During the COVID-19 pandemic, people in care homes have been dying in droves.
Why is this happening? Is it simply because older adults are very
vulnerable to SARS-CoV-2 and therefore it’s not unexpected that many
would succumb?
Or do care homes deserve the lion’s share of the blame, such as by
paying so poorly that many workers have to split their time between
several facilities, spreading the virus in the process?
Alternatively, could medical experts and government bureaucrats, with
the full knowledge of at least the top tier of government officials,
have created conditions shortly after the pandemic struck that
contribute to the high death tolls while engendering virtually no public
backlash against themselves?
This article shows that the third hypothesis is highly plausible. The
people who created the conditions may be unaware of, or oblivious to,
their implications. But it’s also possible that at least some of them
know exactly what they’re doing.
After all – seeing it from an amoral government’s point of view – the
growing numbers of elderly are a big burden on today’s fiscally
strained governments, because in aggregate they’re paying much less into
the tax base than younger people while causing the costs of healthcare
and retirement programs to skyrocket.
Here are three sets of conditions that collectively create a
framework for enabling significantly boosted care-home deaths – and
doing so with impunity – even while most of each set of conditions in
isolation may appear to be purely for the benefit of everyone in
society:
One. Bureaucrats develop extremely broad definitions
of novel-coronavirus infections and outbreaks. This is coupled with the
continuing presence, in a number of care homes scattered across each
jurisdiction, of at least one nurse or physician who follows every
letter of all definitions and rules. (Such individuals are always
present in every discipline, but in the medical milieu their actions can
be deliberate, deadly and very hard to detect.)
Two. Influential organizations and individuals
produce hospital-care-rationing guidelines that recommend younger people
receive higher priority than the elderly during the pandemic, by giving
significant weight to how many years of life patients would have ahead
of them if treatment is successful. Also, some guidelines bar care-home
residents from being transferred to hospital.
Three. The chief coroner and leaders of the funeral,
cremation and burial industries craft procedures that fundamentally
change the way care-home deaths are documented and bodies dealt with.
Their stated goal is to prevent overburdening of medical staff and
body-storage areas during a surge in COVID-19 deaths.
They also put them into effect very quickly with no notice to the
public; this gives those directly affected very limited opportunity for
input or push-back.
Among the many radical changes is death certificates are no longer
completed by people who care for care-home residents; instead, they are
filled in by the chief coroner’s office.
Also, examination of the undisturbed death scene is prevented, as are
all but a very few post-mortems and other sober second looks at the
cause and mode of death.
In the background are the complicit ranks of public-health
organizations, politicians, media and many other influential
individuals. When the pandemic first strikes they focus on how new,
dangerous and poorly understood the virus is. As one side effect, this
scares many care-home staff so much they flee in fear, leaving their
overwhelmed colleagues to cope.
After a short time, they also start to distract the public and
victims’ loved ones from uncovering the three sets of conditions by
focusing on other factors in the rash of deaths among institutionalized
elderly – and by insisting the solution to everything is more testing
and contact tracing, along with accelerated vaccine and anti-viral
development.
This article shows how the three sets of conditions were put in place in Ontario, Canada.
Variations on these conditions very likely have been crafted in other
jurisdictions in North America, Europe and elsewhere. An exclusive
interview with the daughter of one of the dozens of people who died
during an outbreak at an Ontario care home illustrates how the three
sets of conditions work in practice.
Condition Set One: Broad Definitions of Novel-coronavirus Infections and Outbreaks
At the start of the novel-coronavirus epidemic in Ontario, formal
definitions of infections and care-home-outbreaks weren’t issued, at
least not publicly.
Rather, in late March Chief Medical Officer of Health for Ontario,
Dr. David Williams, and the Associate Chief Medical Officer of Health,
Dr. Barbara Yaffe, described the criteria verbally during their daily
press briefings.
An outbreak should be declared when two or three people show symptoms of infection with the novel coronavirus, they said.
Also, polymerase chain reaction testing for viral RNA wasn’t required for confirmation.
This is a loosened version of
criteria used in the province
prior to the novel-coronavirus epidemic. These previous criteria
defined an outbreak as either: two people in the same area of a facility
developing symptoms within two days of each other (making their
infections ‘epidemiologically linked’) and at least one of them testing
positive for viral RNA; or three people in the same area developing
symptoms within two days of each other.
On
March 30
the Ontario health ministry released new rules for defining and
managing care-home outbreaks (with the document confusingly dated April
1). Staff at all Ontario care nursing homes were trained on the new
rules via webinars two days later, on April 1.
The new rules included an
even broader outbreak definition: the presence of only
one person with just
one symptom
of a SARS-CoV-2 infection. Outbreaks were deemed confirmed when just
one resident or staff member tested positive; subsequently, every
resident in the care home showing any coronavirus-infection symptoms is
deemed to have COVID-19.
Notably, however, there wasn’t a symptom list in the document. Dr.
Williams said on April 1 during that day’s press briefing they
deliberately did not include a list of infection.
This is because:
“to look for those symptoms [in the rest of the care-home
residents after the initial case is identified] is a challenge,
particularly in seniors,” […] “They may not mount a fever, they may have
a lot of other symptoms and they may not have obvious symptoms.
[Rather,] any change in their health condition really [can be considered
a symptom].”
A few minutes later Dr. Williams added:
I don’t mind false alarms. [As a result of the looser
outbreak criteria] the numbers [of outbreaks that] we see might be[come]
quite [a bit] larger …. [But that’s because w]e want to ramp up the
sensitivity. [That] means the number of outbreaks will go up, because
we’ve widened the definition.”
One week later, April 8, a
Provincial Testing Guidance Update was issued.
It included the following list of symptoms (most of which are highly
non-specific): fever, any new or worsening acute respiratory illness
symptom – for example cough, shortness of breath, sore throat, runny
nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing –
and pneumonia.
The document also listed several symptoms that are “atypical” but
“should be considered, particularly in people over 65” [italics added]:
unexplained fatigue/malaise, acutely altered mental status and
inattention (i.e., delirium), falls, acute functional decline, worsening
of chronic conditions, digestive symptoms (e.g., nausea/vomiting,
diarrhea, abdominal pain), chills, headaches, croup, unexplained
tachycardia, decreased blood pressure, unexplained hypoxia (even if
mild) and lethargy.
Then on April 22 the province
produced the first COVID-19-screening guidelines
for care homes. It’s broadly similar to the April 8 document, except
that two or more of some of the symptoms – for example sore throat,
runny nose and sneezing, stuffed-up nose, diarrhea – need to be present
for a person to be deemed positive.
On May 2 a new
testing guidance and a new
screening guide were released. Both documents concede that if a person has only a runny or stuffed-up nose,
“consideration should be given to other underlying reasons for these symptoms such as seasonal allergies and post-nasal drip.”
They also narrow the definition of falls considered diagnostic of a
novel-coronavirus infection in people over 65, to falls that are
unexplained or increasing in number.
However, they add to the symptom list another three that are very
non-specific: a decrease in sense of taste, abdominal pain and pink eye.
There are enormous implications to having overly broad
definitions of symptoms and outbreaks, particularly in combination with
other rules put in place at the beginning of the epidemic.
Broad definitions very likely are used in many other jurisdictions
around the world, albeit perhaps masked by the use of somewhat different
terms.
First, in Ontario, in every facility with an outbreak, every resident with even just one symptom
is defined as being a
‘probable’ COVID-19 case. This applies whether these residents had an inconclusive or negative viral-RNA test result –
or even weren’t tested at all.
Second, the cause of death of everyone who had been diagnosed with a
SARS-CoV-2 infection is recorded as being COVID-19. This is a
dictate of the World Health Organization and is followed throughout North America, Europe and elsewhere.
Third, COVID-19-attributed deaths are deemed ‘natural’ by
new rules released by the chief coroner
on April 9 (see ‘Condition Set Three,’ below). In all but an extremely
small number of cases, natural deaths are exempt from any further
investigations or post-mortems. (Over the last 30 years post-mortems
have become rare, but to almost completely remove the possibility is
another matter.)
Taken together, this may explain what the daughter of a woman who
died along with dozens of others, during a COVID-19 outbreak at an
Ontario care home experienced. The daughter granted the author an
exclusive interview on May 13. (Under a pseudonym to shield her from
possible repercussions.)
Diane Plaxton said in the interview that on April 1 she received a
shocking and unexpected phone call from her mother’s care home.
“Your mother’s declining. She’s been having loose bowels and lots
of diarrhea. There’s a DNR on her chart. And we’re not sending anyone
to the hospital. [Likely because of ‘Condition Set Two,’ below]
We’re going to have to put her on palliative care,” Plaxton recalls the head nurse telling her in a cold, uncaring voice.
Plaxton was stunned. She knew about her mother’s diarrhea: it was
from bowel-cleansing meds she’d been on for about nine days, after being
diagnosed with a clogged bowel. Plaxton told the nurse that if her
mother seemed to be declining it probably was from the diarrhea and
resultant dehydration.
She suggested to the head nurse that she give mother IV rehydration. The nurse refused, saying it would
“just prolong the inevitable.”
The head nurse didn’t say the word COVID-19, nor tell Plaxton the home had been declared to have an outbreak that day.
She also didn’t mention that on March 30 the province had issued new
rules on novel-coronavirus infections and outbreaks, then trained all of
Ontario’s care-home staff on them via webinar April 1. As described
above, the rules included very broad definitions of SARS-CoV-2
infections and outbreaks.
Therefore the nurse could well have been complying fully with the new
rules by diagnosing Plaxton’s mother with a novel-coronavirus infection
based on her having diarrhea alone (and without telling Plaxton any of
this).
Furthermore, since transfer to a hospital was not an option (as per
‘Condition Set Two’) and since COVID-19 is deemed to be very frequently
fatal in the elderly, this may be why the head nurse pushed Plaxton so
hard to consent to palliative care for her mother.
Shaken but unbowed, Plaxton asked the head nurse to let her speak to the nurse who had been directly caring for her mother.
Fortunately, that second nurse was kind, and agreed that palliative
care was not appropriate for Plaxton’s mother. She agreed instead to
allow her to not take the bowel-cleaning meds, and to coax her to eat
and drink to recover her fluids and strength. She also said she’d keep
an eye on the slight fever Plaxton’s mother had.
Over the next few days this plan worked, and the nurse told Plaxton she needn’t worry.
That’s why it hit Plaxton like a gut punch when on April 10 she got a
call from another nurse, who was panicking. She told Plaxton her mom
was struggling to breathe and “going fast.”
The nurse said the care home couldn’t transfer her to the hospital.
She asked Plaxton’s permission for the doctor to give her mother
“a shot to ease her passing.”
(The nurse didn’t tell Plaxton what ‘the shot’ was. But it very
likely was morphine, which is routinely used to relieve severe pain. A
high enough dose of morphine slows people’s breathing and hastens their
death.)
Plaxton was reeling. She immediately consulted with her sister;
together they decided to give consent for the shot. Three hours later
their mother was dead.
Condition Set Two: Hospital-care-rationing Guidelines
In mid-March, not long before Plaxton’s mother died,
treatment-rationing guidelines for during the pandemic started to
proliferate.
For example,
on March 21 the UK’s National Institute for Clinical Excellence produced its guidelines.
They’re based on a frailty score and on mortality probabilities
across different age groups for pneumonia and underlying cardiovascular
or respiratory diseases.
On March 23 the paper
“Fair allocation of scarce medical resources in the time of Covid-19” was published in the prestigious
New England Journal of Medicine. The paper’s first recommendation calls for:
maximizing the number of patients that survive treatment with a reasonable life expectancy.”
(Interestingly, the paper’s lead author, Ezekiel Emmanuel, MD, PhD,
is an oncologist, bioethicist and senior fellow at the Center for
American Progress. The centre is secretive about its funders but
according to a 2011 investigation in
The Nation
its supporters included dozens of giant corporations ranging from
Boeing to Walmart. Today, retired general Wesley Clark and executive VP
of global investment firm Blackstone
Henry James are among the organization’s
trustee advisory board members.)
On March 27, the equally influential
Journal of the American Medical Association (JAMA) published
“A framework for rationing ventilators and critical-care beds during the COVID-19 pandemic.”
The paper’s authors assert that:
[y]ounger individuals should receive priority, not
because of any claims about social worth or utility, but because they
are the worst off, in the sense that they have had the least opportunity
to live through life’s stages.”
Ontario Health published guidelines for hospital-treatment rationing
on March 28, albeit not publicly. (To this day the government hasn’t
made the protocol public, nor disclosed whether or when they implemented
it.)
At that time a crush of COVID-19 patients crowding Ontario hospitals
wasn’t a realistic possibility for at least the short or medium terms
(contrary to the pandemic-curve theoretical modelling), because all
elective hospital procedures and surgeries had been cancelled or
indefinitely postponed.
Toronto Star reporter Jennifer Yan obtained a copy of the Ontario treatment-triaging document and wrote
in a March 29 article that:
[u]nder the triage protocol, long-term-care patients who
meet specific criteria will also no longer be transferred to hospitals.”
Then on April 10, the
Canadian Medical Association adopted all the recommendations by Dr. Ezekiel and his co-authors in their
New England Journal of Medicine paper, and advised Canadian physicians to follow them.
The Canadian Medical Association statement (whose authors were not listed) asserted that
“the current situation, unfortunately, does not allow for” the time for Canadian experts to create their own recommendations.
This is tendentious. Canadian healthcare providers and researchers
have access to as much information about COVID-19 as do others around
the world. In addition, many had direct clinical experience with a close
cousin of the novel coronavirus, SARS-CoV,
in 2003.
Indeed four Canadians co-authored an ethical framework for guiding
decision-making during a pandemic that was based on their experience
with SARS and
published in 2006. They made no mention of age as a criterion for treatment triaging in that framework.
On
April 17 the Canadian federal government released information to guide clinicians in rationing healthcare resources during the SARS-CoV-2 epidemic. Unlike at least
some other COVID-19-related guidelines issued in the same period, it was not accompanied by a press release; therefore it has flown under the public radar.
The document includes an emphasis on age-based rationing. It also
explicitly discourages transfer of care-home residents to hospitals:
Long term care (LTC)[care-home] facilities and home care
services will be encouraged to care for COVID-19 patients in place and
may be asked to take on additional non-COVID-19 patients/clients to help
relieve pressure on hospitals”
This is underlined in another place in the document:
If COVID-19 does develop in LTC facility residents, they
should be cared for within the facility if at all possible, to preserve
hospital capacity.”
Prohibiting transfer to hospital drastically narrows the treatment options available to care-home residents.
There have been transfers of care-home residents to hospitals in Canada during the COVID-19 crisis, but
until very recently they have been by far the exception.
(Instead, starting in mid-March as part of the clearing out of
hospitals to make room for a putative surge in COVID-19 patients,
thousands of elderly people were transferred
from hospitals to care homes. This likely also contributed to the care-home death toll. More than one journalist has
compared care homes to the
Diamond Princess cruise ship: virus incubators with people trapped inside.)
All of this may well be why Plaxton was told by nurses at the care home that her mother couldn’t be transferred to hospital.
This also has played out at other care homes.
The medical director of the
Pinecrest nursing home in Bobcaygeon, two hours’ drive northeast of Toronto, strongly advised residents’ family members against considering hospital transfer.
The Globe and Mail reported
on March 29 that Dr. Michelle Snarr wrote families on March 21 (which
was the day after three of the home’s residents tested positive for
SARS-CoV-2) and raised the spectre of significant suffering and possible
death if the elderly people were put on ventilators.
Dr. Snarr reiterated this in a
March 30 television interview.
Once we heard it was COVID, we all knew it was going to run like
wildfire through the facility […] The reason I sent the email was to
give them a heads-up that this is not normal times. Under normal times,
we would send people to the hospital if that was the family’s wishes,
but we knew that was not going to be possible, knowing that so many
people were going to all get sick at once and also knowing the only way
to save a life from COVID is with a ventilator. And to put a frail,
elderly person on a ventilator, that’s cruel.
[In
another interview Dr. Snarr said they weren’t outright refusing hospital transfers.]
The last death attributed to COVID-19 at Pinecrest occurred on April 8; by then,
29 of the home’s 65 residents had perished.
“I’ve never had four deaths in a day at any nursing home I’ve worked at,” Dr. Stephen Oldridge, one of the physicians working at the home, was quoted as saying in the March 29
Globe and Mail article.
“You feel helpless. Because there’s nothing you can do other than support them, give them morphine and make them comfortable.”
Dr. Oldridge
told CBC a similar narrative on April 1:
“There is no vaccine, we have no effective treatment
other than supportive care for these folks, and obviously there’s no
cure. So when the infection takes hold in their lungs, in this elderly
population we can just make them comfortable.”
Still other
media reports
indicate that care-home residents’ families in Canada have denied the
option of transfer to hospital during the pandemic even if the residents
are relatively young, do not have a DNR, and both they and their
families want the option of a transfer. Instead, they are pressured to
put DNRs in place. This also is happening elsewhere,
such as in the UK.
Hugh Scher, a Toronto lawyer who’s been involved in some of Canada’s
highest-profile end-of-life cases, strongly opposes this. He told the
author in a telephone interview:
The notion that long-term-care-home or nursing-home medical directors
can tell residents and their families that they can’t or shouldn’t be
transferred to hospital if they need treatment for COVID or anything
else – I don’t agree with that.
[…]
[But unfortunately] there’s now an aggressive push to say, ‘Granny’s
already ninety-five … and sending her to hospital for a cough or a runny
nose isn’t going to improve her underlying condition. And so she should
be made comfortable and left to die.’
Condition Set Three: New Rules Surrounding Death Certificates and Removal and Disposition of Bodies
On April 9 the Chief Coroner for Ontario, Dr. Dirk Huyer, released rules for an
‘expedited death response’ in handling and disposition of bodies of people who die in care homes and hospitals.
The stated goal was to prevent infection spread, overburdening of
medical staff, and overfilling of hospital morgues and body-storage
areas in care homes in the event of a surge in deaths during the
pandemic.
The new procedures were created jointly by Dr. Huyer’s office, the
Ontario Ministry of Government and Consumer Services and the Bereavement
Authority of Ontario (the province’s funeral-home, cremation-services
and cemetery self-regulatory body).
They are a drastic sea change in the way deaths are handled in the
province. Yet they were launched extremely rapidly with the only “surge”
in sight one in
mathematical models, and a significant body-storage-space problem based on hard data nowhere on the horizon (and still a low probability).
The new procedures went into effect immediately on April 9. Then over
the next three days (the Easter long weekend), Dr. Huyer and the
registrar of the Bereavement Authority of Ontario led webinars on them
for staff of hospitals and care homes across the province.
“We pushed it [writing and releasing the new rules] a little more
quickly than maybe was necessary because it’s a brand-new process and
there’s thousands of people involved,” Dr. Huyer told Toronto Star columnist Rosie DiManno in explaining the haste.
As part of the new rules, the chief coroner’s office now completes
the death certificates of every person who dies in long-term-care homes.
The office also completes some death certificates of people who die in
hospitals. Up until April 9, and for good reason, death certificates in
Ontario were filled in by the physicians or nurse practitioners
who cared for the people before they died.
In addition, as also noted in ‘Condition Set One’ above, COVID-19-attributed deaths are deemed ‘natural’ by the
new rules. And all “natural” deaths are virtually exempt from any further investigations and post-mortems.
(Dr. Huyer was quoted in a
May 18 Globe and Mail
article as saying “a number” of COVID-19-attributed death
investigations have been started – including that of a man whose
daughter believes he died because of neglect at a care home and who
asked the coroner’s office to investigate – but that he doesn’t know
what that number is.)
Dr. Huyer said, in a phone interview:
“All of these things were added during this period of
time to allow not only a timely approach but also an efficient approach
to be able to ensure that people proceed to burial or cremation in a
timely way without requiring extra storage space,”
Yet it was only 10 months ago that the official report on
the high-profile Wettlaufer inquiry
was released. It calls for many more checks and balances surrounding
care – and more rather than less time and transparency in determining
and documenting the causes of death.
Just 18 of the report’s 91 recommendations have been implemented.
(The inquiry probed the killing in southwestern Ontario by nurse
Elizabeth Wettlaufer of eight people, attempted murder of several others
and aggravated assault of two more. All but two of the victims were
LTCH residents.)
Moreover, the April 2020 rules also dictate that families must
contact a funeral home within one hour of a hospital death and within
three hours of a care-home death. The bodies are to be taken to the
funeral home extremely rapidly, and from there to cremation and burial
as quickly as possible.
This journalist wrote about the rules in a
May 11 article.
Diane Plaxton found and read online the May 11 article. She suddenly
understood more of what took place before and after her mother’s April
10 death.
She and this journalist connected, and the May 13 interview ensued.
Plaxton related, in that interview, that three hours after she got
off the phone with her dying mother on April 10, a nurse called and
matter-of-factly said her mother was dead. She asked Plaxton to call a
funeral home.
And about an hour later, while Plaxton was still reeling, another nurse called and again told her to contact a funeral home.
“I got off the phone. That’s when I flew off the handle,” she told the author in the May 13 interview.
“It’s like they’re treating her [body] like a piece of garbage: ‘Get her out of here! Ger her out of here!’”
As if that wasn’t enough trauma, at the funeral home four days later
she saw COVID-19 listed as the cause of her mother’s death. Plaxton
believes what really killed her mother was the combination of
dehydration and chronic diseases including asthma; her shortness of
breath on April 10 may have been an asthma attack, Plaxton surmises.
Making matters even worse, the funeral director told her she couldn’t take a copy or photo of the
‘Cause of Death’ form. He said she’d have to request a copy from the government and it could take months to arrive.
But the funeral director also commiserated with Plaxton. He was
incredulous that her mother had gone from dehydrated to dead so fast. He
also was bewildered by the requirements such as bodies having to be
picked up in haste and arrangements for cremation and burial also having
to be made extremely quickly.
“I’m just taking orders from the top down,” Plaxton recalls the funeral director telling her.
That’s the third of the three sets of conditions that can enable high death rates in care homes.
The three sets are the work of officials, experts and bureaucrats who
– while being seen to serve the public interest and who could be
unaware of, or oblivious to, the implications of the conditions – may in
fact have hidden intentions.
Even if the latter is true, there’s little chance the perpetrators will be caught or punished.
On May 19
the Ontario premier announced
that an independent commission will probe why so many people have died
in the province’s care homes. This journalist believes it’s very
unlikely the commission’s mandate will include scrutinizing the sets of
conditions described in this article.
Perhaps the most elegant element of all is that just one or two
people working at any given care home can suffice to translate the sets
of conditions into actions – or inaction – that can be deadly for
residents. And they’d probably be the only ones held responsible in the
unlikely event any of this ever comes to light.
It’s all as simple as one, two, three.
Full Article & Source:
Were conditions for high death rates at Care Homes created on purpose?
