blogcutter

It's well known that staff and residents of Long Term Care homes have been amongst the hardest hit by Covid-19. But far less attention has been paid to those living and working in retirement homes.

That's a mistake because in Ontario alone, there has been a 70% increase in outbreaks and a 65% increase in staff infections in retirement homes just since September:

https://www.cbc.ca/news/canada/toronto/ontario-retirement-homes-testing-covid-1.5842558?cmp=rss

There could be many reasons for this. Maybe it's down to an overall lack of understanding of the differences between the two types of homes. Maybe part of it is a knee-jerk distaste for homes under private ownership (as most retirement residences are), a perception that they all value profit at the expense of resident health and well-being.

In any case, we need to get rapid testing available in these places, and rapidly! Some of the newer generations of rapid tests may even be conducive to self-testing, whether by staff or residents who are fairly self-sufficient.

Vaccination of both staff and residents of retirement homes should also be a high priority. In fact, many residents of retirement homes are quite mobile and able to get to the vaccination clinics on their own: for that reason they might, unlike Long Term Care residents, be good candidates for vaccines like the Pfizer ones which must be administered from a central location due to storage requirements. Once vaccinated, they would then be less likely to CONTRIBUTE to further community spread, which is a risk too with the more active seniors in our community.

On balance, looking after retirement homes and their people is actually less complex than all those thorny problems endemic to Long Term Care. It would be a fairly quick win, a way to earn brownie points with the aging population, who are definitely a force to be reckoned with at the ballot box!

I certainly don't envy the public health professionals. Many of them have been subject to death threats, online and in-person bullying and harassment and a long list of unpleasant behaviour that may or may not be illegal - simply for doing their job.

While most have no doubt been hired first and foremost for their medical credentials, this is one job where those oft-dubbed "soft skills" are of paramount importance. They have to be ambassadors and mediators and counsellors as well as "just" doctors. It doesn't help when the various stakeholders - politicians, bureaucrats, business people, parents and educators all have different levels of understanding and different, at times competing personal priorities. Common ground must be sought, tempers calmed, fears allayed.

As someone who worked in the bureaucracy for many years, I'd be the first to admit that bureaucrats are often the worst offenders when it comes to erecting needless hoops for others to jump through or spinning endless loops and tangles of red tape. Rules often have good solid reasons and rationales behind them but that doesn't mean they can't be reviewed, revised and simplified!

One of the people who never fails to impress me is Dr. Vera Etches, Ottawa's Chief Medical Officer of Health. Not only does she provide timely, well-informed advice but she keeps her cool and her understanding, empathy and compassion shine through.

With everyone worried about Covid-19, it's easy to understand wanting to exclude potentially infected people from your orbit. But given the nature of the virus, a totally risk-free environment is frankly unachievable - it's a question of managing relative risks and being COVID-WISE.

The quest for an iron-clad guarantee, which some lay people assume could be provided with that piece of paper or e-paper indicating you tested negative for the virus, has led to serious line-ups and bottlenecks in the testing process. In the education system, kids who have only just returned to school after months of absence, are suddenly expected to stay out of school for days or weeks if they show up with a slight sniffle. Then the entire family's life is disrupted for weeks on end for no good reason.

So to clarify matters and reassure anxious people in the school community, Dr. Etches has come out with that tool of the bureaucratic trade, a form letter:

https://www.ottawapublichealth.ca/en/resources/Student-Return-to-School-Attestation.pdf

But unlike the inanities of touch-tone telephone trees or captchas that are supposed to "prove" you're not a robot or some of the other cyber-world innovations, I think most people would agree that this one was crafted with human skill and wisdom!

Today I'm reading an interactive document called "Privacy, Access to Information and You: The COVID-19 Edition" by Brenda McPhail, Cara Zwibel and Jiangyang (JY) Hoh. It's a very readable, well-organized, up-to-date and at times disturbing overview of the current situation. As well as printing off a point-in-time copy, I'm keeping one on my computer and will be scanning it regularly for the latest updates. I particular like its interactive links to the relevant privacy legislation in all the Canadian jurisdictions, as well as to the Office of the Privacy Commissioner's tool to help you determine which law relating to health information applies to you and which office you can approach with questions or complaints.

You can access it here (may take a while to load):

https://ccla.org/cclanewsite/wp-content/uploads/2020/05/Privacy-Access-to-Information-and-You_-The-COVID-19-Edition.pdf

I would consider it required reading for all concerned citizens trying to sort out the ins and outs of privacy of health information in the age of Covid!

Please, sir - I want some more. Information, that is. About Covid-19.

Maybe that sounds completely ludicrous. Aren't we already bombarded with Covidformation every time we pick up a newspaper, turn on the TV or radio, or tune into a podcast?

Well, no. Getting data-bombed is not the same thing as informing oneself. Here are some of the areas where I would like more information:

1. Symptoms of Covid-19

2. Solutions

3. Testing - What kinds of tests are available, and when are they useful?

I'm going to discuss each in turn, although I know I'll only be scratching the surface of what needs to be considered.

First, the symptoms. Fever, dry cough, trouble breathing, loss of senses of smell and taste, double-lung pneumonia. All of those sound like the symptoms of a pretty serious disease. Yet in the next breath, officials tell us that in many (perhaps most) cases, the symptoms are mild and resemble those of the common cold. In my experience, when you get a cold, you don't usually have a fever, or not a very high one anyway. Dry cough? Maybe, but usually it's a rather wet, phlegmy one, at least in the initial stages. And they say that a runny nose is not usually a symptom of Covid 19. Trouble breathing and loss of senses of smell and taste? Well, yes - up to a point. If your nose is all stuffed up and you have to breathe through your mouth, you're not going to be able to smell things very well. And you probably won't taste much either, because the senses of smell and taste are interconnected. Double-lung pneumonia? That's definitely not the same thing as a cold, although certainly a cold can lead to more serious diseases while your resistance is lowered.

So, on to solutions. A vaccine is touted as the ultimate solution, the holy grail, the elixir of life. And I absolutely agree - we definitely should and must work towards developing a vaccine. But is it necessarily the ONLY solution? Are there other options we could explore? What about anti-viral or other drugs, for example? You might say they're a cure rather than a prevention, but it ain't necessarily so - drugs are used preventatively as well as to alleviate symptoms and provide (along with time and TLC) a cure. What about birth control, for example? Or arthritis drugs? For rheumatoid arthritis, I am taking both NSAIDs (Non Steroidal Anti-Inflammatory Drugs) and DMARDs (Disease Modifying Anti Rheumatic Drugs). One of the DMARDs that has been prescribed to me is Hydroxychloroquine, often known as Plaquenil. And interestingly enough, that's one of the drugs that seems to be showing some promise in the treatment of coronavirus too. I'm rather hoping that my own supply line doesn't dry up, although luckily it's not the only weapon in my personal arsenal as I fight the war on arthritis.

Now, about testing. Apparently we need to test far more people than we have been. But when we do test, are we relying on just one type of test?

As I understand it, we are conducting swab tests. Results take time. The usefulness of the results is limited, too. I gather a person tests either positive or negative for the virus, meaning they either a) definitely do have it at time of testing; or b) don't have it, or are only within the first couple of days of contracting it so it may be a false negative that needs to be re-tested.

But are there, for example, other tests that test for having already HAD the virus, or having had a virus similar enough to Covid-19, or having ANTIBODIES to the virus for whatever reason? And if so, would a positive test result for them also mean that they would NOT be a carriers who could put others at risk? Maybe we could issue some sort of certificate to these people (sort of akin to a vaccination certificate) and they could get back out into the community, freed from physical distancing restrictions themselves and also in a position to help those still suffering? If there were enough of them, think what a boon to society that could be, both from a medical and an economic standpoint!

Remember those TB patch tests we used to get? After a family trip to the UK in 1962, my brother always tested positive on those and sometimes got sent off for a chest X-ray. He hadn't had an active case of tuberculosis but evidently he had been exposed to it. I, on the other hand, continued to test negative - I was a fair bit younger and probably not as free to mill about the streets of London.

On the other hand, I DID get pneumonia in the mid-1980s. And then in the summer of 2018, I contracted a nasty lung ailment. My doctor initially decided to treat it as if were pneumonia, even though she had already given me the vaccine, which (unlike the flu vaccine) is supposed to be a one-time thing. I went through the usual diagnoses and treatments - the chest x-ray, the inhaler, the meds, some breathing tests. The symptoms were similar to those of diseases which typically plague smokers, even though I am not a smoker.

I'm not sure she ever did pinpoint what exactly I had had. The good news is that I recovered, although it took a few months. I'm pretty sure I picked it up during Music and Beyond, in early July (lots of crowded venues at a festival like that). It wasn't until some time in October that I got my final breathing test and a clean bill of health.

Could it have been something akin to Covid-19, even if they hadn't identified it yet? And if so, is there a possibility that it could have conferred on me some immunity from, or at least resistance to this nasty virus? I guess I can always hope.

So those are some of the questions uppermost in my mind at the moment.

You know, I have a sweatshirt with this slogan on it: Google can find you 100,000 answers. A librarian will find you the right one.

During this pandemic, people are relying on Google like never before, but libraries are closed. Will people be able to find the right answers before googols and googolplexes of people get infected? Or do I mean googols and googolplexes of the virus since I know there are only a few billion people in the world?

I guess maybe I'm a failure as a librarian because right now, I certainly haven't found the answer. I'm not at all confident that there IS just one right answer - there rarely is.

But right now, I'd settle for a half-decent answer - even if it's multiple choice.