Care homes stricken and running out of body bags. Shelters as crowded hotbeds of infection. An entire jail emptied for deep cleaning, dozens of inmates — infected and not — moved and isolated.

Staff are holding the line: some running scared, some ordered home to self-isolate, some getting sick.

While the COVID-19 outbreak appears to be reaching a plateau in the outside community, within these other walls a second outbreak is running rampant.

Amid allegations of slow and inadequate responses to protect our most vulnerable populations, this week, provincial officials said efforts to contain outbreaks on that second track — in congregate settings like long-term care homes — must be “redoubled” as the rest of the population practises social distancing.

On Tuesday, Toronto Public Health reported that the majority of Toronto’s 190 deaths — 69 per cent — have been in these settings.

These populations were already at greatest risk from the virus, many with underlying health conditions.

“Many have said that COVID-19 is the great equalizer, that it doesn’t discriminate, but that’s sadly not the fact,” said Coun. Joe Cressy, who chairs Toronto’s board of health. “It is preying on the most vulnerable and, in particular, those who are experiencing poverty.”

He said unless we protect those in congregate settings, “we will continue to see mass outbreaks and we will continue to see unnecessary fatalities.”

With this in mind, we check in on where things are at — and the best ways to protect the elderly, the homeless and the incarcerated.

Shelter system

As of Tuesday, there were at least 149 cases in the shelter system and outbreaks at 11 different sites, according to Toronto Public Health.

Toronto bears the responsibility for much of the GTA’s homeless population, with roughly 8,000 people experiencing homelessness at any given time and a shelter system already bursting at the seams.

Homeless advocates and front-line workers have called for protective measures to be put in place more quickly, starting with creating more space.

An open letter from 313 physicians and nurse practitioners asked for local health agencies to order that there be at least two metres between clients, and for the city to open more than 7,000 hotel rooms and other spaces to help with appropriate distancing.

As of April 19, the city was counting over 1,100 people in COVID-19 shelter programs — at community centres, hotels and elsewhere — and a total 7,153 using the shelter system.

The letter also called for testing for all shelter, respite and drop-ins sites, something the city is now pushing the province to do.

Front-line workers and city officials have also raised the problem of not having proper personal protective equipment (PPE). On Tuesday, the city announced it had received three million surgical masks primarily for long-term-care and shelter workers.

Noa Mendelsohn Aviv, with the Canadian Civil Liberties Association (CCLA) and part of a coalition calling for more changes, said “the worst has started” and could have been prevented with proper distancing.

“All we can do now is demand that the city not let it get worse,” she said.

Without further measures, the CCLA is threatening legal action. In a letter, they say the shelter system is being operated in a way that violates Charter rights and freedoms as well as breaching the Ontario Human Rights Code.

Mary-Anne Bédard, head of the city’s shelters, support and housing administration, said they shared the urgency in the letter and have worked to create nearly 1,300 spaces and will continue towards a goal of 2,000 by the end of this month.

“Everything that can be done is being done and we take this responsibility very seriously.”

Jails and prisons

There are outbreaks in six federal prisons and, in a number difficult to compile, provincial jails across the country.

Where it hits, it hits hard.

On Monday, for example, Ontario’s Ministry of Solicitor General revealed it has shut down a Brampton jail for cleaning and moved 60 infected inmates and 49 others to a Toronto jail, where they are in isolation. Eight correctional officers from the Brampton jail also tested positive.

In his daily roundup of federal inmate and staff cases, University of Ottawa criminologist Justin Piché on Monday said there were 352 cases.

There has been one confirmed death of a federal prisoner, a man in his 70s in B.C.

What’s being called for ranges from temperature measuring for intakes and staff, increasing access to PPE, no staff working between institutions, early releases, and police and Crown discretion to reduce the number of people being incarcerated.

Ontario’s jail population, for example, is down by more than 2,000 inmates since the pandemic hit.

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In provincial jails, there is a mix of inmates awaiting trial and those serving sentences shorter than two years. This situation appears more challenging than federal prisons, where many are serving long sentences, and there appears to be more consistency in containment.

While provincial jail populations are shrinking, federally the picture is unclear.

Public Safety Minister Bill Blair has asked the Parole Board of Canada and Correctional Services Canada to reduce prison populations by releasing eligible and low-risk, non-violent offenders, but no plan and no data have been made public.

Advocates and Indigenous leaders have pushed to make use of existing provisions to decarcerate. This includes a call by a Dalhousie University law professor for the Governor General to invoke a discretionary “mercy” power that allows for clemency in exceptional circumstances.

Last week, Blair referred to around 600 federal inmates being released last month, which is average, according to Blair’s press secretary.

There are about 14,000 inmates in federal prisons, and many would not be eligible for release due to the nature of their offences.

The Star asked for federal data on parole and releases but had not heard back in time for this story.

Seniors homes

It’s unclear how many hospitals will follow Premier Doug Ford’s promise to send “SWAT teams” of doctors and nurses to help long-term-care homes combat COVID-19.

What is indisputable, say families, staff, unions and operators, is the need.

Many homes, desperately, need more of everything: hospital staff willing to replace front-line workers, PPE, testing of all residents and staff and, for a stealth virus like COVID, the expertise of infectious disease doctors.

Dr. Susy Hota is the medical director of infection prevention and control at the University Health Network, one of roughly 100 UHN staff volunteering with the Rekai Centres’ two downtown Toronto nursing homes.

Hota is teaching the homes to focus on details. Take the temperature of all staff twice a day. Look for symptoms of respiratory illness. Clearly identify the rooms of residents who are isolated with COVID. And, one of the most important changes, learn the proper “donning and doffing” of PPE to prevent infection.

Hospital expertise is just one part of a much bigger solution.

Ontario’s government-funded long-term-care homes and privately owned retirement homes are two distinctly different systems. But both are struggling with COVID outbreaks, in part because of low-paid, part-time staff who work in multiple jobs to make a living wage.

Both sectors must follow a temporary government order that requires staff to choose one work location, to stop the virus’ spread.

Cathy Hecimovich, CEO of the Ontario Retirement Communities Association, said the association and its retirement home members will work with the Local Health Integration Networks (LHINs) to “absolutely limit the number of workers coming in and out of retirement settings.”

Dr. Samir Sinha, director of geriatrics at the Sinai Health System, said the Ontario government must place permanent restrictions on work in multiple homes and help long-term-care and retirement homes provide full-time work for employees.

Until the pandemic is under control, every action must be connected to infection control, said Laura Tamblyn Watts, CEO of CanAge, a national seniors’ advocacy group.

Focus on testing, with quick results. Do better contact tracing. Organize easier and faster access to PPE. Cleaning, cleaning, cleaning. And, find ways to occupy residents with dementia, who are inclined to wander through other residents’ rooms.

UHN’s Hota said long-term care has challenges, because it is a home.

Homes need to meld the infection control standards of a hospital, she said, with a setting that is comforting, a place where people live.

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