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Such conversations could have benefits for more than just the patients, say the guidelines.

“Early establishment of goals of care may also reduce unnecessary utilization of limited critical care,” they say.

Statistics on the proportion of Canada’s 130 or so COVID-19 deaths that have occurred outside of hospital or the ICU are hard to come by. But in Ontario, 18 of the 53 deaths have been in long-term care homes, said a Health Ministry spokeswoman late Thursday.

That appears to include one of of the largest outbreaks in the country.

When the first cases of the coronarvirus emerged at Pinecrest Nursing Home in Bobcaygeon, Ont., last month, its medical director, Dr. Michelle Snarr, emailed families to warn they may have to decide whether to send their loved ones to hospital. That would involve going on a ventilator, she said, and a frail nursing-home resident would likely “suffer a great deal” and might not survive the ordeal.

Photo by Carlos Osorio/Reuters/File

Snarr could not be reached for comment, but it appears none went the ICU route.

“Under normal times, we would send people to the hospital if that was the family’s wishes, but we knew that was not going to be possible knowing that so many people were going to all get sick at once and also knowing the only way to save a life from COVID is with a ventilator and to put a frail, elderly person on a ventilator, that’s cruel,” she told CTV News.

In Quebec, Micheline Sauriol’s mother died from COVID-19 at a seniors’ home in LaSalle after briefly being taken to Montreal’s Jewish General Hospital and then returned, according to CBC.