Page - 465 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

465A View from the Front Lines of a COVID-19 Outbreak and four staff were COVID-19 positive. On Saturday, April 11, all resi- dents were swabbed. Definitive results showed 40 out of 42 residents had been infected. Tragically, six of them died. Fifty-seven workers were also infected. I am a family doctor. Cancellations caused by the pandemic left me with some availability, so I didn’t hesitate to assist at PHM, thank- ful for an opportunity to be useful. This chapter is my account of the COVID-19 outbreak in that location, but it reveals public policy chal- lenges with broad implications.1 For it is on the front lines of care that health policy finds both inspiration and a testing ground. A major problem for facilities like PHM was severe personnel shortages. Even before COVID-19, PHM was short of staff. Most resi- dents need assistance for feeding, bathing, and toileting. Most need to be moved by mechanical lift from bed to wheelchair and back. As described in the opening chapter of this section, providing appropri- ate care at PHM requires a high degree of human touch, making pub- lic health measures such as physical distancing almost impossible. The personal care needs of residents put them and their caregivers at heightened risk of transmitting infections. The complex medical con- ditions of residents also put them at increased risk of severe illness with COVID-19.2 With news of the outbreak, many staff were unable to continue working. Some needed to self-isolate because they’d had contact with positive cases before full personal protective equipment (PPE) was introduced. Others had symptoms of COVID-19. They needed to be tested and sent home. Those who worked in multiple institutions had to select one location only, and several decided to leave PHM. My first step that Sunday was to connect with Shelley, the Executive Director of PHM. I arranged to go see how I could help. The crisis was evident immediately. The site had 98 people listed on staff. Full function required about 35 staff members in any 24-hour period. That morning they were down to about 10 regular staff, management included. There was a serious need for help to ensure 1. Elizabeth Lin et al, Addressing  Gaps  in  the  Health  Care  Services  Used  by  Adults  with  Developmental Disabilities in Ontario (Toronto: ICES, 2019). 2. Dalton Stevens & Scott D Landes, “Potential Impacts of COVID-19 on Individu- als with Intellectual and Developmental Disability: A Call for Accurate Cause of Death Reporting” (2020), online (pdf): Syracuse  University  Lerner  Center  for  Pub- lic Health Promotion <https://lernercenter.syr.edu/wp-content/uploads/2020/04/ Stevens_Landes.pdf>.