‘Litany of Failures’ Made Long-Term Care COVID-19 Deaths Worse, Says New Report

March 23, 2021

TORONTO, March 23, 2021 – A new report commissioned by the Ontario Nurses’ Association (ONA) and submitted to the Long-Term Care-COVID-19 Commission has found that a litany of failures to learn the lessons of SARS worsened the death toll in long-term care facilities.

ONA commissioned the report from senior advisor to the SARS Commission, Mario Possamai. In the report, Fatal Choices: COVID-19, Nursing and the Tragedy of Long-Term Care, Possamai examines what went wrong and what could have gone right in long-term care through the lens of the experiences and clinical judgment of registered nurses (RNs). Possamai relied on interviews with more than 200 RNs and used the RN declarations submitted in legal proceedings. He also examined ONA’s long-term care-sector member survey.

“Mario Possamai’s work clearly demonstrates that a series of choices made by our government – namely, the failure to err on the side of caution and protect health-care workers and their residents, as well as failing to improve long-term care before the pandemic – left Ontario with an environment ready-made for COVID-19 to run rampant,” says ONA President Vicki McKenna, RN.

In the report, Possamai writes that, “The heartbreaking breadth of COVID-19 in long-term care was not inevitable. Most now-widely accepted fixes reflect either Justice Archie Campbell’s SARS Report recommendations, the clinical judgement of nurses, or the long-term care sector-specific solutions from the past two decades. At the very least, the worse could have been avoided.”

The report examines the shortages of personal protective equipment, the failure to maintain and manage the stockpile after SARS, and the fatal decision made to downgrade precautions, despite ONA’s warning that COVID-19 is spread through aerosols as well as droplets. In a case brought by ONA, Justice Edward Morgan found that the March 2020 downgrading of personal protective equipment was not entirely based on science; the decision, in fact, was shown to be based on shortages of N95 respirators for health-care workers for which the province itself was responsible.

The report also finds that Ontario infectious disease and public health leaders continue to resist better protection of health-care workers and long-term care residents, despite mounting and persuasive evidence to the contrary and revisions in other jurisdictions. Data shows that Ontario health-care workers face a higher risk of being infected with COVID-19 than the general population, and those working in long-term care face an even higher risk – twice as likely as other health-care workers as a whole. Other countries that experienced SARS – China, Hong Kong and Taiwan – had far fewer cases of COVID-19 in long-term care facilities than Ontario, the difference being they learned from SARS and took the precautionary approach, protecting workers and residents against aerosol transmission with N95s and other precautions such as proper ventilation.

The report, along with ONA’s reports to the Commission, can be found here: https://www.ona.org/commission/. ONA remains hopeful that the Commission’s recommendations to government will be implemented, and that long-term care residents and those who care for them will at last be safer. “We owe it to future generations to do nothing less,” McKenna and Possamai agree.

ONA is the union representing more than 68,000 registered nurses and health-care professionals, as well as 18,000 nursing student affiliates, providing care in hospitals, long-term care facilities, public health, the community, clinics and industry.


For more information: 

Sheree Bond (416) 986-8240 (cell) shereeb@ona.org