csmonitor--2020-04-06--Daily for April 6, 2020

Daily for April 6, 2020

Veteran Seattle nurse Carolyn Grant had just finished kicking off her retirement with a trip to Hawaii when she got a text from her old boss : Would Ms. Grant come out of retirement to help the medical center ’ s COVID-19 testing program ?
That night , she said yes .
In Germany , where “ not a single hospital has enough staff , ” says a Berlin ICU nurse , the government is calling medical students to action , and dissolving bureaucratic hurdles so hospitals can mobilize more medical workers .
In Italy , which has seen the @ @ @ @ @ @ @ , the government has asked recently retired doctors to come back to work , and allocated funding to hire 20,000 more health professionals .
Editor ’ s note : As a public service , all our coronavirus coverage is free .
No paywall .
Chronic worker shortages can be patchworked during normal times , but as the COVID-19 pandemic slams medical systems around the globe , having the right personnel can mean the difference between life and death .
Administrators are rehiring retired professionals , tapping medical students before they even graduate , @ @ @ @ @ @ @ to supplement a stretched workforce that even before the current crisis was coming up short .
“ It is like we have a blanket that is too short and everyone is trying to pull it to his side , ” says Nicola Draoli , an Italian nurse .
From Berlin to Seattle , hospitals and clinics are also ramping up telehealth options , which in a few weeks have been overcoming medical , bureaucratic , and consumer resistance that had stymied advocates for years .
As COVID-19 brings waves of patients through hospital @ @ @ @ @ @ @ are turning to solutions that might become increasingly attractive going forward .
“ If there is one positive aspect , this crisis is proving that reforming health care doesn ’ t necessarily take decades .
It ’ s just a matter of will , ” says Mr. Draoli , a member of the central committee of Italy ’ s national federation of nursing .
In Berlin , a nurse in an intensive care unit who prefers to be called Nico because he ’ s not authorized to speak to the news media loves @ @ @ @ @ @ @ of nurses means ironclad job stability .
“ I think I could work at any hospital or any ICU in Germany , ” he says .
But the shortage has downsides : The hospital had closed a quarter of its ICU beds over the last two years due to lack of staff .
Nico was constantly on call to pick up extra shifts , and also needed to clean patient rooms and tidy pharmacies due to a shortage of assistants .
Over the years , Nico has seen colleagues vote with their feet @ @ @ @ @ @ @ , ” he says .
Today , Nico ’ s hospital is prepping for the COVID-19 crisis by adding ICU beds and training non-ICU staff .
Administrators are also preparing to hire medical students , who now have government-mandated flexibility for education , training , and licensing requirements .
“ We ’ re waiting for the big wave of patients , expecting it to hit in late April , ” says Nico .
Germany is currently facing a shortage of 70,000 nurses in hospitals alone , according to Verdi , a German trade @ @ @ @ @ @ @ 300,000 health care workers each year to retirement , ” says Stefan Sell , a professor of economics and social policy at the University of Koblenz .
“ And the younger generation is very small , and young people go into other jobs.
” The situation is no better in other developed countries .
Italy is currently short about 53,000 nurses , estimates Mr. Draoli of the nursing federation .
The United Kingdom ’ s National Health Service is missing about 100,000 health care workers of all kinds , and the United States @ @ @ @ @ @ @ registered nurses each year .
All have aging populations that need more elder and long-term care .
The main reasons are high turnover and not enough new nursing graduates entering the workforce in wealthy countries .
Sociocultural factors also come into play ; most health care workers are women , who are more likely to take part-time shifts because of child care requirements , says Dr. Sell , meaning you need more hires to provide full-time coverage .
Put simply , the job isn ’ t attractive enough , as pay for nursing @ @ @ @ @ @ @ remained competitive .
In Italy , for example , health care salaries have declined from roughly 40 % of the country ’ s annual public health budget two decades ago , to less than a third today .
“ In the U.K. , we have a lot of vacancies that remain unfilled , ” says Dr. Rocco Friebel , a London School of Economics health policy professor .
“ Working conditions are poor .
It ’ s a very high-pressure job.
” Staffing projections worldwide are sobering .
By 2030 , countries in @ @ @ @ @ @ @ expected to face a combined shortage of roughly 2.5 million doctors , nurses , and other workers , with Europe ’ s shortfall at around 1.4 million , according to a 2017 study by medical researchers .
Governments in the U.S. and Europe have attempted to tackle shortages by shifting workloads , digitizing services , providing funding to create elder care positions , and looking at worker wage increases , among other initiatives .
“ In the U.K. , we ’ ve seen a push to employ clinical assistants , who can do @ @ @ @ @ @ @ tasks , which then frees up fully qualified nurses to take care of the most severe cases , ” says Dr. Friebel .
But the main strategy in wealthy nations is to fill their ranks with foreign nurses and health care workers .
The German government is working with Kosovo , Mexico , and the Philippines to integrate workers into its health care system .
In the U.K. , the National Health Service has long tapped European Union nationals , especially those from Poland and other Eastern European countries , to fill jobs @ @ @ @ @ @ @ solution , says Dr. Sell , the German economist , in part because of the competition .
“ A lot of other countries such as the Netherlands , France , and Switzerland are also trying to get people from Russia , Ukraine , and other countries , ” he says .
Also , he points out , many potential migrants don ’ t speak the adopted country ’ s language .
“ Ultimately , we have to get additional staff from our [ home ] labor force , ” says Dr. Sell .
@ @ @ @ @ @ @ such as improving working conditions and education ” for workers .
A shortage that will take decades to solve feels acute in the face of a pandemic .
In the U.S. , top officials are crying out for medical volunteers of all stripes .
In New York , more than 50,000 health care workers have answered Gov .
Andrew Cuomo ’ s pleas .
In California , a newly created health corps to expand the workforce has garnered more than 70,000 registrations from “ underemployed ” medical professionals of all stripes .
In @ @ @ @ @ @ @ last week told recent medical retirees and qualified students , “ Like Uncle Sam , we want you !
” Another infusion of medical manpower is coming from the U.S. military .
Three hundred soldiers from an Army unit in Fort Carson , Colorado , arrived in Seattle last week to set up a 250-bed hospital inside the Seattle Seahawks ’ football stadium , and a Navy hospital ship has docked in New York City .
By caring for patients without COVID-19 , they can free up local hospital beds for those who @ @ @ @ @ @ @ are also being asked to shift gears , as they ’ re redeployed to other units , such as from transplant ICUs to respiratory care .
Italy ’ s worst-hit regions like Lombardy are also tapping another strategy : emphasizing primary-care monitoring and home care rather than hospital admissions .
“ Hospitals have always seen too many people that don ’ t belong in the hospital , ” says Dr. Friebel , the analyst .
As Italian doctors have discovered by necessity , initial screenings of suspected COVID-19 patients can be done without @ @ @ @ @ @ @ out that a lot of both screening and follow-up of [ COVID-19 ] patients – the mild cases – is about asking questions about symptoms , ” says Joseph Kvedar , a Harvard Medical School professor and incoming president of the American Telemedicine Association .
“ It ’ s a perfect setup for [ telehealth ] technology.
” Advocates of telemedicine say many health care needs can , in fact , be serviced without stepping foot into an office , clinic , or hospital .
Inquiries from U.S. clinicians about telehealth have skyrocketed @ @ @ @ @ @ @ same time that states and the federal government are loosening requirements for licensing across state borders and privacy issues around technology .
They ’ re also reexamining what ’ s defined as a “ visit ” for insurance purposes .
“ There ’ s been a staggering amount of creativity and collaboration , ” says Dr. Charlotte Wu , a physician and founder of Harness Health Partners , a Boston-based consultancy .
“ We ’ re seeing an increased acceptance of virtual medicine , leveraging the skills of diverse team members , and @ @ @ @ @ @ @ competitors.
” At Asian Counseling and Referral Service in Seattle , counselors are now offering mental health care by phone and video apps such as Zoom and Doxy.me .
“ We can accept consent via telephone versus in writing ” in treating substance use disorders , says Michael Byun , who runs the nonprofit .
COVID-19 is spurring innovations that might eventually pave the way for routine remote-monitoring of chronic illnesses .
The possibilities are legion .
Seventy percent of U.S. health care costs go to treating health conditions like high blood pressure @ @ @ @ @ @ @ or worsened by smoking , lack of exercise , or poor eating habits ; they can be followed by a virtual-care quick check-in , says Dr. Kvedar .
“ We don ’ t have enough people to deliver service one-to-one in a room at a time , ” says Dr. Kvedar .
“ There ’ s a lot of inefficiency in the way we deliver care .
When the dust settles , I hope we don ’ t go back to doing every single thing in the office.
” New technologies are also @ @ @ @ @ @ @ called on the public to suggest COVID-19 related innovations , and among the entries was a “ digital waiting room ” that vets a patient ’ s symptoms , and an app that rotates nurses more effectively .
Practitioners and researchers are also using artificial intelligence to help forecast disease spread , implement rapid-testing technologies , and develop new approaches to contact tracing .
Back in Seattle , the veteran nurse Ms. Grant has bid her short-lived retirement goodbye ; she ’ s now working 10- to 12-hour days , six days a @ @ @ @ @ @ @ Her day begins early to ensure adequate supplies for the testers , as she leads a team of nurses at the University of Washington Medical Center – Northwest who were displaced from outpatient surgery centers and clinics .
Ms. Grant was part of a wave of nurses who entered the workforce during a severe nursing shortage in the U.S. during the 1980s .
“ Many people in that age bracket are exiting the workforce , ” she says , so it ’ s no surprise they ’ re being called back to fill @ @ @ @ @ @ @ Ms. Grant feels a “ loyalty ” and a call to duty .
“ I am able to help this community at a difficult time.
” This story was reported by Monitor correspondent Lenora Chu in Berlin , staff writer Ann Scott Tyson in Seattle , contributor Daniela Sala in Rome , and contributor Austin Davis in Berlin .
Editor ’ s note : As a public service , all our coronavirus coverage is free .
No paywall .

‘The doctor won’t see you now.’ Rethinking health care delivery in a crisis Collapse
Courtesy of Carolyn Grant View caption Hide caption Carolyn Grant, health services manager at the University of Washington Medical Center and a registered nurse, returned from retirement to help run COVID-19 testing centers. She is shown preparing materials for drive-up testing locations in the Seattle area.
Veteran Seattle nurse Carolyn Grant had just finished kicking off her retirement with a trip to Hawaii when she got a text from her old boss: Would Ms. Grant come out of retirement to help the medical center’s COVID-19 testing program? That night, she said yes.
In Germany, where “not a single hospital has enough staff,” says a Berlin ICU nurse, the government is calling medical students to action, and dissolving bureaucratic hurdles so hospitals can mobilize more medical workers.
In Italy, which has seen the world’s highest coronavirus death toll, the government has asked recently retired doctors to come back to work, and allocated funding to hire 20,000 more health professionals.
Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.
Chronic worker shortages can be patchworked during normal times, but as the COVID-19 pandemic slams medical systems around the globe, having the right personnel can mean the difference between life and death. Administrators are rehiring retired professionals, tapping medical students before they even graduate, and turning to the military and volunteers to supplement a stretched workforce that even before the current crisis was coming up short.
“It is like we have a blanket that is too short and everyone is trying to pull it to his side,” says Nicola Draoli, an Italian nurse.
From Berlin to Seattle, hospitals and clinics are also ramping up telehealth options, which in a few weeks have been overcoming medical, bureaucratic, and consumer resistance that had stymied advocates for years. As COVID-19 brings waves of patients through hospital and clinic doors, health care systems are turning to solutions that might become increasingly attractive going forward.
“If there is one positive aspect, this crisis is proving that reforming health care doesn’t necessarily take decades. It’s just a matter of will,” says Mr. Draoli, a member of the central committee of Italy’s national federation of nursing.
In Berlin, a nurse in an intensive care unit who prefers to be called Nico because he’s not authorized to speak to the news media loves working with patients, and the undersupply of nurses means ironclad job stability. “I think I could work at any hospital or any ICU in Germany,” he says.
But the shortage has downsides: The hospital had closed a quarter of its ICU beds over the last two years due to lack of staff. Nico was constantly on call to pick up extra shifts, and also needed to clean patient rooms and tidy pharmacies due to a shortage of assistants. Over the years, Nico has seen colleagues vote with their feet. “The workload is so heavy,” he says.
Today, Nico’s hospital is prepping for the COVID-19 crisis by adding ICU beds and training non-ICU staff. Administrators are also preparing to hire medical students, who now have government-mandated flexibility for education, training, and licensing requirements.
“We’re waiting for the big wave of patients, expecting it to hit in late April,” says Nico.
A structural staff shortfall
Germany is currently facing a shortage of 70,000 nurses in hospitals alone, according to Verdi, a German trade union. “We’ve lost 300,000 health care workers each year to retirement,” says Stefan Sell, a professor of economics and social policy at the University of Koblenz. “And the younger generation is very small, and young people go into other jobs.”
The situation is no better in other developed countries. Italy is currently short about 53,000 nurses, estimates Mr. Draoli of the nursing federation. The United Kingdom’s National Health Service is missing about 100,000 health care workers of all kinds, and the United States needs to recruit at least 200,000 more registered nurses each year. All have aging populations that need more elder and long-term care.
The main reasons are high turnover and not enough new nursing graduates entering the workforce in wealthy countries. Sociocultural factors also come into play; most health care workers are women, who are more likely to take part-time shifts because of child care requirements, says Dr. Sell, meaning you need more hires to provide full-time coverage.
Put simply, the job isn’t attractive enough, as pay for nursing and medical assistant work hasn’t remained competitive. In Italy, for example, health care salaries have declined from roughly 40% of the country’s annual public health budget two decades ago, to less than a third today.
“In the U.K., we have a lot of vacancies that remain unfilled,” says Dr. Rocco Friebel, a London School of Economics health policy professor. “Working conditions are poor. It’s a very high-pressure job.”
Staffing projections worldwide are sobering. By 2030, countries in North, Central and South America are expected to face a combined shortage of roughly 2.5 million doctors, nurses, and other workers, with Europe’s shortfall at around 1.4 million, according to a 2017 study by medical researchers.
Recruiting foreign nurses
Governments in the U.S. and Europe have attempted to tackle shortages by shifting workloads, digitizing services, providing funding to create elder care positions, and looking at worker wage increases, among other initiatives.
“In the U.K., we’ve seen a push to employ clinical assistants, who can do bookkeeping and a lot of the day-to-day tasks, which then frees up fully qualified nurses to take care of the most severe cases,” says Dr. Friebel.
But the main strategy in wealthy nations is to fill their ranks with foreign nurses and health care workers. The German government is working with Kosovo, Mexico, and the Philippines to integrate workers into its health care system. In the U.K., the National Health Service has long tapped European Union nationals, especially those from Poland and other Eastern European countries, to fill jobs.
That’s only a partial solution, says Dr. Sell, the German economist, in part because of the competition. “A lot of other countries such as the Netherlands, France, and Switzerland are also trying to get people from Russia, Ukraine, and other countries,” he says. Also, he points out, many potential migrants don’t speak the adopted country’s language.
“Ultimately, we have to get additional staff from our [home] labor force,” says Dr. Sell. “That will require a multidimensional strategy such as improving working conditions and education” for workers.
A turn to volunteers, telemedicine
A shortage that will take decades to solve feels acute in the face of a pandemic.
In the U.S., top officials are crying out for medical volunteers of all stripes. In New York, more than 50,000 health care workers have answered Gov. Andrew Cuomo’s pleas. In California, a newly created health corps to expand the workforce has garnered more than 70,000 registrations from “underemployed” medical professionals of all stripes.
In Washington state, Gov. Jay Inslee last week told recent medical retirees and qualified students, “Like Uncle Sam, we want you!”
Another infusion of medical manpower is coming from the U.S. military. Three hundred soldiers from an Army unit in Fort Carson, Colorado, arrived in Seattle last week to set up a 250-bed hospital inside the Seattle Seahawks’ football stadium, and a Navy hospital ship has docked in New York City. By caring for patients without COVID-19, they can free up local hospital beds for those who have the virus.
Health care workers are also being asked to shift gears, as they’re redeployed to other units, such as from transplant ICUs to respiratory care.
Italy’s worst-hit regions like Lombardy are also tapping another strategy: emphasizing primary-care monitoring and home care rather than hospital admissions. “Hospitals have always seen too many people that don’t belong in the hospital,” says Dr. Friebel, the analyst.
As Italian doctors have discovered by necessity, initial screenings of suspected COVID-19 patients can be done without a physical visit.
“It turns out that a lot of both screening and follow-up of [COVID-19] patients – the mild cases – is about asking questions about symptoms,” says Joseph Kvedar, a Harvard Medical School professor and incoming president of the American Telemedicine Association. “It’s a perfect setup for [telehealth] technology.”
Advocates of telemedicine say many health care needs can, in fact, be serviced without stepping foot into an office, clinic, or hospital.
Inquiries from U.S. clinicians about telehealth have skyrocketed, Dr. Kvedar says, at the same time that states and the federal government are loosening requirements for licensing across state borders and privacy issues around technology. They’re also reexamining what’s defined as a “visit” for insurance purposes.
“There’s been a staggering amount of creativity and collaboration,” says Dr. Charlotte Wu, a physician and founder of Harness Health Partners, a Boston-based consultancy. “We’re seeing an increased acceptance of virtual medicine, leveraging the skills of diverse team members, and collaborating across institutions – who were traditionally competitors.”
Virtual care, digital fixes
At Asian Counseling and Referral Service in Seattle, counselors are now offering mental health care by phone and video apps such as Zoom and Doxy.me. “We can accept consent via telephone versus in writing” in treating substance use disorders, says Michael Byun, who runs the nonprofit.
COVID-19 is spurring innovations that might eventually pave the way for routine remote-monitoring of chronic illnesses. The possibilities are legion. Seventy percent of U.S. health care costs go to treating health conditions like high blood pressure or high cholesterol that are attributed to or worsened by smoking, lack of exercise, or poor eating habits; they can be followed by a virtual-care quick check-in, says Dr. Kvedar.
“We don’t have enough people to deliver service one-to-one in a room at a time,” says Dr. Kvedar. “There’s a lot of inefficiency in the way we deliver care. When the dust settles, I hope we don’t go back to doing every single thing in the office.”
New technologies are also helping tackle staffing shortages. Germany recently called on the public to suggest COVID-19 related innovations, and among the entries was a “digital waiting room” that vets a patient’s symptoms, and an app that rotates nurses more effectively. Practitioners and researchers are also using artificial intelligence to help forecast disease spread, implement rapid-testing technologies, and develop new approaches to contact tracing.
Back in Seattle, the veteran nurse Ms. Grant has bid her short-lived retirement goodbye; she’s now working 10- to 12-hour days, six days a week, managing COVID-19 testing sites. Her day begins early to ensure adequate supplies for the testers, as she leads a team of nurses at the University of Washington Medical Center – Northwest who were displaced from outpatient surgery centers and clinics.
Ms. Grant was part of a wave of nurses who entered the workforce during a severe nursing shortage in the U.S. during the 1980s. “Many people in that age bracket are exiting the workforce,” she says, so it’s no surprise they’re being called back to fill the gaps they’ve left. Ms. Grant feels a “loyalty” and a call to duty. “I am able to help this community at a difficult time.”
This story was reported by Monitor correspondent Lenora Chu in Berlin, staff writer Ann Scott Tyson in Seattle, contributor Daniela Sala in Rome, and contributor Austin Davis in Berlin.
Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.


csmonitor--2020-03-20--‘I love this city to my bones’: How Mayor Jenny Durkan leads Seattle

“ We ’ re a gritty city .
We come back from adversity , ” Ms. Durkan says .
“ But this one is going to test everyone ’ s will , and everybody ’ s mettle.
” Along with Washington state Gov .
Jay Inslee , and King County Executive Dow Constantine , she ’ s determined to rise above blame-game politics and “ speak in one voice as one government , ” as she said in a press conference March 11 .
“ I love this city to my bones .
This is so hard , ” she @ @ @ @ @ @ @ s going to have such deep , long-term consequences.
” To Ms. Durkan , getting the local response right isn ’ t just about accountability .
Seattle is where she grew up as one of eight children , where she sold linens at JCPenney , where she graduated from law school .
Two months ago , the United States ’ first case of COVID-19 was confirmed just north of Seattle .
That discovery set the Emerald City into uncharted waters .
The pandemic ’ s double whammy on public health and the economy @ @ @ @ @ @ @ shaking Seattle ’ s foundations .
Seattle Mayor Jenny Durkan , the granddaughter of an Irish Catholic immigrant , sits in her City Hall suite wearing a shamrock pin .
It ’ s St. Patrick ’ s Day – but her office , and the city outside , is nearly empty .
It was Monday , March 2 , when Mayor Jenny Durkan took the call at her Seattle home .
On the line was Harvard-trained epidemiologist Trevor Bedford , who had caught the mayor ’ s attention with an ominous tweet two @ @ @ @ @ @ @ s tracking of the new coronavirus .
Dr. Bedford had connected the genetic dots between the first U.S. coronavirus case – a man who tested positive Jan. 20 after returning from Wuhan , China , to Snohomish County north of Seattle – and a teenager who tested positive in the same county on Feb. 28 .
“ This strongly suggests that there has been cryptic transmission in Washington state for the past 6 weeks , ” tweeted Dr. Bedford .
Ms. Durkan urgently tracked down Dr. Bedford , who studies infectious diseases at @ @ @ @ @ @ @ Center , to dig into his predictions .
Why did they depart so starkly from what government health officials were reporting ?
“ His modeling , frankly , was very different from what public health was telling me , ” Ms. Durkan recalls .
Editor ’ s note : As a public service , all our coronavirus coverage is free .
There is no paywall .
As the former U.S. attorney listened carefully to the evidence , the shocking revelations sank in .
“ After talking with him , there was little doubt @ @ @ @ @ @ @ accurate , ” she recounts , a belief other top experts would confirm .
“ We aren ’ t dealing with five cases .
We are dealing with hundreds of cases , and our time to act was yesterday.
” She sketched out the math in a chart on a piece of paper , one she has carried ever since .
“ Over 70,000 cases , ” she thought , “ in six weeks.
” She pauses .
“ It was one of the most sobering moments of my entire life.
” The @ @ @ @ @ @ @ Ms. Durkan signed a proclamation of civil emergency for Seattle – the blue-collar town where she ’ d grown up as one of eight children , where she ’ d sold linens at JCPenney and later graduated from law school .
The city she loves .
[ Editor ’ s note : As a public service , all our coronavirus coverage is free .
No paywall . ]
Two weeks later , on St. Patrick ’ s Day , Ms. Durkan , the granddaughter of an Irish Catholic immigrant , sits virtually alone @ @ @ @ @ @ @ wearing a shamrock pin .
Sunshine glints off the nearby skyscrapers , the deserted streets , and , a few blocks away , the waters of Elliott Bay .
The lobby of City Hall , adorned with a huge , gold seal of Chief Seattle , is eerily empty .
Her lone assistant apologetically requests that all the mayor ’ s visitors first wash their hands , and remain several feet apart from her .
But even at a distance , Ms. Durkan ’ s gregarious warmth , quick wit , and no-nonsense @ @ @ @ @ @ @ coming in , ” she greets this reporter , raising one hand and making a “ V ” with four fingers in a Vulcan salute , popularized by Spock in “ Star Trek.
” I bungle the return salute , which , perhaps aptly , means : Live long and prosper .
“ It takes practice !
” she says , flashing a smile .
The heaviness of the moment , though , is unmistakable , as Ms. Durkan presides over a city that has gone from boom to virus-inflicted bust virtually overnight @ @ @ @ @ @ @ has been one of the fastest-growing cities in the country .
But the double whammy of the pandemic on public health and the economy is akin to an earthquake , shaking the Emerald City ’ s foundations .
Asked whether this is the biggest challenge of her career , Ms. Durkan doesn ’ t hesitate .
“ No question about it , by a magnitude of several factors , ” she says .
“ I don ’ t think that our country has dealt with a more impactful and complicated and widespread crisis @ @ @ @ @ @ @ Ms. Durkan is relying not only on top scientists but also her own , well-honed political instincts to guide Seattle through today ’ s uncharted waters .
The daughter of a legendary Washington state senator and lobbyist , she learned to stand her ground by tussling with her siblings .
When she graduated from the University of Washington Law School in 1985 , she recalls her mother commenting : “ Finally , someone is going to pay you to argue.
” But she also learned the art of compromise and teamwork .
On @ @ @ @ @ @ @ , she huddled for two hours with Washington state Gov .
Jay Inslee , King County Executive Dow Constantine , and other senior officials to ensure they were on the same page .
“ Once we heard the science , I don ’ t think there was anyone in the room that didn ’ t feel the government had to make some significant steps to reduce public gatherings , ” she says .
“ It ’ s not either-or .
It ’ s really more of a dial , ” she says .
@ @ @ @ @ @ @ and if that seems not to be working , you have to accelerate through the dial pretty quickly.
” On March 11 , Ms. Durkan stepped before the cameras flanked by Governor Inslee , Mr. Constantine , and other officials to unveil that first step – a ban on gatherings of more than 250 people .
But first , she set the stage .
“ One of the most important things we can do , according to the World Health Organization , is to speak in one voice as one government , ” @ @ @ @ @ @ @ words , she elbow-bumped with the governor , made the Vulcan salute , and stepped aside .
“ This is something Mayor Jenny Durkan was born to do , ” says a longtime Seattle journalist who spoke on condition of anonymity .
“ She ’ s good at centrist , Democratic government.
” The Washington state team was determined , as Ms. Durkan said later , to rise above the pull of blame-game politics and “ fight the virus instead of each other.
” In contrast , a few days earlier , as @ @ @ @ @ @ @ to bring vital emergency aid , President Donald Trump referred to Governor Inslee as “ a snake ” for alleging the administration had not “ stuck to the science.
” Robust local leadership has emerged in part amid a weak federal government response , analysts say .
There was “ a lack of strong leadership from the feds , ” says Ann Marie Kimball , professor emeritus of epidemiology at the University of Washington .
Moreover , she says , “ all epidemics and pandemics are really local , so local officials are @ @ @ @ @ @ @ the response ] … and they speak with a voice we recognize.
” Americans expressed more confidence in their state governments than in President Trump or the federal government in handling the coronavirus , according to a Wall Street Journal/NBC News poll released this week .
Carrying her hand-sketched chart of future cases , Ms. Durkan has no time to waste on infighting .
She knows Seattle and Washington are only about 11 days behind Italy – one of the world ’ s hardest-hit countries – on the steeply rising COVID-19 curve .
@ @ @ @ @ @ @ because they have reached a crisis point , it sends a signal to us , ” Ms. Durkan says .
“ We should take that step now.
” Yet state and local resources only go so far .
What is keeping her awake at night is the lack of protective equipment such as gloves , masks , and gowns for Washington ’ s first responders and medical personnel .
Last Friday , she visited Seattle ’ s Harborview Medical Center , only to see medical workers reaching into almost empty bins of masks @ @ @ @ @ @ @ , our health care system fails , ” warns Ms. Durkan , who says she spent dozens of hours last weekend trying to help secure more protective equipment .
Washington has already received some supplies from national reserves , but is awaiting approval to get another 180,000 masks and face shields and 65,000 respirators .
Hospital surge capacity is also inadequate without federal help , she says .
More shelters for Seattle ’ s most vulnerable population , particularly some 11,000 people experiencing homelessness , are another critical need .
And given the @ @ @ @ @ @ @ lose their jobs , “ we need something bigger than the New Deal to put money in the pockets of workers ” and supplement private , local , and state relief efforts , Ms. Durkan says .
For example , Amazon executives pledged $ 5 million for small firms such as restaurants and food trucks in the vicinity of the company ’ s downtown Seattle headquarters .
Seattle ’ s vibrant patchwork quilt of neighborhoods is suffering , she says , and she takes such losses personally .
She remembers growing up during @ @ @ @ @ @ @ 1970s , when the airplane maker cut more than 40,000 workers .
In her friends ’ neighborhoods , “ there was empty house after empty house , and dandelions pushing up , ” she recalls .
“ I love this city to my bones .
This is so hard , ” she says .
“ You know it ’ s going to have such deep , long-term consequences.
” But Ms. Durkan also has a tough streak that Seattle needs right now .
After college , she moved to an Alaskan fishing village @ @ @ @ @ @ @ Then she worked as a baggage handler and dues-paying Teamster to help her pay for law school .
The first openly gay U.S. attorney , and the first female Seattle mayor for nearly a century , she speaks her mind and tells it like it is .
“ We ’ re a gritty city .
We come back from adversity , ” she says .
“ But this one is going to test everyone ’ s will , and everybody ’ s mettle.
” Editor ’ s note : As a public service @ @ @ @ @ @ @ .
There is no paywall .

“We’re a gritty city. We come back from adversity,” Ms. Durkan says. “But this one is going to test everyone’s will, and everybody’s mettle.”
Along with Washington state Gov. Jay Inslee, and King County Executive Dow Constantine, she’s determined to rise above blame-game politics and “speak in one voice as one government,” as she said in a press conference March 11.
“I love this city to my bones. This is so hard,” she says. “You know it’s going to have such deep, long-term consequences.”
To Ms. Durkan, getting the local response right isn’t just about accountability. Seattle is where she grew up as one of eight children, where she sold linens at JCPenney, where she graduated from law school.
Washington was the first state hit with the new coronavirus, meaning its leaders had no U.S. peers to look to for guidance. At the epicenter, near Seattle, Mayor Jenny Durkan has relied on science, teamwork – and speed.
Two months ago, the United States’ first case of COVID-19 was confirmed just north of Seattle. That discovery set the Emerald City into uncharted waters. The pandemic’s double whammy on public health and the economy has been akin to an earthquake, shaking Seattle’s foundations.
Seattle Mayor Jenny Durkan, the granddaughter of an Irish Catholic immigrant, sits in her City Hall suite wearing a shamrock pin. It’s St. Patrick’s Day – but her office, and the city outside, is nearly empty.
It was Monday, March 2, when Mayor Jenny Durkan took the call at her Seattle home. On the line was Harvard-trained epidemiologist Trevor Bedford, who had caught the mayor’s attention with an ominous tweet two days earlier about his Seattle lab’s tracking of the new coronavirus.
Dr. Bedford had connected the genetic dots between the first U.S. coronavirus case – a man who tested positive Jan. 20 after returning from Wuhan, China, to Snohomish County north of Seattle – and a teenager who tested positive in the same county on Feb. 28. “This strongly suggests that there has been cryptic transmission in Washington state for the past 6 weeks,” tweeted Dr. Bedford.
Ms. Durkan urgently tracked down Dr. Bedford, who studies infectious diseases at Seattle’s Fred Hutchinson Cancer Research Center, to dig into his predictions. Why did they depart so starkly from what government health officials were reporting?
Why We Wrote This Washington was the first state hit with the new coronavirus, meaning its leaders had no U.S. peers to look to for guidance. At the epicenter, near Seattle, Mayor Jenny Durkan has relied on science, teamwork – and speed.
“His modeling, frankly, was very different from what public health was telling me,” Ms. Durkan recalls.
Editor’s note: As a public service, all our coronavirus coverage is free. There is no paywall.
As the former U.S. attorney listened carefully to the evidence, the shocking revelations sank in.
“After talking with him, there was little doubt in my mind that the modeling was accurate,” she recounts, a belief other top experts would confirm. “We aren’t dealing with five cases. We are dealing with hundreds of cases, and our time to act was yesterday.”
She sketched out the math in a chart on a piece of paper, one she has carried ever since. “Over 70,000 cases,” she thought, “in six weeks.”
She pauses. “It was one of the most sobering moments of my entire life.”
The next day, at 1:33 pm, Ms. Durkan signed a proclamation of civil emergency for Seattle – the blue-collar town where she’d grown up as one of eight children, where she’d sold linens at JCPenney and later graduated from law school. The city she loves.
[Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.]
Career’s toughest challenge
Two weeks later, on St. Patrick’s Day, Ms. Durkan, the granddaughter of an Irish Catholic immigrant, sits virtually alone in her 7th floor office suite, wearing a shamrock pin. Sunshine glints off the nearby skyscrapers, the deserted streets, and, a few blocks away, the waters of Elliott Bay.
The lobby of City Hall, adorned with a huge, gold seal of Chief Seattle, is eerily empty. Her lone assistant apologetically requests that all the mayor’s visitors first wash their hands, and remain several feet apart from her.
But even at a distance, Ms. Durkan’s gregarious warmth, quick wit, and no-nonsense demeanor comes through.
Ann Scott Tyson/The Christian Science Monitor View caption Hide caption Seattle’s normally bustling 4th Avenue, outside City Hall, is empty on March 17, 2020. Mayor Jenny Durkan signed a proclamation of civil emergency on March 3 amid the coronavirus crisis.
“Thanks for coming in,” she greets this reporter, raising one hand and making a “V” with four fingers in a Vulcan salute, popularized by Spock in “Star Trek.” I bungle the return salute, which, perhaps aptly, means: Live long and prosper. “It takes practice!” she says, flashing a smile.
The heaviness of the moment, though, is unmistakable, as Ms. Durkan presides over a city that has gone from boom to virus-inflicted bust virtually overnight. For the past decade, Seattle has been one of the fastest-growing cities in the country. But the double whammy of the pandemic on public health and the economy is akin to an earthquake, shaking the Emerald City’s foundations.
Asked whether this is the biggest challenge of her career, Ms. Durkan doesn’t hesitate. “No question about it, by a magnitude of several factors,” she says. “I don’t think that our country has dealt with a more impactful and complicated and widespread crisis in many generations.”
In response, Ms. Durkan is relying not only on top scientists but also her own, well-honed political instincts to guide Seattle through today’s uncharted waters. The daughter of a legendary Washington state senator and lobbyist, she learned to stand her ground by tussling with her siblings. When she graduated from the University of Washington Law School in 1985, she recalls her mother commenting: “Finally, someone is going to pay you to argue.” But she also learned the art of compromise and teamwork.
On the Sunday after Dr. Bedford briefed her, she huddled for two hours with Washington state Gov. Jay Inslee, King County Executive Dow Constantine, and other senior officials to ensure they were on the same page.
“Once we heard the science, I don’t think there was anyone in the room that didn’t feel the government had to make some significant steps to reduce public gatherings,” she says. “It’s not either-or. It’s really more of a dial,” she says. “You try the first step, and if that seems not to be working, you have to accelerate through the dial pretty quickly.”
On March 11, Ms. Durkan stepped before the cameras flanked by Governor Inslee, Mr. Constantine, and other officials to unveil that first step – a ban on gatherings of more than 250 people. But first, she set the stage. “One of the most important things we can do, according to the World Health Organization, is to speak in one voice as one government,” she said. After a crisp few words, she elbow-bumped with the governor, made the Vulcan salute, and stepped aside.
“This is something Mayor Jenny Durkan was born to do,” says a longtime Seattle journalist who spoke on condition of anonymity. “She’s good at centrist, Democratic government.”
The Washington state team was determined, as Ms. Durkan said later, to rise above the pull of blame-game politics and “fight the virus instead of each other.” In contrast, a few days earlier, as Vice President Mike Pence visited the state to bring vital emergency aid, President Donald Trump referred to Governor Inslee as “a snake” for alleging the administration had not “stuck to the science.”
Robust local leadership has emerged in part amid a weak federal government response, analysts say. There was “a lack of strong leadership from the feds,” says Ann Marie Kimball, professor emeritus of epidemiology at the University of Washington. Moreover, she says, “all epidemics and pandemics are really local, so local officials are in the best position to tailor [the response] … and they speak with a voice we recognize.”
Americans expressed more confidence in their state governments than in President Trump or the federal government in handling the coronavirus, according to a Wall Street Journal/NBC News poll released this week.
A city unbowed
Carrying her hand-sketched chart of future cases, Ms. Durkan has no time to waste on infighting. She knows Seattle and Washington are only about 11 days behind Italy – one of the world’s hardest-hit countries – on the steeply rising COVID-19 curve.
“Every time Italy takes a step because they have reached a crisis point, it sends a signal to us,” Ms. Durkan says. “We should take that step now.”
Yet state and local resources only go so far. What is keeping her awake at night is the lack of protective equipment such as gloves, masks, and gowns for Washington’s first responders and medical personnel. Last Friday, she visited Seattle’s Harborview Medical Center, only to see medical workers reaching into almost empty bins of masks.
“If our workers get sick, our health care system fails,” warns Ms. Durkan, who says she spent dozens of hours last weekend trying to help secure more protective equipment. Washington has already received some supplies from national reserves, but is awaiting approval to get another 180,000 masks and face shields and 65,000 respirators. Hospital surge capacity is also inadequate without federal help, she says.
More shelters for Seattle’s most vulnerable population, particularly some 11,000 people experiencing homelessness, are another critical need. And given the expectation hundreds of thousands of people will lose their jobs, “we need something bigger than the New Deal to put money in the pockets of workers” and supplement private, local, and state relief efforts, Ms. Durkan says. For example, Amazon executives pledged $5 million for small firms such as restaurants and food trucks in the vicinity of the company’s downtown Seattle headquarters.
Seattle’s vibrant patchwork quilt of neighborhoods is suffering, she says, and she takes such losses personally. She remembers growing up during the “Boeing bust” of the 1970s, when the airplane maker cut more than 40,000 workers. In her friends’ neighborhoods, “there was empty house after empty house, and dandelions pushing up,” she recalls.
“I love this city to my bones. This is so hard,” she says. “You know it’s going to have such deep, long-term consequences.”
But Ms. Durkan also has a tough streak that Seattle needs right now. After college, she moved to an Alaskan fishing village and taught English for two years. Then she worked as a baggage handler and dues-paying Teamster to help her pay for law school. The first openly gay U.S. attorney, and the first female Seattle mayor for nearly a century, she speaks her mind and tells it like it is.
Get stories that
empower and uplift daily. By signing up, you agree to our Privacy Policy Already a subscriber? Log in to hide ads.
“We’re a gritty city. We come back from adversity,” she says. “But this one is going to test everyone’s will, and everybody’s mettle.”
Editor’s note: As a public service, all our coronavirus coverage is free. There is no paywall.


csmonitor--2020-03-20--Daily for March 20, 2020

Daily for March 20, 2020

Syrians now entering their 10th year of war could be forgiven for believing they have already faced the modern equivalent of the biblical Four Horsemen of the Apocalypse .
But the millions of refugees and internally displaced Syrians are bracing for yet another trial : the coronavirus .
Even technologically advanced nations like China , Italy , and the United States are struggling to stop the spread of COVID-19 .
But the rudimentary camps full of Syrian victims of conflict – many of them having endured a cold winter in tents , lack of basic hygiene , and malnourishment – @ @ @ @ @ @ @ pandemic .
[ Editor ’ s note : As a public service , all our coronavirus coverage is free .
No paywall . ]
Experts say there is still a window to act to take life-saving health and hygiene measures .
And one key is for Western donors to recognize that preventing an uncontrolled regional outbreak improves their own long-term risk calculations at home .
That will be a challenge , as countries around the world remain engulfed by their own domestic needs .
And even before the coronavirus , humanitarian efforts in @ @ @ @ @ @ @ of conflict ; donor fatigue ; neglect as populations filled sprawling camps or moved , newly homeless , toward safer borders ; and weak governments besieged by popular protests in Iraq , Lebanon , and Syria .
The trajectory of the virus suggests that it will hit areas with high concentrations of refugees – such as Syria , Afghanistan , Yemen , and Venezuela , says Jan Egeland , head of the Norwegian Refugee Council ( NRC ) .
“ Then my open question to any decision-maker ... trying to curb the spread @ @ @ @ @ @ @ do social distancing , if you live in a refugee camp with 10 people per small tent ?
” “ How can you do constant hand-washing , if your water ration is three liters per day , and that ’ s supposed to go to drinking and cooking ?
And how , ” he continues , “ are you supposed to care for the infected and quarantine the vulnerable , when there is no health care ?
” Grim conditions in opposition-controlled Idlib , Syria , highlight the depths of the challenges ahead @ @ @ @ @ @ @ shrinking rebel enclave has forced one million people from their homes .
Syrian government forces backed by Russia and Iran have captured nearly half of the enclave since renewing an offensive last December with relentless bombing .
That forced into even tighter quarters the 3 million people in Idlib – among them Islamist militants , including former Al Qaeda affiliates , trucked there as part of cease-fire deals brokered when other rebel-held regions were defeated .
The latest United Nations situation report for northwest Syria , published Monday , notes : “ Inadequate @ @ @ @ @ @ @ and sites leave many new IDPs [ internally displaced people ] in overcrowded conditions without formalized camp support.
” It adds that , “ access to food has become an increasing concern.
” Indeed , some 1.5 million people in Idlib depend on food aid , and in January alone , 1,227 trucks crossed the border with supplies from Turkey , the largest number in seven years .
A tenuous cease-fire brokered March 5 by Turkey and Russia , both of which have troops deployed in and around the province , still holds @ @ @ @ @ @ @ before the December offensive began , the population of Idlib was “ already extremely vulnerable.
” The World Health Organization says Syria ’ s health system – especially after years in which government and allied forces targeted health infrastructure behind rebel lines – is “ on its knees.
” Beyond Syria ’ s borders , neighbors Turkey , Lebanon , and Jordan have absorbed millions of refugees .
“ In Syria you have this perfect storm .
When we needed the health system the most , it was bombed .
When people were @ @ @ @ @ @ @ distance themselves , they had to flee their houses to temporary , crowded camps , ” says Mr. Egeland .
“ So as bad as it is in Italy and China and increasingly in the rest of Europe , I can not see why it would not be 10 times worse when you have none of the mitigating measures that we have , ” he says .
But the solution that can ease the impact is still within reach , if donors can see the need for a holistic approach .
“ What @ @ @ @ @ @ @ .
It ’ s not rocket science .
It ’ s a logistical challenge , ” says Mr. Egeland , whose 14,000 field workers with NRC aim to double to 4 million the number of people across multiple war zones they reach with water and sanitation .
That means more latrines , and 10 times more running water points for washing , and decongesting camps by tripling or quadrupling the space devoted to displaced people .
It means expanding health care , public hygiene campaigns , and building quarantine facilities – all actions @ @ @ @ @ @ @ at bay in the Middle East , and so make it less likely to persist there as a threat to the rest of the world .
The need to act is urgent , experts say .
“ You have 6 million refugees from Syria , 6 million internally displaced in Syria – including a million recently in Idlib – another 1.5 million displaced in Iraq , all of them living in oppressively unsustainable conditions that , by all indications , ” are consistent with transmission of the virus , says Julien Barnes-Dacey , @ @ @ @ @ @ @ Africa program at the European Council on Foreign Relations in Brussels .
Another key factor is the governments of Syria , Lebanon , and Iraq , all “ hollowed out ” over recent years by multiple layers of crises and short on leadership and resources , says Mr. Barnes-Dacey .
But that very concern may be causing some shift in regional thinking , with Exhibit A being unexpected support for Iran – epicenter of the virus in the Middle East – by the United Arab Emirates and some other Persian Gulf states , @ @ @ @ @ @ @ Islamic Republic is host to 9 out of 10 of the 21,000-plus confirmed cases of COVID-19 across the Middle East , and a number of its leadership elite are among more than 1,800 citizens who have died .
Suffocating U.S. sanctions have complicated both medical exports to Iran and the cash transfers to pay for them .
The UAE nevertheless expressed its support for Iran and “ highlighted the importance of collective work and efforts to survive this global challenge.
” It made two shipments of medical supplies to Iran , including two @ @ @ @ @ @ @ , masks , and other equipment , on March 16 .
“ They recognize obviously that what happens in Iran doesn ’ t stay in Iran , and it can easily overflow across the Gulf , ” says Mr. Barnes-Dacey .
Such moves are “ first and foremost about self-preservation , and [ Persian Gulf states ’ ] desire to ensure that the situation in Iran is containable , ” he says .
“ But it points to a model of possible regional collaboration that could be a constructive way of reinforcing efforts @ @ @ @ @ @ @ ” says Mr. Barnes-Dacey .
“ If Arab Gulf states are prepared to do something with Iran , it suggests that fault lines and conflict lines will likely be deprioritized in the case of a threat that challenges everyone equally.
” On a wider scale , that is the case the NRC ’ s Mr. Egeland is making to donor countries like the U.S. and members of the European Union , about the need to look now at easing the effect of the virus among the most vulnerable refugees and displaced in Syria @ @ @ @ @ @ @ for the virus , anywhere in the world , when we live in a global world with global pandemics ?
” he says .
“ If it gets a stronghold in camps with half a million people ... it means it can always come back .
“ If hand-washing is a mitigating factor in New York City , it ’ s also important for New York City that there are hand-washing facilities in Syria , because it started with patient zero in Wuhan , and now we are sitting in quarantine in Oslo @ @ @ @ @ @ @ is under mandatory quarantine there after a visit to South America .
“ So if there are no hand-washing facilities in Syria a year from now , how can you get rid of this virus ?
It ’ s a perfect example of ideals and interests intertwined.
” [ Editor ’ s note : As a public service , all our coronavirus coverage is free .
No paywall . ]

How do you do social distancing in a refugee camp? Collapse
Ghaith Alsayed/AP View caption Hide caption Members of a humanitarian aid agency disinfect Ibn Sina hospital as prevention against the coronavirus in the city of Idlib, Syria, Thursday, March 19, 2020.
Syrians now entering their 10th year of war could be forgiven for believing they have already faced the modern equivalent of the biblical Four Horsemen of the Apocalypse.
But the millions of refugees and internally displaced Syrians are bracing for yet another trial: the coronavirus.
Even technologically advanced nations like China, Italy, and the United States are struggling to stop the spread of COVID-19. But the rudimentary camps full of Syrian victims of conflict – many of them having endured a cold winter in tents, lack of basic hygiene, and malnourishment – may be uniquely vulnerable to the global pandemic.
[Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.]
Experts say there is still a window to act to take life-saving health and hygiene measures. And one key is for Western donors to recognize that preventing an uncontrolled regional outbreak improves their own long-term risk calculations at home.
That will be a challenge, as countries around the world remain engulfed by their own domestic needs.
And even before the coronavirus, humanitarian efforts in the Middle East were beset by years of conflict; donor fatigue; neglect as populations filled sprawling camps or moved, newly homeless, toward safer borders; and weak governments besieged by popular protests in Iraq, Lebanon, and Syria.
The trajectory of the virus suggests that it will hit areas with high concentrations of refugees – such as Syria, Afghanistan, Yemen, and Venezuela, says Jan Egeland, head of the Norwegian Refugee Council (NRC). “Then my open question to any decision-maker ... trying to curb the spread of the virus: How can you do social distancing, if you live in a refugee camp with 10 people per small tent?”
“How can you do constant hand-washing, if your water ration is three liters per day, and that’s supposed to go to drinking and cooking? And how,” he continues, “are you supposed to care for the infected and quarantine the vulnerable, when there is no health care?”
Grim conditions in opposition-controlled Idlib, Syria, highlight the depths of the challenges ahead. Recent bombardment of this last, shrinking rebel enclave has forced one million people from their homes. Syrian government forces backed by Russia and Iran have captured nearly half of the enclave since renewing an offensive last December with relentless bombing.
That forced into even tighter quarters the 3 million people in Idlib – among them Islamist militants, including former Al Qaeda affiliates, trucked there as part of cease-fire deals brokered when other rebel-held regions were defeated.
The latest United Nations situation report for northwest Syria, published Monday, notes: “Inadequate land for the formation of new camps and sites leave many new IDPs [internally displaced people] in overcrowded conditions without formalized camp support.”
It adds that, “access to food has become an increasing concern.” Indeed, some 1.5 million people in Idlib depend on food aid, and in January alone, 1,227 trucks crossed the border with supplies from Turkey, the largest number in seven years.
Felipe Dana/AP View caption Hide caption A boy walks out of a heavily damaged building where he is currently living, in Idlib, Syria, March 12, 2020. Idlib is the last urban area still under opposition control in Syria, located in a shrinking rebel enclave in the northwestern province of the same name. Syria’s civil war, which entered its 10th year March 15, 2020, has shrunk in geographical scope – focusing on this corner of the country – but the misery wreaked by the conflict has not diminished.
A tenuous cease-fire brokered March 5 by Turkey and Russia, both of which have troops deployed in and around the province, still holds. But the U.N. notes that even before the December offensive began, the population of Idlib was “already extremely vulnerable.”
The World Health Organization says Syria’s health system – especially after years in which government and allied forces targeted health infrastructure behind rebel lines – is “on its knees.” Beyond Syria’s borders, neighbors Turkey, Lebanon, and Jordan have absorbed millions of refugees.
“In Syria you have this perfect storm. When we needed the health system the most, it was bombed. When people were supposed to be able to quarantine and distance themselves, they had to flee their houses to temporary, crowded camps,” says Mr. Egeland.
“So as bad as it is in Italy and China and increasingly in the rest of Europe, I cannot see why it would not be 10 times worse when you have none of the mitigating measures that we have,” he says.
But the solution that can ease the impact is still within reach, if donors can see the need for a holistic approach.
“What can we do? Water and sanitation. It’s not rocket science. It’s a logistical challenge,” says Mr. Egeland, whose 14,000 field workers with NRC aim to double to 4 million the number of people across multiple war zones they reach with water and sanitation.
That means more latrines, and 10 times more running water points for washing, and decongesting camps by tripling or quadrupling the space devoted to displaced people. It means expanding health care, public hygiene campaigns, and building quarantine facilities – all actions the NRC says may keep the virus at bay in the Middle East, and so make it less likely to persist there as a threat to the rest of the world.
The need to act is urgent, experts say.
“You have 6 million refugees from Syria, 6 million internally displaced in Syria – including a million recently in Idlib – another 1.5 million displaced in Iraq, all of them living in oppressively unsustainable conditions that, by all indications,” are consistent with transmission of the virus, says Julien Barnes-Dacey, head of the Middle East and North Africa program at the European Council on Foreign Relations in Brussels.
Another key factor is the governments of Syria, Lebanon, and Iraq, all “hollowed out” over recent years by multiple layers of crises and short on leadership and resources, says Mr. Barnes-Dacey.
But that very concern may be causing some shift in regional thinking, with Exhibit A being unexpected support for Iran – epicenter of the virus in the Middle East – by the United Arab Emirates and some other Persian Gulf states, despite long-simmering tensions with Iran.
The Islamic Republic is host to 9 out of 10 of the 21,000-plus confirmed cases of COVID-19 across the Middle East, and a number of its leadership elite are among more than 1,800 citizens who have died. Suffocating U.S. sanctions have complicated both medical exports to Iran and the cash transfers to pay for them.
The UAE nevertheless expressed its support for Iran and “highlighted the importance of collective work and efforts to survive this global challenge.” It made two shipments of medical supplies to Iran, including two planeloads carrying thousands of pairs of gloves, masks, and other equipment, on March 16.
“They recognize obviously that what happens in Iran doesn’t stay in Iran, and it can easily overflow across the Gulf,” says Mr. Barnes-Dacey.
Such moves are “first and foremost about self-preservation, and [Persian Gulf states’] desire to ensure that the situation in Iran is containable,” he says.
“But it points to a model of possible regional collaboration that could be a constructive way of reinforcing efforts to contain and manage the situation,” says Mr. Barnes-Dacey. “If Arab Gulf states are prepared to do something with Iran, it suggests that fault lines and conflict lines will likely be deprioritized in the case of a threat that challenges everyone equally.”
On a wider scale, that is the case the NRC’s Mr. Egeland is making to donor countries like the U.S. and members of the European Union, about the need to look now at easing the effect of the virus among the most vulnerable refugees and displaced in Syria and beyond.
“Why make strongholds for the virus, anywhere in the world, when we live in a global world with global pandemics?” he says. “If it gets a stronghold in camps with half a million people ... it means it can always come back.
“If hand-washing is a mitigating factor in New York City, it’s also important for New York City that there are hand-washing facilities in Syria, because it started with patient zero in Wuhan, and now we are sitting in quarantine in Oslo,” says Mr. Egeland, who is under mandatory quarantine there after a visit to South America.
“So if there are no hand-washing facilities in Syria a year from now, how can you get rid of this virus? It’s a perfect example of ideals and interests intertwined.”
[Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.]


csmonitor--2020-05-29--‘Friendliest boundary in the world’ divides families in pandemic

The Lathrops , who married in 2018 , have been split by the closure since it began .
“ We had anticipated that I would be receiving my green card in May or June this year , ” says Jenn Lathrop , a Canadian citizen .
“ And then we were hoping to be able to start a family .
But obviously that won ’ t happen.
” The 5,525-mile border is often called the friendliest boundary in the world , where Canadians dip south for milk or gas , and Americans vacation at their cottages north .
But the @ @ @ @ @ @ @ .
A petition lobbying the Canadian government for family members to be reunited has filled up with personal stories of separation : from those with health issues unable to care for family , or fathers separated from babies , or pregnant spouses trapped on the other side of the border .
When the U.S.-Canada border shuttered , at midnight on March 21 , to all but essential and commercial traffic , it was just one of many international closures intended to stop the spread of the coronavirus .
But along the world ’ @ @ @ @ @ @ @ felt even more baffling to binational families who have seen their American-Canadian lives suddenly divided .
Jenn and Will Lathrop knew they were in for some long distance when they got married in the fall of 2018 , until she , a Canadian , could get her green card and start life anew with her American husband .
She lives 30 minutes from the U.S.-Canada border in British Columbia , he just 10 in Washington state .
And on most days , getting through border patrol was no more than a five-minute affair @ @ @ @ @ @ @ or south .
That was , until the border shuttered , at midnight on March 21 , to all but essential and commercial traffic .
It happened as international travel ground to a halt worldwide in an attempt to stop the coronavirus pandemic .
( This month the closure was extended until at least June 21 . )
But along the world ’ s largest undefended boundary , where notions of two open countries have persisted even after the strictures put in place after 9/11 , the closure has felt even more baffling @ @ @ @ @ @ @ their American-Canadian lives suddenly divided in ways that make sense in government ministries but not in their own minds .
The Lathrops have only seen each other twice since it shut – the first time across a ditch where they were watched by U.S. border patrol agents and Royal Canadian Mounted Police ( RCMP ) telling families not to touch or share items .
Mr. Lathrop likened it to what prison must feel like .
“ We were only inches apart , yet there is that barrier , ” he says .
Editor @ @ @ @ @ @ @ service , all our coronavirus coverage is free .
No paywall .
The experience , says Len Saunders , the Lathrops ’ immigration lawyer , whose office in Blaine , Washington , sits three blocks from the border , is something he would never have imagined “ in my wildest dreams.
” The U.S.-Canada border , which spans 5,525 miles , is often called “ the friendliest boundary in the world , ” where Canadians dip south for milk or gas , and Americans vacation at their cottages north .
A library in @ @ @ @ @ @ @ a symbol of that friendship .
It ’ s been contentious at various points since it was first established in the 18th century .
After 9/11 , tensions flared after its porousness , usually defended as a point of trust between both countries , was criticized by American leaders who imposed new requirements .
Today ’ s relatively seamless closure of nonessential traffic while trade continues , is owed in part to the work of shoring up bilateral institutions and relationships since then , says Theresa Cardinal Brown , director of immigration policy @ @ @ @ @ @ @ , D.C. “ In the current situation , ” she says , “ where frankly the government of Canada and the government of the United States are not on the same page on a lot of issues , they 're working together on this issue on the border.
” There has been friction today too .
In March , President Donald Trump suggested sending troops to its northern border to prevent the spread of COVID-19 – something widely dismissed in Canada .
If anything , where per capita rates of COVID-19 deaths and @ @ @ @ @ @ @ the threat is perceived to come from the south .
Premiers in provinces that share borders with the U.S. , from Doug Ford in Ontario to John Horgan in British Columbia , have lobbied Canadian Prime Minister Justin Trudeau to keep the border sealed off for now .
That ’ s been devastating to some families though .
Emma Holmes in Ottawa started a petition lobbying the Canadian government for family members to be reunited .
It received 4,000 signatures in its first week alone , with personal stories of separation spilling across @ @ @ @ @ @ @ issues unable to care for family or fathers separated from babies or pregnant spouses trapped on the other side of the border .
Mark Belanger , a lawyer in Vancouver with the Border Solutions Law Group , says border agents aren ’ t consistently determining what is “ essential ” and what isn ’ t .
He normally helps clients on work visas but says he has been increasingly fielding calls from those who have been denied entry to Canada and should not have been .
“ We 're dealing with inconsistencies in @ @ @ @ @ @ @ do decisions always seem to make sense on a personal level .
As Mr. Lathrop puts it : “ If they are going to let people go to tattoo parlors and weed shops , let families visit each other.
” Instead , the couple has to wait – and no one knows for how long .
“ We had anticipated that I would be receiving my green card in May or June this year .
And then we were hoping to be able to start a family .
But obviously that won ’ @ @ @ @ @ @ @ .
“ I 'm grateful that we ’ re both healthy right now in separate countries .
But you never know what 's going to happen in the next month .
And the border could still be shut.
” She was talking right before they are about to meet for a second time – this time at Peace Arch Park , neutral territory where she was hoping to be able to sit on a park bench and at least hold hands .
“ Going back to elementary school here , ” she jokes @ @ @ @ @ @ @ other in mid-May , he swept her up in his arms .
It ’ s the most unrestrained touch they ’ ve experienced in two months – and it ’ s the most they can expect for now .
Editor ’ s note : As a public service , all our coronavirus coverage is free .
No paywall .

There are few borders in the world as open as that between the United States and Canada. Now, its closure amid the coronavirus pandemic is having a profound effect on binational families.
The Lathrops, who married in 2018, have been split by the closure since it began. “We had anticipated that I would be receiving my green card in May or June this year,” says Jenn Lathrop, a Canadian citizen. “And then we were hoping to be able to start a family. But obviously that won’t happen.”
The 5,525-mile border is often called the friendliest boundary in the world, where Canadians dip south for milk or gas, and Americans vacation at their cottages north. But the current situation has split relationships and families. A petition lobbying the Canadian government for family members to be reunited has filled up with personal stories of separation: from those with health issues unable to care for family, or fathers separated from babies, or pregnant spouses trapped on the other side of the border.
When the U.S.-Canada border shuttered, at midnight on March 21, to all but essential and commercial traffic, it was just one of many international closures intended to stop the spread of the coronavirus. But along the world’s largest undefended boundary, it has felt even more baffling to binational families who have seen their American-Canadian lives suddenly divided.
Jenn and Will Lathrop knew they were in for some long distance when they got married in the fall of 2018, until she, a Canadian, could get her green card and start life anew with her American husband.
But long distance is relative.
She lives 30 minutes from the U.S.-Canada border in British Columbia, he just 10 in Washington state. And on most days, getting through border patrol was no more than a five-minute affair. Their weekends were easily spent north or south.
Why We Wrote This There are few borders in the world as open as that between the United States and Canada. Now, its closure amid the coronavirus pandemic is having a profound effect on binational families.
That was, until the border shuttered, at midnight on March 21, to all but essential and commercial traffic. It happened as international travel ground to a halt worldwide in an attempt to stop the coronavirus pandemic. (This month the closure was extended until at least June 21.)
But along the world’s largest undefended boundary, where notions of two open countries have persisted even after the strictures put in place after 9/11, the closure has felt even more baffling and unimaginable. Binational families have seen their American-Canadian lives suddenly divided in ways that make sense in government ministries but not in their own minds.
The Lathrops have only seen each other twice since it shut – the first time across a ditch where they were watched by U.S. border patrol agents and Royal Canadian Mounted Police (RCMP) telling families not to touch or share items. Mr. Lathrop likened it to what prison must feel like. “We were only inches apart, yet there is that barrier,” he says.
Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.
The experience, says Len Saunders, the Lathrops’ immigration lawyer, whose office in Blaine, Washington, sits three blocks from the border, is something he would never have imagined “in my wildest dreams.”
The U.S.-Canada border, which spans 5,525 miles, is often called “the friendliest boundary in the world,” where Canadians dip south for milk or gas, and Americans vacation at their cottages north. A library in Quebec straddles the boundary with Vermont, a symbol of that friendship.
It’s been contentious at various points since it was first established in the 18th century. After 9/11, tensions flared after its porousness, usually defended as a point of trust between both countries, was criticized by American leaders who imposed new requirements. Today’s relatively seamless closure of nonessential traffic while trade continues, is owed in part to the work of shoring up bilateral institutions and relationships since then, says Theresa Cardinal Brown, director of immigration policy with the Bipartisan Policy Center in Washington, D.C.
“In the current situation,” she says, “where frankly the government of Canada and the government of the United States are not on the same page on a lot of issues, they're working together on this issue on the border.”
Courtesy of the Lathrops View caption Hide caption Jenn and Will Lathrop met one time at a ditch at Zero Avenue in mid-April, the only place they could meet, but border patrol and RCMP abounded in the area. They weren't supposed to touch, but border authorities let them give each other a hug goodbye.
There has been friction today too. In March, President Donald Trump suggested sending troops to its northern border to prevent the spread of COVID-19 – something widely dismissed in Canada. If anything, where per capita rates of COVID-19 deaths and infection are much lower in Canada, the threat is perceived to come from the south. Premiers in provinces that share borders with the U.S., from Doug Ford in Ontario to John Horgan in British Columbia, have lobbied Canadian Prime Minister Justin Trudeau to keep the border sealed off for now.
That’s been devastating to some families though. Emma Holmes in Ottawa started a petition lobbying the Canadian government for family members to be reunited. It received 4,000 signatures in its first week alone, with personal stories of separation spilling across its pages, from those with health issues unable to care for family or fathers separated from babies or pregnant spouses trapped on the other side of the border.
Mark Belanger, a lawyer in Vancouver with the Border Solutions Law Group, says border agents aren’t consistently determining what is “essential” and what isn’t. He normally helps clients on work visas but says he has been increasingly fielding calls from those who have been denied entry to Canada and should not have been. “We're dealing with inconsistencies in adjudication,” he says.
Nor do decisions always seem to make sense on a personal level. As Mr. Lathrop puts it: “If they are going to let people go to tattoo parlors and weed shops, let families visit each other.”
Instead, the couple has to wait – and no one knows for how long. “We had anticipated that I would be receiving my green card in May or June this year. And then we were hoping to be able to start a family. But obviously that won’t happen,” says Ms. Lathrop. “I'm grateful that we’re both healthy right now in separate countries. But you never know what's going to happen in the next month. And the border could still be shut.”
She was talking right before they are about to meet for a second time – this time at Peace Arch Park, neutral territory where she was hoping to be able to sit on a park bench and at least hold hands. “Going back to elementary school here,” she jokes.
Get stories that
empower and uplift daily. By signing up, you agree to our Privacy Policy Already a subscriber? Log in to hide ads.
Instead, when they saw each other in mid-May, he swept her up in his arms. It’s the most unrestrained touch they’ve experienced in two months – and it’s the most they can expect for now.
Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.


csmonitor--2020-05-28--‘They didn’t get to die with dignity’: Canada reexamines care for seniors

The Vancouver Coastal Health system in British Columbia may show one way forward .
At present the system has managed 14 outbreaks by implementing measures including constant testing and containment and proper use of protective equipment .
More permanent changes , such as improvements for staff , would both limit the spread of disease and provide better continuity of care for residents , says Michael Schwandt , a medical health officer in the system .
But the coronavirus crisis has exposed a glaring shortcoming in Canada : More than 80 % of its COVID-19 fatalities are linked to nursing homes @ @ @ @ @ @ @ s attention that we really need to put in an effort to change the nature of how we provide nursing home services in the country , ” says John Hirdes , a professor at the University of Waterloo .
He foresees a growing discussion about extending the concept of the Canada Health Act to nursing homes and home care .
For years , Canada has been lauded for its universal health protections , and per capita during the pandemic , the country has fared much better than its neighbor , the United States @ @ @ @ @ @ @ disease .
France Brideau checks her phone each morning when she wakes up to see if her mother has called .
But it ’ s just a reflex , a realization that hits heavily each day : Her mother , Thérèse Duguay , died in mid-April from COVID-19 .
“ It ’ s strong , that bond , ” Ms. Brideau says in a telephone interview from her home in Laval , a city in the Canadian province of Quebec .
“ She was there for me for 56 years.
” Ms. Duguay @ @ @ @ @ @ @ facility , where she moved in February 2019 after her care at home got too complicated .
A year later , that move unwittingly placed her in the heart of a pandemic .
In Quebec , which has seen the highest coronavirus infection and mortality rates in Canada , 63 % of COVID-19 fatalities have occurred in long-term care facilities , known as CHSLDs .
Per capita , Canada has fared much better than the United States in containing the spread of the disease .
But although both countries have suffered outbreaks in @ @ @ @ @ @ @ much more severe in Canada : More than 80 % of COVID-19 fatalities in the country are linked to them , according to Theresa Tam , Canada ’ s chief public health officer .
Editor ’ s note : As a public service , all our coronavirus coverage is free .
No paywall .
Canada is not alone in confronting a high mortality rate among older people , especially those in institutional care .
But in a country lauded for its universal health protections , the death rate and shocking conditions in some @ @ @ @ @ @ @ whether its safety net is supporting those most vulnerable .
In Quebec and Ontario , the military has been deployed to assist nursing facilities that have been hardest hit .
This week the Canadian Armed Forces shook the nation with a damning report on the unsafe state of five long-term care facilities in Greater Toronto .
Ontario Premier Doug Ford promised justice , calling the findings “ heartbreaking ” and “ gut-wrenching.
” Advocates and victims ’ families are calling for public inquiries as to what went wrong and for new national standards @ @ @ @ @ @ @ They want emergency measures that were implemented to contain the outbreaks – such as better wages for personal support workers so they don ’ t have to patch together part-time work to make ends meet – to become permanent .
Some want the entire industry to be rethought .
“ We ’ ve been able to kind of eke along with minimal staffing levels in nursing homes , but COVID has blown it apart .
It ’ s shown it just wasn ’ t sustainable , ” says John Hirdes , a professor @ @ @ @ @ @ @ Health Systems at the University of Waterloo in Ontario .
“ This has focused everybody ’ s attention that we really need to put in an effort to change the nature of how we provide nursing home services in the country.
” The principles behind Canada ’ s publicly funded health system , which requires that all medically necessary hospital and doctor services be covered , does not extend to nursing or home care .
While all the provinces and territories provide some coverage for such care , run by a mix of @ @ @ @ @ @ @ extensively , says Paul Williams , a University of Toronto professor and co-chair of the Canadian Research Network for Care in the Community .
“ I think it was massively shocking to people to find out what was going on in places which are understaffed and underfunded , ” he says .
It ’ s not shocking to advocates , though .
Paul Brunet , who heads a patients ’ rights group that launched a class-action lawsuit in 2018 on behalf of Quebec ’ s CHSLD patients , says understaffing and a lack @ @ @ @ @ @ @ patients have not received the care they are entitled to under the law .
In Canada , “ everyone has access to all the care he or she might need , but when there ’ s budget cuts ... unfortunately the poorest and the oldest normally [ take the hit ] , ” he says .
“ To me , it is discrimination .
It is prejudice.
” And many believe it set the country up for failure when the pandemic swept through .
In one of the most notorious cases , residents @ @ @ @ @ @ @ were left abandoned without water and in full diapers for days , the Montreal Gazette reported .
At least 51 residents died as a result of the outbreak , which is now the subject of three inquiries .
Quebec Premier François Legault has acknowledged the problem , saying that “ society failed ” to protect those most vulnerable and that successive governments did not invest enough in the CHSLDs .
“ I think that many people are responsible .
I don ’ t exclude myself , ” Mr. Legault told reporters .
In @ @ @ @ @ @ @ for turning a blind eye to the problem before the pandemic , said he ’ d launch an independent commission to probe the failings , in which around 1,500 nursing home residents have died from COVID-19 ( among more than 2,100 in total ) .
An investigation by the Toronto Star showed that seniors in for-profit care are four times as likely to die as those in public facilities .
According to Sharleen Stewart , president of the Service Employees International Union Healthcare that represents 60,000 front-line health workers in Ontario , low @ @ @ @ @ @ @ older and more clinically complex over the past two decades – have left the system dangerously exposed .
One key reason for COVID-19 ’ s rapid spread : Personal support workers in nursing facilities , paid far less than their counterparts in hospitals , have to work in multiple facilities , she says .
“ Early on in March , when the government was calling us together to talk about a pandemic plan , I asked the question : What are we going to do about the fact that 1 in 3 personal @ @ @ @ @ @ @ ?
” She says she was ignored .
“ Somebody needs to be accountable for this.
” No outbreak is “ inevitable , ” argues Michael Schwandt , a medical health officer in the Vancouver Coastal Health system in British Columbia .
At present the system has managed 14 outbreaks by implementing measures including constant testing and containment and proper use of protective equipment .
The system has declared eight of those outbreaks over .
He says more permanent changes , such as staff earning a living wage at a single center and @ @ @ @ @ @ @ sick , would both limit the spread of disease and provide better continuity of care for residents .
“ I have a lot of hope , ” he says .
“ I think that we ’ ve seen some improvements put in place in short order in [ British Columbia ] to limit the impacts of the pandemic , and with some of those successes , I hope that some of those measures will be made permanent and will spread to other [ places ] as well.
” Dr. Hirdes foresees a growing @ @ @ @ @ @ @ concept of the Canada Health Act to nursing homes and home care , although how that would be achieved is unclear .
As a start , Dr. Williams says that Canadians would welcome national standards , but he ’ d like the process to lead to an overhaul of the industry – finding more ways that seniors can stay in their communities , and not just increasing funding for institutional settings .
“ I hope they take this as an opportunity to rethink , as many other countries have , the entire idea @ @ @ @ @ @ @ of long-term care beds , ” he says .
For now , many like Ms. Brideau are left wondering if they ’ d still have their loved ones if the system had implemented changes earlier .
On April 12 , just a week after her mother tested positive , Ms. Brideau says she got a phone call from the CHSLD telling her that her mother ’ s condition had deteriorated and that she should come in .
Ms. Duguay died that afternoon .
“ When I hear anything about COVID-19 now , my @ @ @ @ @ @ @ throat tightens , ” Ms. Brideau says .
“ They didn ’ t get to die with dignity .
...
I ’ m really disappointed in society , disappointed in everything that is happening.
” Editor ’ s note : As a public service , all our coronavirus coverage is free .
No paywall .

The Vancouver Coastal Health system in British Columbia may show one way forward. At present the system has managed 14 outbreaks by implementing measures including constant testing and containment and proper use of protective equipment. More permanent changes, such as improvements for staff, would both limit the spread of disease and provide better continuity of care for residents, says Michael Schwandt, a medical health officer in the system.
COVID-19 has tested the effectiveness of safety nets. The alarming concerns about nursing homes that have surfaced in Canada, a country known for its health coverage, are spurring a national reexamination.
But the coronavirus crisis has exposed a glaring shortcoming in Canada: More than 80% of its COVID-19 fatalities are linked to nursing homes. “This has focused everybody’s attention that we really need to put in an effort to change the nature of how we provide nursing home services in the country,” says John Hirdes, a professor at the University of Waterloo. He foresees a growing discussion about extending the concept of the Canada Health Act to nursing homes and home care.
For years, Canada has been lauded for its universal health protections, and per capita during the pandemic, the country has fared much better than its neighbor, the United States, in containing the spread of the disease.
France Brideau checks her phone each morning when she wakes up to see if her mother has called. But it’s just a reflex, a realization that hits heavily each day: Her mother, Thérèse Duguay, died in mid-April from COVID-19.
“It’s strong, that bond,” Ms. Brideau says in a telephone interview from her home in Laval, a city in the Canadian province of Quebec. “She was there for me for 56 years.”
Ms. Duguay contracted the novel coronavirus in a long-term facility, where she moved in February 2019 after her care at home got too complicated. A year later, that move unwittingly placed her in the heart of a pandemic. In Quebec, which has seen the highest coronavirus infection and mortality rates in Canada, 63% of COVID-19 fatalities have occurred in long-term care facilities, known as CHSLDs.
Why We Wrote This COVID-19 has tested the effectiveness of safety nets. The alarming concerns about nursing homes that have surfaced in Canada, a country known for its health coverage, are spurring a national reexamination.
Per capita, Canada has fared much better than the United States in containing the spread of the disease. But although both countries have suffered outbreaks in nursing homes, that problem has been much more severe in Canada: More than 80% of COVID-19 fatalities in the country are linked to them, according to Theresa Tam, Canada’s chief public health officer.
Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.
Canada is not alone in confronting a high mortality rate among older people, especially those in institutional care. But in a country lauded for its universal health protections, the death rate and shocking conditions in some homes have generated an urgent conversation about whether its safety net is supporting those most vulnerable.
In Quebec and Ontario, the military has been deployed to assist nursing facilities that have been hardest hit. This week the Canadian Armed Forces shook the nation with a damning report on the unsafe state of five long-term care facilities in Greater Toronto. Ontario Premier Doug Ford promised justice, calling the findings “heartbreaking” and “gut-wrenching.”
Advocates and victims’ families are calling for public inquiries as to what went wrong and for new national standards for long-term care to be established. They want emergency measures that were implemented to contain the outbreaks – such as better wages for personal support workers so they don’t have to patch together part-time work to make ends meet – to become permanent. Some want the entire industry to be rethought.
Courtesy of France Brideau View caption Hide caption France Brideau (right) lost her mother, Thérèse Duguay, in mid-April from COVID-19. She had been residing in a nursing home. Approximately 80% of COVID-19 fatalities in Canada have been linked to long-term care facilities, causing the country to look hard at its failings when it comes to older people.
“We’ve been able to kind of eke along with minimal staffing levels in nursing homes, but COVID has blown it apart. It’s shown it just wasn’t sustainable,” says John Hirdes, a professor at the School of Public Health and Health Systems at the University of Waterloo in Ontario. “This has focused everybody’s attention that we really need to put in an effort to change the nature of how we provide nursing home services in the country.”
The Canadian setup for health care
The principles behind Canada’s publicly funded health system, which requires that all medically necessary hospital and doctor services be covered, does not extend to nursing or home care. While all the provinces and territories provide some coverage for such care, run by a mix of public and for-profit entities, it varies extensively, says Paul Williams, a University of Toronto professor and co-chair of the Canadian Research Network for Care in the Community. “I think it was massively shocking to people to find out what was going on in places which are understaffed and underfunded,” he says.
It’s not shocking to advocates, though. Paul Brunet, who heads a patients’ rights group that launched a class-action lawsuit in 2018 on behalf of Quebec’s CHSLD patients, says understaffing and a lack of funding have meant for years that patients have not received the care they are entitled to under the law. In Canada, “everyone has access to all the care he or she might need, but when there’s budget cuts ... unfortunately the poorest and the oldest normally [take the hit],” he says. “To me, it is discrimination. It is prejudice.”
And many believe it set the country up for failure when the pandemic swept through. In one of the most notorious cases, residents in a privately owned CHSLD in Montreal were left abandoned without water and in full diapers for days, the Montreal Gazette reported. At least 51 residents died as a result of the outbreak, which is now the subject of three inquiries.
Quebec Premier François Legault has acknowledged the problem, saying that “society failed” to protect those most vulnerable and that successive governments did not invest enough in the CHSLDs. “I think that many people are responsible. I don’t exclude myself,” Mr. Legault told reporters.
In Ontario, Mr. Ford, under fire for turning a blind eye to the problem before the pandemic, said he’d launch an independent commission to probe the failings, in which around 1,500 nursing home residents have died from COVID-19 (among more than 2,100 in total). An investigation by the Toronto Star showed that seniors in for-profit care are four times as likely to die as those in public facilities.
According to Sharleen Stewart, president of the Service Employees International Union Healthcare that represents 60,000 front-line health workers in Ontario, low staffing levels – while populations have grown older and more clinically complex over the past two decades – have left the system dangerously exposed. One key reason for COVID-19’s rapid spread: Personal support workers in nursing facilities, paid far less than their counterparts in hospitals, have to work in multiple facilities, she says.
“Early on in March, when the government was calling us together to talk about a pandemic plan, I asked the question: What are we going to do about the fact that 1 in 3 personal support workers work more than one job?” She says she was ignored. “Somebody needs to be accountable for this.”
One way forward?
No outbreak is “inevitable,” argues Michael Schwandt, a medical health officer in the Vancouver Coastal Health system in British Columbia. At present the system has managed 14 outbreaks by implementing measures including constant testing and containment and proper use of protective equipment. The system has declared eight of those outbreaks over. He says more permanent changes, such as staff earning a living wage at a single center and being able to take off work when sick, would both limit the spread of disease and provide better continuity of care for residents.
“I have a lot of hope,” he says. “I think that we’ve seen some improvements put in place in short order in [British Columbia] to limit the impacts of the pandemic, and with some of those successes, I hope that some of those measures will be made permanent and will spread to other [places] as well.”
Dr. Hirdes foresees a growing discussion in the country about extending the concept of the Canada Health Act to nursing homes and home care, although how that would be achieved is unclear. As a start, Dr. Williams says that Canadians would welcome national standards, but he’d like the process to lead to an overhaul of the industry – finding more ways that seniors can stay in their communities, and not just increasing funding for institutional settings.
“I hope they take this as an opportunity to rethink, as many other countries have, the entire idea of care over the longer term instead of long-term care beds,” he says.
For now, many like Ms. Brideau are left wondering if they’d still have their loved ones if the system had implemented changes earlier. On April 12, just a week after her mother tested positive, Ms. Brideau says she got a phone call from the CHSLD telling her that her mother’s condition had deteriorated and that she should come in.
Get stories that
empower and uplift daily. By signing up, you agree to our Privacy Policy Already a subscriber? Log in to hide ads.
Ms. Duguay died that afternoon. “When I hear anything about COVID-19 now, my eyes fill up with tears and my throat tightens,” Ms. Brideau says. “They didn’t get to die with dignity. ... I’m really disappointed in society, disappointed in everything that is happening.”
Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.