‘A lot of unnecessary deaths’: Geriatrician Samir Sinha on Ontario’s vaccine plan

TVO.org speaks with the University Health Network’s director of geriatrics about the province’s approach to prioritization — and why it could put more older Ontarians at risk
By Ashley Okwuosa - Published on Mar 04, 2021
The first Pfizer-BioNTech COVID-19 vaccine in Ontario is administered to personal support worker Anita Quidangen at a hospital in Toronto on December 14, 2020. (Frank Gunn/CP)

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Last week, Ontario provided more information about its vaccination rollout. Those 80 years and older are set to start receiving vaccinations during the third week of March. Adults 75 and older will be up starting April 15, and adults 70 and older starting May 1. U of T’s Isaac Bogoch, a member of the province’s vaccination task-force, referred to the timeline as a “worst-case scenario” and noted that those target dates could change if additional vaccines are approved.

Some experts, such as geriatrician Samir Sinha, are questioning the province’s approach to vaccine prioritization and arguing that it puts older Ontarians at risk.

TVO.org speaks with Sinha, the director of geriatrics at Sinai Health System and the University Health Network, about the best-and worst-case scenarios for seniors — and the future of long-term care in the province.

TVO.org: Last Wednesday, the province announced a “worst-case scenario” vaccination timeline for the general public over the next few months. What are your thoughts on this rollout?

Samir Sinha: When 96 per cent of the deaths that have occurred in Ontario to date have been amongst older people, it tells us that age should be the one simple criterion we use to effectively vaccinate the population.

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The challenge is when you look at Ontario’s rollout versus the federal government’s advice through its National Advisory Committee on Immunization. NACI has come out with guidance talking about who should be in phase one and who should be in phase two; what they recommended is that we prioritize vaccinating people living in congregate settings. Seniors living in congregate settings, like long-term-care and retirement homes, seniors 70 and older, and high-risk front-line health-care providers are all within that first group.

Then you want to move on to the second phase, which would include essential workers — for example, teachers, construction workers, people working in grocery stores. Essentially, Ontario has presented its own vaccination strategy that mixes groups one and two, and therefore starts deprioritizing the greatest risk group, which is those who are older adults.

Every province and territory in Canada is getting vaccinations on a per capita basis. So Ontario is essentially getting 40 per cent of the vaccine supply because it actually represents 40 per cent of the population. Ontario hasn’t been getting less than other provinces, yet Ontario is the major jurisdiction that’s really fallen behind the majority of the other provinces and territories in getting key populations vaccinated. By December 21, Ontario had enough vaccines available to actually vaccinate its entire long-term-care and retirement-home population. Yet Ontario took until February 14 to get its long-term-care residents vaccinated. Most other provinces had vaccinated their long-term-care populations by the middle of January. Most other provinces have now started vaccinating their older population.

But as you have probably seen, they’re not going to start vaccinating people older than 80 across Ontario on a mass basis until their portal is ready on March 15. The question is, we’re still getting vaccines coming in every week, so who else are we vaccinating? It’s actually not helping us to reduce the overall number of cases and deaths in Ontario from COVID-19. I’ll give you an example: just this past Saturday, 20 Ontarians died. You know how many of them were older than 60 years of age? Nineteen. Again, our data shows that 96 per cent of our deaths to date have occurred in Ontarians 60 and older, so why wouldn’t we actually prioritize vaccinating them? And here’s the kicker. By the end of April, we’ll actually have received enough doses of vaccine to have given every older person and every high-risk front-line provider a vaccine. Yet we’re talking about not getting to 60-year-olds until July.

TVO.org: Initially, members of the task force defended the idea of vaccinating essential workers before some seniors — vaccination task-force chair Rick Hillier previously said that vaccinating essential workers would provide extra protection for vulnerable seniors. You’re advocating for the opposite?

Sinha: It’s very disturbing when the science is clear showing that age is the number one defining risk factor. I don’t know what our ethical framework is trying to achieve here, because if you told me our number one goal is that we value all Ontarians — and we want to create the lowest number of deaths amongst Ontarians — then we would actually follow what the science says.  And the science says that you should start by using age as the number one risk factor and go down and vaccinate from highest to lowest ages.

The problem is when you start to mix in other groups that we perceive could be at risk of getting COVID-10. You know, the risk of getting COVID-19 is a different risk than actually getting seriously ill and dying from COVID-19. And I think that’s maybe what everybody’s mixing up. Right now, Ontario’s strategy is just going to see a lot of unnecessary deaths, particularly among older adults.

TVO.org: Task-force member Isaac Bogoch referred to the rollout announced last Wednesday as a worst-case scenario. What if it were to become a reality?

Sinha: We’re going to have a lot of seniors getting sick, ending up in hospital, and dying. As simple as that. When we have a best-case scenario in front of us that we could create ourselves, with the same amount of vaccine — i.e, we could give every senior a dose of the vaccine by the end of April — why wouldn’t we actually do that? Right now, what they’re trying to do is compare a worst-case scenario to a scenario that would get better if we had more vaccines. What I’m trying to say is your worst-case scenario really should be every senior and high-risk front-line health-care worker gets a vaccine by the end of April, and the best scenario would be, well, we can do them by the end of March if we get we get more vaccine in our hands earlier.

TVO.org: Many people have said that communication by the province during the pandemic has been confusing and led to mistrust. What do you think about how COVID-19 information has been communicated to or about seniors?

Sinha: I think it’s been terrible. It’s really disappointing because, again, you can imagine a population that quickly realized that they were the ones at highest risk of getting sick and dying from COVID-19 — a terrifying year for those living in long-term-care homes, in our retirement homes, and seniors in general living in the community. And when you actually have a vaccine that’s available, and all of a sudden they watch people getting vaccinated who clearly are at lower risk of getting sick or dying? It just adds insult to injury, because now they’re asking, “When exactly are we going to get our vaccines?”

Then they hear that, by the way, you’re not even going to get your chance, on average, for a vaccine until you book one or find out if you can get one on March 15, because we’re testing this portal. What concerns me is they bought software that was widely criticized in California for not being easily available and usable. They already said that the portal will be available in English or French, but they haven’t made it clear if the phone line that’s going to be launched that day will have the capacity to take the number of calls that are expected. They haven’t indicated whether that phone line will be available, like the provincial service 211, in 150 different languages of choice. No one’s made it clear whether that hotline will be available to help people who don’t have access to a computer. It’s how those seniors, especially those who are homebound, quickly get deprioritized, especially when they’re competing against a lot of younger and more able people in that first group. So, my concern is, we’re probably not even going to get to a bunch of 80-year-olds until maybe April.

TVO.org: Public-health regions in Ontario have been tasked with developing their own plans to distribute the vaccine, and we’re seeing that some seniors in parts of the province, such as Ottawa, will start receiving vaccines.

Sinha: I’m grateful that a number of public-health units have started offering vaccines to older people well ahead of when the Ontario government portal will be ready. And I think they’re recognizing that age and postal codes, for example, should be one of the greatest defining factors of how we actually vaccinate the most vulnerable amongst us. You have a number of public-health units that are not waiting till the March 15 deadline, because they want to get these shots into the right arms. Even Ottawa is going, “We’re going to focus on older people specifically in high-risk neighborhoods first,” which I think is excellent. It’s exactly what the Ontario Science Table has come out and said is the approach we should have.

TVO.org: With the independent commission on long-term-care, it’s come out that public-health experts have known for a while how bad things could get in long-term-care homes. And I’m wondering how you feel, in hindsight, looking at where we are now?

Sinha: I feel horrible about it, because we knew early on there were things that we should do. You know, it was sad when I realized that my interpretations of the evidence from the early days were correct. The advice that we were giving to our National Institute of Aging was exactly what [British Columbia] did early on and why they had such a good pandemic response. Even after the first wave — when you could forgive some people for saying, “Well, they didn’t know better” or “They were too slow to act” — at least we knew way more about what we could do to prevent the second wave from happening.

What was disappointing was to see that provinces like Ontario simply didn’t take the steps that that other provinces did to really avert a deadly second wave, and that would have been by improving its overall staffing levels and by strengthening Infection Prevention and Control to the level that was being requested. Quebec actually implemented this by putting a dedicated IPAC team into every single home, and Ontario didn’t do that. So, now, how do we actually help save lives in our long-term-care settings and our retirement settings? It would be by getting this population vaccinated as soon as possible, and Ontario seems to be continually dragging its heels behind pretty much the rest of Canada.

TVO.org: What do you think is the future for long-term-care homes post COVID-19?

Sinha: We produced a report this past fall called “Pandemic Perspective,” and we had virtually every older Ontarian and every older Canadian say that they would want to live in their homes for as long as possible, and about 60 per cent of Canadians basically changed their mind on whether they would want either them or a loved one to move into a long-term-care home. There’s a significant drop-off. We’re actually releasing a report [today] looking at people’s views on long-term care, and, again, what we’re going to show overall is that the majority of Canadians basically have lost faith in our long-term-care system. They knew that there were problems beforehand; they now know that there are serious problems. And the majority of Canadians do not want to end up in long-term care. They would rather receive care in their own home, if at all possible, and I think there’s going to be much greater support for the provision of home and community care.

TVO.org: And what would it take for older Canadians to kind of regain that trust?

Sinha: I think everyone has come to realize how grossly underfunded these settings are. In Canada, overall, we spend 30 per cent less on providing long-term care than other OECD countries. If you look at a country like Denmark, they spend about 2.4 per cent of their GDP on the provision of long-term care; in Canada, we spend about 1.3 per cent. And that’s about 30 per cent less than the average OECD country. Number two, we spend the majority of our dollars on warehousing older people in long-term-care homes rather than caring for them in their own home. What we know is that Denmark also spends two-thirds of its dollars providing people care in their own home, as opposed to funding care for people in long-term care.

This interview has been condensed and edited for length and clarity.​​​​​​​

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