The LTC report, an expired PPE stockpile, and a province utterly unprepared

OPINION: The final report from the Long-Term Care COVID-19 Commission is an indictment of Ontario’s whole emergency-preparedness effort
By Matt Gurney - Published on May 03, 2021
Merrilee Fullerton, minister of long-term care, answers questions in Toronto on April 28, 2021. (Frank Gunn/CP)

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It was just on Thursday that I wrote here at TVO.org about the auditor general's report into the COVID-19 disaster in the province’s long-term-care homes. The AG’s report was limited in time to a specific window — it covered events up to December 31, 2020. The second wave of the pandemic began in November 2020 and continued until roughly February; the third wave followed so quickly, it's hard to draw a bright line between the two.

When I cracked open the Long-Term Care COVID-19 Commission's final report, published Friday (by which I mean I downloaded the PDF), I was planning to mostly skip the early chapters on the deep background of the pandemic in Ontario and its early phases. I'd jump right to the new stuff, I figured.

But I found myself strangely pulled into it. It’s a captivating read. It's a horrific read. A terrible tragedy unfolded, and this report breaks it down. I just couldn't look away. And, to my surprise, the report wasn’t a narrow examination of the LTC system and the tragedy there. It was bigger and worse: it is an indictment of a province that was flattened by a crisis that was not just foreseeable, but foreseen — and not prepared for, despite ample warning.

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To be clear, it is of course about the LTC system; those early chapters do indeed recap most of what the AG covered. The short, concise version goes something like this: Ontario's LTC system was known to be a fragile, rickety mess for many years, but successive governments did nothing meaningful to fix it. Staffing shortages were a chronic issue. Not only are more people in the system, but they're also sicker, with more complicated medical and cognitive issues, than before — more people are requiring more care each. These were all true facts before COVID-19 hit North America in early 2020. And they meant that the system was a disaster waiting to happen.

And then the disaster did happen. Ontario wasn't ready for it, and it overwhelmed the system.

I knew all that even before the AG's report, although it certainly served as an effective reminder. But the commission's report, even when covering this well-trodden ground, is just impossible to stop reading — because it reveals, in brutal terms, our manifest unpreparedness.

Canadians are blessed to live in a rich, peaceful country, even if, yes, those blessings are unevenly distributed. It's just an objective fact, however, that life here is not just good; in aggregate terms, it has never been better. Our key metrics for quality of life are sky-high, relative to virtually any other place in the world and certainly to any prior moment in history. Okay, sure, we can accept that the past 14 months have been lousy. But, in historical terms, other than perhaps late 2019, when else would you rather be living? Where else would you rather be?

The commission's report reveals how fragile it all was. I'm not sure this isn't a chicken-and-egg problem. There is something very human about coming to take entirely for granted what is, in fact, historically rare — and Canadians have been at peace and safe from most harms for longer than most people have ever known. It's hard to argue for the importance of robust emergency planning in a country where nothing ever goes wrong.

But, of course, things do go wrong, and indeed had gone wrong. The average citizen might not wander around thinking about influenza and SARS, but what the hell is the point of having a government if it forgets its most basic, core responsibility — protecting the common public good for the benefit of all. This did not happen here. The report is just devastating, in the calm, measured language typical of such things, in its rational, unembellished description of how unprepared Ontario was for this disaster.

And there's no excuse for that. The report notes, over and over, that we were ground zero for the North American SARS outbreak in 2003. We had a living memory of these kinds of threats, and some institutional memory, too. We had flu-pandemic scares and the Ebola scare, which should have sufficed to remind us, especially the SARS-tested Ontarians, that these threats always loom and rarely give much early warning. We had the least excuse of any jurisdiction in the Western world to get caught unprepared.

But, gosh, we were so unprepared.

One small part of the report jumped out at me with almost physical force. It's on page 112, for those interested in checking it out themselves. Part of a broader section on our total, chronic unseriousness in planning for disaster, it discusses the state of Ontario's provincial stockpile of personal protective equipment — items such as high-quality masks, surgical gloves, and gowns. Ontario had set aside tens of millions of dollars in the years immediately after SARS to establish a stockpile of such gear, which was good. Officials correctly realized that, in a global crisis, there would be a run on such material and that having a stockpile on hand was a good idea. (This did indeed happen, as you’ll recall from the first panicked months.)

But not all the money set aside for the stockpile’s creation was spent. Not all the targeted supplies were purchased. And the supplies weren't rotated on a regular basis, which is just an unconscionable failure of incredibly basic inventory management. All of us intuitively know to use the item in our pantry with the approaching best-before date before we use the brand-new one we just bought. What works for the jars of pasta sauce we have at home, though, was apparently too complex for the Ontario government, which didn't rotate and replace stockpiled supplies on a regular basis. This led to an absurd situation in which the stockpile had largely expired, and put the province in a situation that was actually worse than unprepared. Instead of having a stockpile of usable items, it was spending time, energy, and money figuring out how to destroy the expired items it had.

That's when the report drops the incredible, jaw-dropping line: "By the end of 2019, 90 per cent of the stockpile was expired and the government was undertaking organized efforts to destroy the expired equipment. However, there does not appear to have been any corresponding action taken by the government to replenish the supplies."

Imagine that. This is beyond a situation where the government's left hand didn't know what the right hand was doing. This is the government's left hand actively trying to destroy the right hand. Instead of putting in a basic inventory-management system that rotated and replaced equipment on a regular basis, we created a stockpile, ignored it for years, and then destroyed it. It didn't seem to occur to anyone to replace what was being destroyed. And, best (worst) of all, in the case of the expired N-95 respirator masks, which Ontario was desperately scrambling for at the outset, the masks themselves didn't expire. The elastic bands attached to them did. The masks could have been adapted and used. But, nah. Easier to just destroy them and not bother replacing them.

The report goes on and on in this vein. The province was not prepared for a foreseeable emergency, reacted slowly when COVID-19 appeared, and failed to meaningfully prepare for a second wave despite the tragedy of the first. But what jumps out at me isn't even that finding about the LTC system itself, but the absolutely searing, devastating indictment of the provincial emergency-preparedness effort as a whole. No one could look around at the past 14 months and deny that Ontario has struggled. This report, though, reads like a first draft of a much bigger study into just how unprepared Ontario was, overall, for this kind of emergency or, really, for any kind of emergency. Would we have done better after a natural disaster? A cyberattack? An attack by a hostile enemy nation? These risks are all remote, sure. But so was a coronavirus mutation. And yet here we are.

The long-term-care system was where the crisis became most acute. But it is not where the failures began or ended. It was much broader and worse than that. And much scarier for it.

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