infecting 375, it sparked an official investigation into how the province had coped with the viral threat. “If we do not learn the lessons to be taken from SARS. . . and if we do not make present governments fix the problems that remain, we will pay a terrible price in the face of future outbreaks of virulent disease,” concluded investigation chair Archie Campbell in his final report.

That price is now being paid, largely on the backs of Canada’s long-term care workers and residents.

Photo illustration by Dash Dixon

One of the lessons from the SARS report was that the country needed to have “sufficient quantities of medical supplies, secure supply chains and the means to distribute the supplies.” But as the new coronavirus has revealed, some of the provincial stockpiles of PPE weren’t maintained and the National Emergency Strategic Stockpile—intended to supplement provincial supplies during infectious disease outbreaks, natural disasters, and other public health events—turned out to be insufficient.

As early as January, global supply chains were disrupted and Canadian medical suppliers of PPE were indefinitely out of stock. Canada confirmed its first COVID-19 case on January 25, yet it wasn’t until the end of March that it signed contracts for domestic production of medical supplies, such as surgical masks and rapid tests for coronavirus.

The SARS Commission had also highlighted the importance of the "precautionary principle”— erring on the side of caution—when it comes to protecting frontline workers. In the early confusion of how SARS spread, Ontario’s frontline workers had been told they didn’t need N95 respirators — a decision that would later prove to have put them at greater risk. “Action to reduce risk need not await scientific certainty,” Campbell wrote in the final report.

There are similar unknowns with COVID-19. Medical experts agree that it spreads through contaminated surfaces and droplets that are expelled when someone coughs or sneezes, but the data isn’t yet in on whether it travels through the air like measles.

From the start of the pandemic the Public Health Agency of Canada instructed healthcare workers not to be concerned about airborne transmission of the virus, except during particularly messy procedures such as intubation.

Only Ontario, the epicentre of Canada’s 2003 SARS outbreak, demurred. The province's ministry of health had been advising healthcare workers to adhere to the precautionary principle and to treat the new coronavirus as if it were airborne.

But Ontario’s healthcare workers couldn’t easily act on that advice. In recent years the province had let millions of N95s expire and then had disposed of them without replenishing the stock. Facing criticism by infectious disease experts who were concerned that the province would burn through its limited supply, the chief medical officer of health, David Williams reversed course, telling the province’s healthcare workers to simply adhere to droplet and contact precautions.

Union official Michael Hurley recalls being taken aback by the about-face during a meeting with Williams and other health officials. “When it becomes clear that there aren't enough supplies in Ontario, the Ontario government responds by changing the safety protocols,” said Hurley, a vice president of Canadian Union of Public Employees, which represents 30,000 long-term care home workers in Ontario. “I heard Dr. Williams say that when we get the supply problem dealt with, we can return to the precautionary principle, which I think is an admission that the whole watering down of the safety standards is all supply related. It's not got anything to do with whether people actually believe this is an airborne virus.” (Williams did not respond to The Capital’s request for comment.)

Meanwhile, evidence was mounting that COVID-19 did indeed spread through the air. A choir practice in Washington State that resulted in two deaths and 53 infections was leading some experts to speculate that the virus could be transmitted through the air in close-knit, indoor environments. Researchers from Princeton University, the Centers for Disease Control and Prevention, the University of California, and the National Institute of Allergy and Infectious Diseases reported on March 17 that the virus could “remain viable and infectious in aerosols for hours.” In an April 2 article in the journal Nature, an Australian aerosol scientist said  it was a “no-brainer” that COVID-19 could spread through the air.

As this data came in, Doris Grinspun was still trying to get even basic surgical masks into Ontario’s long-term care homes.

Around the time Canada’s COVID-19 lockdowns began, the federal government started procuring bulk orders of PPE and medical supplies, according to PHAC spokesperson André Gagnon. Since early April, it has allocated to the provinces and territories approximately 2.5 million N95 respirators “and equivalents,” 41 million surgical masks, 11.5 million pairs of nitrile gloves, 5 million face shields, and 1.4 million protective gowns.

But that PPE largely went to hospitals and acute-care settings, not the long-term care homes that were fast becoming hotbeds of COVID-19.  In most provinces, said CARP’s Lennox, “seniors and long-term care were an afterthought in this pandemic.”

That wasn’t the case in BC, where the policy response quickly focused on the province’s long-term care sector. And even there, BC still couldn’t keep the virus from hitting 9% of the province’s care homes. The other hard-hit provinces (Quebec, Ontario, and Alberta) fared much worse, with the percentage of stricken care homes ranging from 14% (Alberta) to 29% (Ontario), according to the National Institute on Ageing’s Long-Term Care COVID-19 Tracker.

One factor that accounts for the provinces’ different outcomes was the timing of specific policy responses, according to Samir Sinha, the National Institute on Ageing’s director of health policy research.

These measures included restricting non-essential visits, limiting staff to working at one site, and requiring staff and visitors to wear surgical masks.  “Provinces that acted more definitively and earlier probably have helped to avoid a number of unnecessary outbreaks from occurring,” Sinha said.

In this, BC is the gold standard; despite having some of the country’s first COVID-19 cases (and sharing many direct transportation links with the first areas affected by the virus), the province has been able to ride out the pandemic with fewer overall care home deaths than Quebec would eventually see in the course of a single day.

BC began implementing most of its measures to protect the long-term care sector by the end of March—before the federal government had even issued its guidelines. The first outbreak in a Canadian care home occurred on March 5, at the Lynn Valley Care Centre in North Vancouver. Soon after, BC banned non-essential visitors, made masks and gloves mandatory for staff, and offered guidance for contact tracing and isolating those with respiratory symptoms.

BC acted faster in part because it had been keeping a close eye on what was happening south of its border. By mid-March, the US-based Centers for Disease Control and Prevention was reporting that staff members working in multiple facilities had contributed to the virus’s spread in Washington State nursing homes.

To prevent BC suffering the same fate, provincial health officer Bonnie Henry restricted staff to one facility and made them full-time government employees, topping up their pay to compensate for the loss of the part-time jobs that had kept many of them afloat. She issued the order on March 26.

By contrast, every other province waited critical weeks before following suit. Quebec announced its rule restricting workers to a single site on April 2; Ontario waited until April 14, after the virus had spread to 114 homes, but then exempted temp agency workers; Alberta announced the rule on April 10.

Nova Scotia didn’t recommend that staff refrain from working in multiple sites until April 17th, after the virus had already infected seven care homes, and even then it stopped short of issuing a mandatory order. The province didn’t even require surgical masks until April 12, more than two weeks after BC had put the measure in place and five days after PHAC recommended it. “Had they actually followed suit with implementing their actions when BC did, you may have been able to stop the biggest outbreak east of Montréal,” said Sinha. That outbreak, at Northwood Manor, killed 56 residents and accounts for all but three of Nova Scotia’s COVID-19 deaths.

“In a country where every province and territory is responsible for its own long-term care system,” Sinha said, “you can see how literally days of delays in implementing things can result in an exponential number of lives lost.”

The provinces also had different testing strategies. BC rationed its COVID-19 tests, like other provinces, but prioritized testing those who were  most vulnerable, including long-term care residents. Unlike other provinces, which reserved tests at care homes for those with symptoms, BC sagely adapted its testing regimen to the unique characteristics of COVID-19. It didn’t just test those exhibiting mild or atypical symptoms, it tested anyone who might have been exposed. In a recent op-ed, Bonnie Henry credited the province’s liberal testing strategy with catching developing cases before the virus spread. Michael Schwandt, medical health officer with Vancouver Coastal Health, also said that an aggressive policy of testing care home residents even if they were merely suffering from fatigue or simply didn’t feel like themselves was instrumental in staving off outbreaks.

In short, BC was vigilant in locking down its care homes, and in locking them down early. By the end of May, although the virus had killed 112 long-term care residents, a large-scale crisis had been averted.

The pandemic has been playing out much differently in Ontario and Quebec.

Photo illustration by Dash Dixon

Across the country—but nowhere more clearly than in Quebec and Ontario—the pandemic took an existing staffing crisis in care homes and turned it into a full-fledged disaster. The long-term care sector lacked the surge capacity to compensate for workers falling sick. And when facilities closed their doors to family visits in an effort to protect residents from the virus, they essentially lost an informal workforce—family members who regularly feed, dress, and sometimes even bathe their loved ones. “If you’re going to take those people out, you’re going to need a bigger labour force, because we haven’t had enough people providing the care, and families are one way the gap gets filled,” said York University sociology professor Pat Armstrong, who has done research into long-term care.

In Quebec, it’s also common for families to hire private caregivers to assist their loved ones in long-term care residences. These caregivers, like families, were banned from nursing homes after the pandemic hit.

In the span of three weeks, more than a thousand of Quebec’s long-term care residents died of COVID-19. Staff in many homes stopped showing up to work, either because they needed to quarantine or feared carrying out their duties without protective gear. Some residents, left to fend for themselves, died not from the virus but from lack of food or water. The family doctor who’s taking shifts in a Montréal nursing home knows of a resident who died of hypoglycemia. “No one should die of hypoglycemia,” he said. “She could have been saved by a cracker.”

In the most infamous case, staff abandoned Résidence Herron, a private nursing home near Montréal, leaving two nurses to care for 130 residents. When authorities arrived, they found residents in abominable conditions, unfed, dehydrated, and wearing soiled diapers. After gaining access to patient files, they determined that 31 residents had died at the home in the span of a few weeks; at least five from  COVID-19.

The CBC later revealed that one of the care home’s owners requested PPE from the local public-health agency four days before the first resident had tested positive for the virus—but the request had been denied.

Three weeks after the pandemic hit, and after the horrific situation at Résidence Herron had come to light, Quebec Premier François Legault announced that long-term care homes were a top priority. Following BC’s lead, he restricted workers to a single site and boosted their pay.

But it was too late. By mid-April, outbreaks raged in 80 of the province’s 2,215 long-term care facilities.

Meanwhile, Quebec’s already depleted healthcare sector was short about 9,500 workers; 4,000 had tested positive for the virus, and the other 5,500 seemed to be avoiding work out of fear, forcing government officials to admit that long-term care residents weren’t even getting basic care. As an emergency measure, private caregivers were allowed to return to work provided they tested negative for the virus. The province then sent hospital workers into the long-term care sector, and the premier issued a desperate plea for medical specialists to volunteer to work in the homes. On April 17, they were forced to call in the army.

Soldiers enter the Centre de santé Saint-Lambert as part of Operation Laser, the military's deployment to understaffed care homes (Department of Defence).

By late April, Ontario too was falling back on desperate measures to contain the catastrophe, such as deploying hospital staff to care homes and requesting help from the military.

In the first weeks of the pandemic, the virus claimed the lives of nearly half the residents at Pinecrest Nursing Home, a 65-bed facility in Bobcaygeon, Ontario, where there was no space to isolate the sick.

The experience at another home, Anson Place Care Centre in Hagersville, illustrates how only a handful of missed opportunities could transform a facility into a place of mass death. COVID-19 was introduced to Anson Place’s building on March 6 by a handler from an exotic-animal petting zoo.  Notably, the handler had entertained residents of a retirement home on the first floor but never set foot in the care centre upstairs.

As soon as management learned of the possible exposure, the first floor retirement home isolated its residents in their rooms. But, critically, the staff continued sharing stairwells, bathrooms, and even a lunchroom with the long-term care workers upstairs.

It wasn’t long before the residents upstairs started dying. “We have old ward rooms, and there is no way to have social distancing, because the beds are a foot or two away from each other with a curtain drawn in between,” said Rebecca Piironen, a personal support worker. “We had a lot of people die very quickly.” This fact could have had a grim benefit: The rooms where residents had died could have been cleaned and then used to isolate other residents who had tested positive. But even this common sense precaution was not done.

The first Anson Place death officially linked to COVID-19 occurred on March 16, only 10 days after the exotic-animal handler’s visit, though Piironen has her doubts it was really the first. Four sudden deaths attributed to cancer in the previous weeks had looked nothing to her like the slow cancer deaths she was used to witnessing.

Ruby McCarroll, one of the Anson Place residents who died of complications from COVID-19. Her son, Mike McCarroll is now the lead plaintiff in a class action lawsuit against the facility (Handout)

Remarkably, for 13 days after the first official COVID-19 death, she said she and other staff worked without any PPE—not even basic surgical masks. During the course of their duties, PSWs routinely get coughed, sneezed, and breathed on, and sometimes even spit at.

Lisa Roth, the executive director of Anson Place, said in an email to The Capital, “Throughout the COVID-19 outbreak in our home, we have made sure that the necessary personal protective equipment (PPE) is available to all staff, at all times.”

Piironen said masks arrived at the end of March, and that face shields and goggles followed in early April. Yet many of her colleagues worked only with surgical masks because management, in line with what the ministry of health was recommending at the time, said further protection wasn’t necessary. The N95s were locked up, and Piironen said staff didn’t have access to them until after a court action by the Ontario Nurses’ Association.

At a news conference on the last day of March, with COVID-19 cases in 10 long-term care homes, a reporter asked Ontario Premier Doug Ford why the province hadn’t acted more quickly to protect vulnerable residents. Ford replied that the province was doing everything it could. And then he made it seem as if the crisis couldn’t have been predicted: “I just wish we had a crystal ball a month ago, a month and a half ago, to see where this was going,” he said.

For a province ostensibly doing everything it could in March, however, Ontario would find plenty more that it could do in April.

The province allowed COVID-19 to spread for another two weeks before it adopted BC-style measures that accounted for the disease’s ability to spread through asymptomatic carriers. At first, Ontario’s Ministry of Health had openly discouraged most testing of asymptomatic long-term care residents, saying it was “generally not recommended.” By the middle of April the ministry recommended proactive surveillance testing to catch cases before outbreaks occurred, and by the end of the month it was ordering public health units to facilitate testing for all long-term care staff and residents.

In early April, nearly a month into the lockdowns, Grinspun’s calls for universal masking were still being ignored. Throughout March, she said, she repeatedly raised the idea in her daily 9am calls with Ontario’s public-health authorities. Her association had issued a public statement on the topic on March 22, and on April 1, she posted an urgent plea on her blog, saying, “There is a horrific crisis unfolding innursing homes, and a direct link between lack of proper protection and mounting infection clusters….RNAO has been sounding the alarm bell for well over a month. We will not stop saying it: The time is NOW, to ensure all nursing homes are provided with sufficient quantities of surgical masks and other essential PPE, so that all staff wear one at all times – to prevent outbreaks and NOT after an outbreak has happened.”

It wasn’t until PHAC recommended masking in long-term care homes five days later – three weeks into the pandemic –that chief medical officer of health David Williams finally issued a directive requiring all staff and essential visitors to immediately begin wearing masks “at all times for the duration of full shifts or visits.” By then, there were already outbreaks in at least 58 of the province’s long-term care homes.

The directive also called for isolation of infected residents. In the following days, Ontario continued to step up its efforts. On April 10, a new order required frontline workers within two metres of suspected or confirmed COVID-19 cases to have appropriate PPE, including N95 respirators or their equivalent. The province said that the gear would be available to anyone who needed it, and that the Ministry of Health’s Emergency Operations Centre could respond to “every escalated request for PPE” within 24 hours.

That weekend, Ontario delivered supplies to 102 care homes, but even then protective gear didn’t find its way to everyone who needed it. At Eatonville Care Centre workers were practically begging for protection in the middle of an outbreak. A representative for the Service Employees International Union Healthcare sent an email on their behalf to the care home’s executive director on April 15, citing a number of infection control failures. Among them, “surgical masks are not being given or are worn all day” and the frontline workers were not being provided with N95s—“yet supervisors are wearing them.”

The Concerned Ontario Doctors also sounded the alarm about limited access to PPE. In an open letter to Prime Minister Justin Trudeau and Ontario Premier Ford on April 14, a day before Canada’s COVID-19’s death toll reached 1,000, the group laid out specific measures that it said could still save lives, including ramping up testing in long-term care homes and making sure workers had proper PPE. “Asymptomatic frontline healthcare workers without adequate PPE are unknowingly acting as vectors for COVID-19 transmission,” the letter said.

On April 15—five weeks into the pandemic—the province launched a COVID-19 Action Plan for Protecting Long-Term Care Homes, promising “immediate action” on testing and screening, training for staff to manage  outbreaks and the spread of the virus, and emergency deployment of hospital workers to plug staffing shortages.

Despite this, there were still critical tools that the province declined to use, such as forcibly taking over the operations of struggling care homes or enforcing the province’s PPE and isolation directives.

On April 22, the Ontario Nurses’ Association (ONA) took four care homes, including Anson Place, to court, seeking emergency injunctions to force them to provide adequate PPE to their workers and to comply with public-health directives.

At Anson Place, more than 30 frontline workers had been sent into quarantine due to suspected infections, including personal support worker Rebecca Piironen. To replace them the management brought in church volunteers and student trainees that Piironen said weren’t trained in the proper use of PPE. In addition, none had been fit-tested for N95s.

“I’m hearing stories about how some of these students would put PPE on, but then go in each room with the same PPE on,” said Piironen. “So they ended up having contaminated PPE and going into a room where there were residents that were testing negative.” Some of those residents later tested positive, she said: “One just died recently.”

Piironen doesn’t understand why she and her and her colleagues didn’t have access to PPE sooner; why the sick weren’t isolated; and why staff from the retirement home on the first floor, where the virus was introduced, were able to mix with the long-term care staff. “They should have had us all locked down and isolating,” she said.

Twenty-seven Anson Place residents have died from COVID-19 and 105 have contracted the virus. Roth describes the current situation as “stable.” But it’s far from over. Twenty-eight residents still have COVID-19. Twenty-nine staff have tested positive for COVID-19. “I don't know why they chose to play Russian roulette with our lives,” said Piironen. “They’re lucky that none of us have died from it yet.”

Anson Place is now one of six long-term care homes in Ontario facing a class-action lawsuit related to its handling of the pandemic.

In this May 5 photo, members from 12e Régiment blindé du Canada assist at the Résidence Berthiaume-Du Tremblay long-term care centre  in Montréal (Department of Defence).

Almost all of Canada’s COVID-19 fatalities have occurred, and are continuing to occur, in long-term care homes. According to the National Institute on Ageing, 81% of all COVID deaths in Ontario are now linked to care-home outbreaks; in Quebec, it’s 83%. In Ontario, COVID-19 has killed 1,680 long-term care residents and 7 staff members; in Quebec, 3,118 residents and 3 staff members have died.

The situation in Ontario and Quebec continues to spiral. In a single long-term care facility in Quebec, in the Town of Mount Royal, every one of its 226 residents, and nearly 150 employees, has contracted the coronavirus. On Monday, Ontario issued an order forcibly seizing control of two care homes that have been unable to contain the spread of COVID-19. On Wednesday, the province announced it was mobilizing inspection teams to ensure hard-hit care homes were following public-health orders.

The rapid spread of the virus in Canada’s care homes—where more than 23,000 people have been infected—highlights the “slow implementation of effective infection control measures,” according to a study by the International Long-Term Care Policy Network.

Even if Canada had done everything right, COVID-19 was going to kill Canadians. But what differentiates a pandemic that kills several dozen, as in BC’s care homes, or a few thousand, as in Quebec’s, is largely a matter of public policy. “The information that the federal and the provincial governments acted on in April—all that information was available in January,” said Gill, of Concerned Ontario Doctors.

In a pandemic it’s been said that if you’re on time, you’re late—and that you have to be early to be on time. “Most lay people might not know that,” said the Montréal family doctor who’s now working in a nursing home, but public-health authorities should. “It’s their job,” he said.