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(05-09-2020, 02:43 PM)Pjeffster Wrote: (05-08-2020, 08:26 PM)KevinL Wrote: Would the difference in out public health unit and those around us, be our lack of teaching hospital? There are such institutions in Toronto, Hamilton, and London, but not here...
The difference I see, and what I heard from people in the field: WR didn't set priority on LTC homes and retirement homes. This would be in reference to testing and PPE. Lots of cities outside WR did, in particular, places like London, Kingston, Thunder Bay (no teaching hospitals in either place) and Hamilton, but we prioritized FR's and hospitals first. 2nd thing, our testing is lagging large. Our regional Chair doesn't like the comparisons, nor does our doctor, but it is where we failed. Our numbers are comparable only to Toronto, but Toronto isn't expected to have the best numbers due to its sheer size. Even Ottawa massively outperformed us.
I think some people are going to look for reasons why we did poorly and why it isn't a bad thing, but the reality is that we didn't do good. Things like tests being super low is a local issue, not provincial, no matter what public health or Karen Redman says. I get that she's trying to support the local health unit, but she too needs to look at their performance here and be honest in her assessment.
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No teaching hospital in Kingston? Really?
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(05-09-2020, 02:43 PM)jeffster Wrote: (05-08-2020, 08:26 PM)KevinL Wrote: Would the difference in out public health unit and those around us, be our lack of teaching hospital? There are such institutions in Toronto, Hamilton, and London, but not here...
The difference I see, and what I heard from people in the field: WR didn't set priority on LTC homes and retirement homes. This would be in reference to testing and PPE. Lots of cities outside WR did, in particular, places like London, Kingston, Thunder Bay (no teaching hospitals in either place) and Hamilton, but we prioritized FR's and hospitals first. 2nd thing, our testing is lagging large. Our regional Chair doesn't like the comparisons, nor does our doctor, but it is where we failed. Our numbers are comparable only to Toronto, but Toronto isn't expected to have the best numbers due to its sheer size. Even Ottawa massively outperformed us.
I think some people are going to look for reasons why we did poorly and why it isn't a bad thing, but the reality is that we didn't do good. Things like tests being super low is a local issue, not provincial, no matter what public health or Karen Redman says. I get that she's trying to support the local health unit, but she too needs to look at their performance here and be honest in her assessment.
As I had mentioned before, though, it seems that another key difference aside from testing was making sure staff was properly trained in fit with PPE - in particular, masks. While some believe (as do I) that it give offers a layer of protection to the wearer, the main focus is that it offers protection to the none-wearer -- in this case, patients and seniors in LTC homes and retirement homes.
A good example of what happens without the use of masks if you have a group of infected people (perhaps asymptotic) is Tyson Meats in Waterloo, Iowa. I think it was something around 1,000 employees infected by the time the plant was shut-down.
We really need to look closely how we handled the 1918 Spanish Flu. I believe they were heavy into social distancing and masks for long enough for the R0 level to go well below 1.0 and eradicate the disease. Wearing masks should become standard until we have a vaccine or unit the R0 remain below 1.0 for the disease to disappear.
How involved does the region itself get involved in LTC homes, though? I know the regional LTC home Sunnyside has been doing a phenomenal job. They were weeks ahead of even the hospitals in terms of limiting public access and implementing measures like face masks, shields, social distancing in the facility and so on. Someone I know who works there said they were also well stocked on PPE. She said they were locked down to the public around March (maybe February?).
I figured it was up to LTC homes to initially follow the guidelines of the Ministry of Health as well as implement their own pandemic plans and to be in contact with the regional public health unit after that. One error it seems that LTC homes made was permitting staff to work multiple jobs. It was pretty late that Doug Ford issued an order that prohibited staff from working at multiple care facilities - be it hospitals or long term. Sunnyside actually took that step weeks before Doug Ford issued any orders, which is probably one reason they've only had 4 staff cases so far and have manged to keep it that way.
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The LTC facilities are not under the management of regional public health authorities. They are managed and coordinated by the local LHINs (Local Health Integration Networks), which are independent organizations reporting up to the Ministry of Health.
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(05-09-2020, 05:30 PM)panamaniac Wrote: (05-09-2020, 02:43 PM)jeffster Wrote: The difference I see, and what I heard from people in the field: WR didn't set priority on LTC homes and retirement homes. This would be in reference to testing and PPE. Lots of cities outside WR did, in particular, places like London, Kingston, Thunder Bay (no teaching hospitals in either place) and Hamilton, but we prioritized FR's and hospitals first. 2nd thing, our testing is lagging large. Our regional Chair doesn't like the comparisons, nor does our doctor, but it is where we failed. Our numbers are comparable only to Toronto, but Toronto isn't expected to have the best numbers due to its sheer size. Even Ottawa massively outperformed us.
I think some people are going to look for reasons why we did poorly and why it isn't a bad thing, but the reality is that we didn't do good. Things like tests being super low is a local issue, not provincial, no matter what public health or Karen Redman says. I get that she's trying to support the local health unit, but she too needs to look at their performance here and be honest in her assessment.
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No teaching hospital in Kingston? Really?
I stand corrected then. And I think we can add Thunder Bay to that too (my bad). Either way though, I don't think having a teaching hospital made a difference, as Kingston Public Health was calling the shots, not the hospital. Again, it's been our LTC & retirement homes that have the issues, and not having the oversight and PPE which seems to be a regional job.
When I read up on Kingston, Public Health had pulled workers (mainly officers that inspected restaurant and other food handling places like grocery stores) and got them to inspect, train and equip LTC&R Homes.
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(05-09-2020, 07:48 PM)ac3r Wrote: How involved does the region itself get involved in LTC homes, though? I know the regional LTC home Sunnyside has been doing a phenomenal job. They were weeks ahead of even the hospitals in terms of limiting public access and implementing measures like face masks, shields, social distancing in the facility and so on. Someone I know who works there said they were also well stocked on PPE. She said they were locked down to the public around March (maybe February?).
I figured it was up to LTC homes to initially follow the guidelines of the Ministry of Health as well as implement their own pandemic plans and to be in contact with the regional public health unit after that. One error it seems that LTC homes made was permitting staff to work multiple jobs. It was pretty late that Doug Ford issued an order that prohibited staff from working at multiple care facilities - be it hospitals or long term. Sunnyside actually took that step weeks before Doug Ford issued any orders, which is probably one reason they've only had 4 staff cases so far and have manged to keep it that way.
Not enough, apparently. My understanding is, as I mentioned before, that cities like Kingston, London, Ottawa, Thunder Bay, Windsor, Hamilton and some other places mandated training, PPE, and testing for all LTC and assisted retirement homes, regardless if they were government owned or for profit. Those cities went beyond what the province was suggesting and what the federal government was suggesting. They implemented 'best practices' while Canada's Chief Public Health Officer was still waiting for the science to answer the questions (in particular, the usefulness of masks in preventing the spread of the virus). All these cities ended up with zero to a few issues in those area's.
Now, due to the fact that it's not expected that residents of LTC homes and assisted retirement homes to contract covid-19 as they're not out and about visiting other countries or people from other countries, so they're low risk. As opposed to people that could come into the hospital with covid-19 like symptoms. Waterloo Region went with the best known science at the time: PPE for hospital workers and FR's in case they're in contact with someone that may have out of country, or if that someone came into contact with someone recently out of country (community transmission). And obviously you need to keep your nurses and doctors free from risk as much as possible, even if that particular science is missing (how much protection do masks offer?).
Because WR's Public Health Doctor was still declaring low risk, there wasn't much thought to workers, in particular, PSW's that works in this LTC's,. etc. So 'best practices' were ignored (due to lack of science). Obviously some workers at these home got covid-19 -- and without PPE as it was not mandated by the region, it ended up killing people.
Waterloo Region followed provincial guidelines and looked to the federal government for hints, but they didn't go above and beyond that -- as our public health doctor kept saying covid-19 was 'low risk' as recently as March 13. It was just after that when Trudeau said it was an issue that Waterloo Region followed suit with taking covid-19 seriously.
Perhaps one way we can look at it:
1) The Feds give guidelines or laws that we follow.
2) The province likewise can give extra guidelines and laws.
3) The local governments have to follow the above -- but they can adjust for local needs - including by-laws.
4) Private business can go above and beyond all recommendations and laws, etc.
By-laws can include having sufficient PPE for emergencies. And sufficient testing units available.
Many times the buck stops at the regional level as they need to ensure these homes are being inspected properly and thoroughly and have the needed tools.
I believe the worst performing cities/regions were Waterloo and Toronto. And I can guarantee that after this covid-19 is over, the public health in many cities will not exist the same way. It's really no different than what happened with the Walkerton e-coli outbreak. The province will download these things from cities and upload different work -- or at the very least, they're going to have a much more clear set of rules on how to handle these homes.
The next pandemic that occurs, guarantee the masks will be out right away.
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(05-10-2020, 12:05 AM)jeffster Wrote: The next pandemic that occurs, guarantee the masks will be out right away.
Perhaps the provincial government will stockpile millions of masks for the next one...
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So long as the stockpile is properly maintained. Apparently a huge stack of masks had to be tossed out somewhere in the States because it hadn't been checked in nearly a decade, and was basically rotted away. Rotate your inventory!
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(05-10-2020, 12:05 AM)jeffster Wrote: Because WR's Public Health Doctor was still declaring low risk, there wasn't much thought to workers, in particular, PSW's that works in this LTC's,. etc. So 'best practices' were ignored (due to lack of science).
I have a few issues with this. First, each region as its own challenges (for example, Waterloo Region has much more travel and more exposure to Toronto commuters than Thunder Bay does) and its own constraints, whether staffing, labs or supplies. We don't know the details on those so I am loth to lay blame at this point.
Second, the region has no control or responsibility for LTC facilities, these are managed by the province through the LHIN network.
And "best practices" were not yet generally agreed upon in early March. Yes, it turns out that Thunder Bay's choices were good and produced good results, but that was not yet known at that time. Otherwise you can be sure that many, many more regions, cities, provinces, states and countries would have done the same thing.
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A good day in Ontario again, with the new-case count up by only 294, the lowest since late March, for a 1.5% increase and only 7.7% of active cases. 389 recovered and 35 dead for a net decrease of 130 active cases. There are now 3,832 active cases, given 14,772 recoveries and 1,634 deaths.
Our "official" mortality rate is 8.7% (deaths as a percentage of total cases) bit it is trending to 10% (deaths as a percentage of total resolved cases).
433,994 tests to date with 17,618 for the day. Only 1.7% of the daily tests were positive. 961 cases currently hospitalized (-55) and 195 in the ICU (-8).
Quebec added 735 cases today, a second daily drop, for a 2.0% increase. Quebec reported 283,023 tests done to date, only 1,700 in the last 24h so that number may be incorrect, some tracking methodology has changed, or else there was a significant issue with testing. 199 cases currently in ICU (-6).
April
2020-04-01 4611 (+11%) 2020-04-02 5518 (+20%) 2020-04-03 6101 (+8%) 2020-04-04 6997 (+15%) 2020-04-05 7944 (+14%)
2020-04-06 8580 (+8%) 2020-04-07 9340 (+9%) 2020-04-08 10031 (+7%) 2020-04-09 10912 (+9%) 2020-04-10 11677 (+7%)
2020-04-11 12292 (+5%) 2020-04-12 12846 (+5%) 2020-04-13 13557 (+6%) 2020-04-14 14248 (+5%) 2020-04-15 14860 (+5%)
2020-04-16 15857 (+7%) 2020-04-17 16798 (+6%) 2020-04-18 17521 (+4%) 2020-04-19 18357 (+5%) 2020-04-20 19319 (+5%)
2020-04-21 20126 (+4%) 2020-04-22 20965 (+4%) 2020-04-23 21838 (+4%) 2020-04-24 22616 (+4%) 2020-04-25 23267 (+3%)
2020-04-26 24107 (+4%) 2020-04-27 24982 (+4%) 2020-04-28 25757 (+3%) 2020-04-29 26594 (+3%) 2020-04-30 27538 (+4%)
May
2020-05-01 28648 (+4%) 2020-05-02 29656 (+4%) 2020-05-03 31865 (+2%) 2020-05-04 32623 (+2%) 2020-05-05 33417 (+2%)
2020-05-06 34327 (+3%) 2020-05-07 35238 (+3%) 2020-05-08 36150 (+3%) 2020-05-09 36986 (+2%) 2020-05-10 37721 (+2%)
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(05-10-2020, 11:41 AM)tomh009 Wrote: And "best practices" were not yet generally agreed upon in early March. Yes, it turns out that Thunder Bay's choices were good and produced good results, but that was not yet known at that time. Otherwise you can be sure that many, many more regions, cities, provinces, states and countries would have done the same thing.
Well, I guess the right answer would be to look at all cities in Ontario that did things right, with a focus on Kingston, Thunder Bay and Hamilton, basically every region outside Toronto and Waterloo Region (and Peel Region I think did poorly too) and adopt those practices, and then look at where things went horribly wrong (mostly just Waterloo Region and to an extent, Peel and Toronto) and learn from that for the next time for when/if it happens again.
I guess for me, and my feelings being somewhat critical of our public health unit is simply based on my training with PPE. I had a lot of arguments with people who claimed PPE was more risky than it was safe. No argument from me regarding social distancing. But I really do hope we do better next time.
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Yes, learning from mistakes is absolutely the right thing. It's a little bit early yet, but we should not wait too long.
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Ontario saw a new-case count of 308, slightly higher than yesterday but only a 1.5% increase on the total and only 8,2% of active cases. 359 recovered and 35 dead for a net decrease of 86 active cases. There are now 3,746 active cases, given 15,131 recoveries and 1,669 deaths.
447,964 tests to date with 13,970 for the day, with the expected lower weekend throughput. Only 2.2% of the daily tests were positive. 1027 cases currently hospitalized (+66 -- was yesterday's drop a mistake?) and 194 in the ICU (-1).
Quebec added 748 cases today for a 2.0% increase. Quebec reported 288,977 tests done to date, 5,900 in the last 24h. 193 cases currently in ICU (-6).
April
2020-04-01 4611 (+11%) 2020-04-02 5518 (+20%) 2020-04-03 6101 (+8%) 2020-04-04 6997 (+15%) 2020-04-05 7944 (+14%)
2020-04-06 8580 (+8%) 2020-04-07 9340 (+9%) 2020-04-08 10031 (+7%) 2020-04-09 10912 (+9%) 2020-04-10 11677 (+7%)
2020-04-11 12292 (+5%) 2020-04-12 12846 (+5%) 2020-04-13 13557 (+6%) 2020-04-14 14248 (+5%) 2020-04-15 14860 (+5%)
2020-04-16 15857 (+7%) 2020-04-17 16798 (+6%) 2020-04-18 17521 (+4%) 2020-04-19 18357 (+5%) 2020-04-20 19319 (+5%)
2020-04-21 20126 (+4%) 2020-04-22 20965 (+4%) 2020-04-23 21838 (+4%) 2020-04-24 22616 (+4%) 2020-04-25 23267 (+3%)
2020-04-26 24107 (+4%) 2020-04-27 24982 (+4%) 2020-04-28 25757 (+3%) 2020-04-29 26594 (+3%) 2020-04-30 27538 (+4%)
May
2020-05-01 28648 (+4%) 2020-05-02 29656 (+4%) 2020-05-03 31865 (+2%) 2020-05-04 32623 (+2%) 2020-05-05 33417 (+2%)
2020-05-06 34327 (+3%) 2020-05-07 35238 (+3%) 2020-05-08 36150 (+3%) 2020-05-09 36986 (+2%) 2020-05-10 37721 (+2%)
2020-05-11 38469
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Good news, if it can be sustained. One waits to see what impact the new, limited openings might have.
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Thinking again about Quebec's test positivity rate, if it is the same proportion as the previous numbers I would think that the new cases are 12% of the number of tests but 30% of those cases might be by epidemiological link (household contacts + symptoms), so 9%. Still higher than it should be.
I also wonder about % of active cases and whether it's useful to look at particular regions and their rates.
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(05-11-2020, 06:38 PM)plam Wrote: Thinking again about Quebec's test positivity rate, if it is the same proportion as the previous numbers I would think that the new cases are 12% of the number of tests but 30% of those cases might be by epidemiological link (household contacts + symptoms), so 9%. Still higher than it should be.
I also wonder about % of active cases and whether it's useful to look at particular regions and their rates.
The difference in the number of positive tests as compared to Ontario really is huge. There were three days in early April, a few weeks after Ontario started detailed reporting, when there were over 12% positives. Even in the first two weeks from when Ontario started reporting the number of daily tests, the positives averaged only 10.2%. And to me that means that today there is still significantly more COVID-19 in the wild in La Belle Provence.
I would really like to know the number of active cases for Quebec but I have not seen that published anywhere. Please let us know if you see that somewhere!
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