Saturday, 2nd May 2020

Every death even the cruelest death drowns in the total indifference of Nature

Peter Weiss in Marat/Sade.

Except that for death in the time of Covid, indifference is manifested by a system-wide hysteria about the danger to everyone but the elderly in senior care facilities. 

While governments literally yell at people to stay at home, going so far as to arrest some intrepid joggers or park walkers they systematically ignore the charnel houses senior care facilities have become. In Spain soldiers entered a care home to find residents, unfed, unwashed, some lying in their own waste, others already dead from neglect. 

Every disease brings its heart wrenching stories. There is never a good time for a loved one to go. But we don’t make policy on individual stories — we can’t. We need to put resources where there’s the greatest need; it’s what the field of epidemiology is all about. But as a society we have made a commitment, however imperfect, to take care of each other when we get old. Often that means the institutional care of the elderly, for whatever reason, usually illness, economic necessity or both. Most would prefer to be independent or live with their family. But working class people are frequently too time and budget constrained with their own children and work commitments to take care of their old folks or attend to complicated medical needs. Thus we have seniors’ long term care facilities. 

They are part of the health management system, which are either private, government funded or a combination of both. In the last decades most of them, especially the government-run institutions have suffered from the same austerity measures that have hit everyone below the economic level of the wealthy and highly paid professionals. 

Take the Lynn Valley Care Centre in North Vancouver BC for example: they have a mix of private and public funding. Most of their residents live with chronic diseases such as cancer, heart disease, dementia and chronic obstructive pulmonary disease (COPD). It is why they are there. 

The painful truth is that in the past several years, austerity has hit care homes hard. Funding and resources have been repeatedly cut resulting in a steady drop in quality of care. At Lynn Valley the healthcare workers had their union decertified when the work was outsourced to a private company. Wages and benefits were cut and, crucially, sick days were drastically reduced. I’ll return to this story later. 

Most readers know the Covid-19 story by now, mysterious outbreak in China, dire predictions of a “Spanish Flu type outbreak killing millions”, our healthcare controllers moving fast to lock us down to “save lives”. Decisions were made around the world to prioritise Covid-19 response. Elective procedures were cancelled, hospital beds were freed up and emergency rooms were cleared. Having chest pains? Take deep breaths but don’t bother the front line Covid workers. 

But did the healthcare authorities simply forget or disregard epidemiology 101, regarding senior care facilities? It seems so. Because no apparent thought was given to their situation. Vulnerable people, elderly, most with serious comorbidities, living in close contact with each other and their caregivers. What could possibly go wrong? As it turns out, a lot. 

Covid-19 is particularly virulent to seniors, especially those with comorbidity. What followed is the literal decimation of the elderly in care homes around the world. The spectre of a lonely, protracted and painful death for thousands of elderly hovered above the world’s senior citizens, many of whom have survived war and associated hardships.  Most of these marginalised human beings were left without adequate care and almost all were quarantined from their loved ones, literally abandoned in their final hours. 

One has to wonder if it was just a careless mistake in the rush to confront an emerging “plague”? Or. Was it worse, uncaring disregard for people seen as no further use to society? Was it a sinister cull to save on the high costs of maintaining life? We won’t get a clear answer to that but it was very probably “all of the above.” 

While the media covered Covid-19 virtually 24/7, indulging shamelessly in associated “fear porn,” they somehow missed where the largest number of deaths were occurring. Television was the worst, with headlines continually stoking people’s fear of vulnerability to an agonising death. Endless videos of people on life-support, harried medics saying “we’re doing all we can” but looking hopeless; worried spouses pacing hospital corridors. Meanwhile the most gruesome deaths were being ignored, which doesn’t mean there were no stories but as they used to say in journalism, they were buried on the back pages--mostly in the print press. TV was for the Nightmare on all of our Elm Streets. 

But those were hyped up horror stories that could have been written in any season with a serious flu outbreak. The barely told stories of how Covid-19 has hit seniors’ homes and have been made worse by our governments’ policies are truly horrific. Here is just a sampling: 

Globe & Mail April, 12th 2020
Montreal, Quebec

“Résidence Herron, Montreal PQ, The Quebec coroner, health authorities and the police have launched investigations in the wake [of the discovery]. They found dehydrated residents lying listless in bed, unfed for days, with excrement seeping out of their diapers. “I’d never seen anything like it in my 32-year nursing career,” said Loredana Mule, a nurse on the team. “It was horrific — there wasn’t enough food to feed people, the stench could’ve killed a horse. 

After she left the home, she said, she collapsed in her car and wept. 

A skeleton staff of two nurses had been left to care for a private residence with nearly 150 beds, she said. The remaining staff had fled amid the outbreak of the coronavirus, leaving patients, some paralysed or with other chronic illnesses, to fend for themselves. 

Relatives described a facility where only one or two orderlies remained on each floor, urine bags were left dripping on floors, residents struck by COVID-19 were not properly isolated and others lacked food or clean drinking water. 

In announcing the deaths on Saturday, the premier of Quebec, said there appeared to be “gross negligence.” 

New York Times, April 15
New Jersey

The call for body bags came late Saturday. By Monday, the police in a small New Jersey town had gotten an anonymous tip about a body being stored in a shed outside one of the state’s largest nursing homes. When the police arrived, the corpse had been removed from the shed, but they discovered 17 bodies piled inside the nursing home in a small morgue intended to hold no more than four people.

New York Times, March 21
Kirkland Wash. (suburb of Seattle)

Since the first positive tests at Life Care came back on Feb. 28, 129 people there — including 81 residents, about two-thirds of its population — have tested positive for the virus, and 35 people have died. Dozens of its workers have received coronavirus diagnoses, suggesting that the center’s frantic efforts to sanitise the building, quarantine residents and shield staff members with gowns and visors may have come too late.”

And it’s not just in Canada and the US, deaths in senior care facilities have been a hallmark of the Coronavirus tragedy everywhere in the world. 

NYT, March 25, updated March 29
Spain

A Deluged System Leaves Some Elderly to Die, Rocking Spain’s Self-Image 

Even amid the coronavirus crisis, the tragedy unfolding in Spain’s nursing homes has shocked a nation that takes pride in its reverence for older people and in its health care system. 

Soldiers who were sent to disinfect nursing homes had found people “completely abandoned, or even dead, in their beds,” the defense secretary, Margarita Robles, revealed on Monday. More gruesome discoveries followed, including the revelation of two dozen deaths in a single nursing home in Madrid. 

Amid the thousands of tragedies created by the virus, the stories emerging from those homes have shaken the nation not only for their horror, but for undermining the view the Spanish had of themselves. Spain’s government has not said how many bodies or neglected residents have been found in nursing homes, but Spanish public prosecutors are investigating possible criminal neglect.” 

France 24, April 3
Alsace region

“The French government on Thursday said at least 884 people had died at care homes from the coronavirus, its first estimate since the start of the epidemic. © Stéphane de Sakutin, AFP 

“Long a neglected branch of French healthcare, care homes for the elderly are accustomed to working in the shadows, their losses unremarked. As the coronavirus pandemic spreads like wildfire, they are bracing for a “bloodbath” – the full scale of which may never be known.” 

Sarah Marcenat 25, the assistant nurse at a care home in eastern France ...has never witnessed death on this scale – so sudden, so sinister, so lonely. 

Located in the Alsace region, the heart of France’s coronavirus​ outbreak, Marcenat’s nursing home... residents are dying one by one, their families kept at bay. 

“I’m terrified at the idea they’ll pass away alone in their rooms, far from everyone,” she says in an interview with FRANCE 24. “They only have us now, with whom to share their last breath.” 

Reports from around the world indicate that as much as 40--50% and perhaps more of the mortality has occurred in long term senior care facilities. And while many of these deaths were, arguably, not preventable, certainly the gross neglect of thousands of elderly is something that should never happen in the 21st century. 

And I can personally attest to the same thing where I live in British Columbia on Canada’s west coast. Here seniors’ care facilities have been the locus where the greatest number of the deaths have occurred. And just two care homes have accounted for almost all of the deaths. Yet our local media, especially TV, have barely covered it. A few years ago this situation would have been a huge scandal and the press would have gone after it  like a dog with a bone. 

Instead when they did cover it CTV News did a story of a woman who played the trumpet outside of her dad’s care home because she wasn’t allowed in to see him. Yes it was a touching story but they failed miserably to report the context as well, not the least of which is that Samantha Monkton’s dad and every other resident there was denied the comfort of his family at a time of such extreme stress. Her father, Garry, died a week later, reportedly of Covid-19 and yet he had not been hospitalised. 

So while our Chief Medical Health Officer Dr. Bonnie Henry has focused on the general population, on lockdown, “flattening the curve” and haranguing younger people to stay 6 feet apart there has been literal carnage among the elderly with little response. On April 9 when the BC death toll was 50 people, 38 of them were over 80, and 24 of them had died in senior care facilities but only 8 of those were hospitalised before they died. At the present time here (and likely in most regions) 70% of the deaths are occurring in 5% of the population of over 80s. And it’s not just the elderly who are already suffering from our misguided efforts. We have over 4,000 empty hospital beds, ICU utilisation is at 45%. The “overwhelming of our healthcare system” has just been a chimera. 

As in most news reports there are lessons to be taken. Here are some takeaways I would suggest. 

The deaths of the elderly, especially those in care homes, has been used to frighten people who by reason of being in a lower age cohort have a relatively low risk of serious complications from Covid-19. Because, and this is important, most people are not aware of the mortality skew towards seniors. As a consequence almost everything about the response is misguided. The people in the upper age brackets at risk are not getting the help they need and everybody else is being put through a grotesque and harmful regimen with no compensating benefits. And recall I mentioned Lynn Valley Care Centre at the top of this article. Well this is the story of how cutbacks brought death to that care centre: 

A practical nurse had no sick day benefits left. They’d been drastically cut alongside her pay. She reported for work one day feeling like she had a cold. But she was sending money to her family in the Philippines and could not afford to take an unpaid day off. So she went to work but it wasn’t a cold; it was Covid-19 and so this hardworking young woman was the carrier who brought disease to her care home. 

However, a note here is in order. Class persists and as such the threat of death and neglect in a care home is not universal: There are care homes for the wealthy and privileged and they appear to be having a much easier ride during this pandemic. Tapestry in Vancouver has 2 senior care facilities. I’ve visited their UBC location, Tapestry at Wesbrook Mall and it rivals 5 star hotels in the city. 

One can’t accuse the Vancouver media of ignoring seniors’ care facilities entirely. A widely covered story by the local media was a Zumba class for residents to enjoy from their balconies at Tapestry, Arbutus Walk. As the first line of one story says, “Vancouver seniors residents are not letting social distancing stop them from getting up and getting exercise.”  It’s hard to imagine that only a few miles away seniors are locked up in their rooms with their daily food being left outside the door so that care workers won’t have to see or touch them. Are they condemned to endure this purgatory until the disease claims them or until the government remembers they exist? Either way this is a black mark on Canadian society and one I never expected to witness. 

I have not fully delved into another aspect of this truly horrific story which is that these care home deaths are being used to inflate the numbers and the fear without people being aware of how they are occurring. That has been mostly obscured. And now it’s becoming clearer that many of the deaths are from neglect and while they may have the virus--we the public don't really know--they are actually dying of dehydration, malnutrition and even starvation.  

Finally, as an elder (born 1940) with coronary artery disease (CAD), which puts me in the high risk category myself, I can state firmly I am not afraid. Nor do I feel invincible. I just realise nothing about Covid-19 puts me at either higher or lower risk than I already may be from, flu, pneumonia or heart disease. Respiratory illnesses with serious morbidity and mortality are something we have lived with for a long time. We cope. And we don’t demolish our society to save lives because that is truly a fool's errand, which like our current lockdowns and social distancing are going to have much more serious consequences, including mortality, for us in the future.

Note on the links. Some media, mostly ‘print’ press, have covered this story and done a good job; so credit where credit is due to the New York Times, Globe and Mail and many local papers. 

However, this story has not been allowed to filter through to a wide audience because it is so overwhelmed by the barrage of fear mongering in most of the mainstream press and as I’ve said, television. This story, which should outrage all of us and raise the hackles of our collective humanity has been buried under a tsunami of misinformation and panic-storming by a media cartel working, as always, in lock-step with the ruling classes who own and control them.