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Expert panel warns of crisis in long-term care home staffing

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The chair of a panel looking at Nova Scotia’s long-term care system says staffing levels at some homes have reached a crisis point and need to be increased to deal with increasingly complex needs for residents.

Janice Keefe made the comments after the release of a report by the three-person expert panel on Tuesday. It includes five recommendations and 22 action items to be completed within the next two years.

The report noted high rates of chronic disease and dementia among residents, as well as staff recruitment and retention problems, are contributing to pressures on the system.

“There needs to be a much greater investment in long-term care in our province,” Keefe told reporters.

Panel members Cheryl Smith and Janice Keefe speak to reporters. (CBC)

Nursing staff regularly work without a full complement of people, which sets the stage for a variety of problems, according to the report. It called for a short-term focus on attracting new people to the profession and making those already in the system feel valued. There is an immediate call to hire long-term care assistants and a full-time licensed practical nurse for each site.

The report said efforts to increase staff should include using more nurse practitioners and other providers such as occupational therapists and physiotherapists to improve care.

“So when you look at adding allied health to the system, it’s actually helping focus on the care that the resident would get on a regular basis,” said Cheryl Smith, a nurse practitioner and member of the panel.

Improved bedsore care

The panel was appointed in the months following the death of Chrissy Dunnington, who died in March after developing a severe infection related to a huge bone-deep bedsore on her backside.

The panel endorsed and recommended “full implementation of the Nova Scotia Long-Term Care Pressure Injury Prevention Strategy,” which was introduced last year.

Keefe said recommendations such as increased staffing levels, and regional hubs of experts that smaller homes could tap into as needed, should all help improve bedsore care and prevent things from reaching such dire stages. The panel also recommended increased training for continuing-care assistants and 24/7 access to primary care for residents.

The report also called for an update of the Homes for Special Care Act, which hasn’t seen an update in 30 years.

The three-person panel was made up of Keefe, Smith and Dr. Greg Archibald, a family doctor, wound-care expert and Dalhousie University professor.

The province tasked them with looking at proper bedsore care, patient and worker safety, and the appropriate care and protection of vulnerable people. They were not responsible for considering the number of long-term care beds in the province.

While bed numbers weren’t a part of the panel’s mandate, Keefe said it’s important “to fix what we have in the system right now before we go down a pathway of adding beds without staff to be able to work in those facitilies. We have to improve our system right now in order to be able to attract workers to this sector.”

Keefe called the report a first step and said it would be up to government to take it from here. The recommendations are not costed, as that was not part of the panel’s mandate, however Smith said the recommendations “implicity have funding attached.”

The province has pledged to act on all the panel’s recommendations. It will be working with the Nova Scotia Health Authority, the long-term care sector and partners to implement them, according to a news release.

The government said it is already working on some of the issues highlighted in the report, including developing a vacancy survey, taking steps toward registering continuing-care assistants, and improving access to occupational therapists, physiotherapists and nurse practioners.

Health Minister Randy Delorey was not in Halifax for the report’s release. The minister was in his constituency of Antigonish for a local announcement.

Report falls short for some people

The report didn’t go far enough for some people.

The Nova Scotia Nurses Union called it a “missed opportunity” to reform the system and recommend minimum staff levels.

In a release, president Janet Hazelton said recommendations around staffing levels, workload and workplace violence would have helped recruit and retain staff. 

Gary MacLeod, chair for the Advocates for the Care of the Elderly, said the lack of a mandate to consider the number of beds or funding amounts to “babysteps on a long run to improvement.”

He said he’s heard many meetings and presentations on how to fix long-term care in the last decade, but he’s seen little improvement in the system during that time. He stressed the need for more long-term care beds and more regular, direct care for residents.

“My own mother, she experienced bedsores and it wasn’t because she was bedridden or in a wheelchair, it was because she wasn’t being bathed properly,” he said.

Tory long-term care critic Barb Adams said the report lacks new information and should have looked at the need for new long-term care beds. (CBC)

Barb Adams, the Tory critic for long-term care and a physiotherapist, said all of the recommendations have been talked about “for more than a decade.”

“The homecare workers and the health-care workers in those facilities could have told you all of this 10 years ago. The problem is that you need the funding in order to enact these things.”

The lack of clear numbers for staff need, time spent with patients and demand is problematic, said Adams.

NDP Leader Gary Burrill said the report “amplifies and underlines” what families, residents, staff and administrators have been saying for some time — in order to fix the situation there needs to be serious increases in staff.

Burrill said an easy solution would be legislated ratios of levels of care that people can expect when they move into homes of care.

While he commended the panel for noting the ratios aren’t good enough, Burrill said he was disappointed a number wasn’t suggested.

“We do have a lot of research about this subject.”

‘It made me feel grateful that we came forward’

Norma Silverstein, whose father died from septic shock last year after he developed severe bedsores while living at Harbourstone Enhanced Care in Sydney, said she was pleased with the report.

Silverstein said the report has a number recommendations that could prevent serious ulcers and wounds.

“It made me feel grateful that we came forward and disclosed what happened to us in the first place,” Silverstein said.

Elizabeth Deveau said she is encouraged by the report for the most part.

Deveau’s 40-year-old sister, Chrissy Dunnington, died as a result of complications from an untreated pressure ulcer she developed at the Shannex-owned Parkstone Enhanced Care in Halifax in 2016, according to her family.

Deveau said calls for improved training and a special space for young adults are steps in the right direction, but said she’s disappointed the report doesn’t include the creation of an independant arm for investigations or fines for repeated offences.

“We can’t change what happened to our sister, but with our involvement and staying on top of it and pushing for change, it is our hope that we can help move change forward for other people for the future,” Deveau said.

High response rates

Since being appointed in September, members of the advisory panel met with 375 people and organizations, including residents of long-term care facilities, their families, the people who work providing care, their union, administrators and others who have a stake in the group’s work.

Initially they were supposed to report back by Nov. 30, but they received a three-week extension, in part due to the volume of feedback they received.

The panel called for an arm’s length committee to monitor the government’s efforts to put the recommendations into action.

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Health Ranger posts new microscopy photos of covid swabs, covid masks and mysterious red and blue fibers

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(Natural News) What follows is a series of microscopy photos of covid swabs (a synthetic swab, then a cotton swab), a covid mask and some zoomed-in photos of mysterious red and blue fibers found in the masks.

The magnification range for these photos is 50X to 200X. Most were taken with white light, but several (as indicated) were taken with UV light.

The images shown here are 600 pixels wide. We have higher resolution images available to researchers and indy media journalists; contact us for those hi-res images.

More microscopy investigations are under way, and new images will be posted as they are finalized.

First, this series shows the carbon fiber layer of a covid mask, illuminated with UV light:

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5,800 test positive, 74 die of coronavirus at least 14 days after getting fully vaccinated

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(Natural News) The Centers for Disease Control and Prevention (CDC) on Thursday, April 15, confirmed some 5,800 breakthrough coronavirus (COVID-19) cases in the U.S.

A breakthrough COVID-19 case is defined as someone who has detectable levels of SARS-CoV-2 – the virus that causes COVID-19 – at least 14 days after getting fully vaccinated against the disease.

Nearly 400 breakthrough cases required treatment at hospitals and 74 died. A little over 40 percent of the infections were in people 60 years and above and 65 percent were female. About 29 percent of the vaccine breakthrough infections were reportedly asymptomatic. The figures were for cases through April 13.

CDC Director Rochelle Walensky told a congressional hearing on Thursday that the causes of the breakthrough cases are being probed. “Some of these breakthroughs are, of course, failure of an immune response in the host. And then some of them we worry might be related to a variant that is circulating. So we’re looking at both,” she said.

The CDC is monitoring reported cases “for clustering by patient demographics, geographic location, time since vaccination, vaccine type or lot number, and SARS-CoV-2 lineage.” It has created a national COVID-19 vaccine breakthrough database, where state health departments can enter, store and manage data for cases in their region.

Where available, respiratory specimens that tested positive for COVID-19 will be collected for genomic sequencing “to identify the virus lineage that caused the infection.”

Positive test less than two weeks after getting fully vaccinated is not a breakthrough case

The number of cases the CDC has identified does not include people who contracted COVID-19 less than two weeks after their final dose. The two-week marker is important, said infectious disease expert Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.

A human body should have enough time to develop antibodies to SARS-CoV-2 after that timeframe. Before then, a person won’t necessarily have the built-up immunity needed to fight off an infection. According to Dr. Adalja, cases that occur before the two-week mark are not considered breakthrough cases.

Dr. Adalja also noted that more research is needed to determine if highly infectious variants of the virus are behind the breakthrough cases. “It is crucial to study breakthrough cases to understand their severity, their contagiousness and what role variants may be playing,” Dr. Adalja said.

More than 78 million people have been fully vaccinated against COVID-19 in the U.S. as of April 15.

“To date, no unexpected patterns have been identified in case demographics or vaccine characteristics,” the CDC said in a statement. “COVID-19 vaccines are effective and are a critical tool to bring the pandemic under control.”

But the CDC conceded that “thousands of vaccine breakthrough cases will occur even though the vaccine is working as expected.”

Dr. William Schaffner, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, agreed with the CDC. “These vaccines that we’re using are fabulous but they’re not perfect,” he said. “At best, they’re 95 percent effective in preventing serious illness, but minor illnesses can occur.”

According to U.S. drug regulators, Pfizer’s COVID-19 vaccine is 95 percent effective in preventing infection. Moderna’s was shown in a clinical trial to be 94.1 percent effective while Johnson & Johnson’s was 66.9 percent effective. Only Johnson & Johnson vaccine, which received its emergency use authorization from the Food and Drug Administration (FDA) on Feb. 27, was tested when variants were circulating.

The percentages are based on results from vaccine recipients two weeks after the final vaccination.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, stated in a briefing last week that the breakthrough cases are not a cause for concern.

“I think the important thing is to look at what the denominator of vaccinated people is. Because it is very likely that the number of breakthrough cases is not at all incompatible with the 90-plus percent vaccine efficacy,” he said. “So I don’t think that there needs to be concern about any shift or change in the efficacy of the vaccine.”

More info needed before drawing conclusions from breakthrough cases

The percentage of vaccine breakthroughs in a population depends on multiple factors, including vaccine efficacy, the amount of virus circulating and the length of time since vaccination, according to Natalie Dean, an assistant professor of biostatistics at the University of Florida.

“I love to see small numbers as much as anyone, but know that numbers like this cannot be directly interpreted as a measure of vaccine efficacy (although I have a feeling they will be). We can only interpret them against a background rate in unvaccinated people,” Dean wrote on Twitter.

“Similarly, ‘most breakthroughs have been in elderly adults’ should not be read as the vaccine is less effective in elderly adults. The majority of vaccinations (and the longest amount of follow-up time) have been in elderly adults. Again, we need more info to interpret.”

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More people died from fentanyl overdose than coronavirus in San Francisco last year

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(Natural News) More people died from fentanyl overdose than coronavirus (COVID-19) in San Francisco last year, a microcosm of a larger nationwide problem coinciding with the pandemic.

Data from San Francisco’s Office of the Chief Medical Examiner shows that 708 people were killed by fentanyl in 2020, an astonishing 118 times more since the introduction of the drug in the city just five years earlier.

That figure nearly tripled the 254 COVID-19 deaths recorded in the city for the whole of last year. More than 8 in 10 deaths were male, and just under half were white. People aged 55 to 64 made up nearly a quarter of the fatalities. Nearly 40 percent of the deaths occurred in open-air drug markets such as the Tenderloin and South of Market.

The number of overdose deaths in the city could have been far worse as more than 3,000 addicts suffering from an overdose were administered with naloxone, the lifesaving medication that reverses overdoses.

San Francisco’s death rate from fentanyl overdose continues to rise this year as 135 died by overdose in January and February, putting the city on pace for more than 800 deaths by the end of the year.

The city has become a significant part of a larger trend. The Centers for Disease Control and Prevention (CDC) released data on Wednesday, April 14, showing that more than 87,000 Americans died from drug overdose over the 12-month period that ended in September last year – the highest since the opioid epidemic began in the 1990s.

Lockdowns lead to more cases of drug overdose

The surge represents an increasingly urgent public health crisis that may be correlated to the government’s monotonous battle plan against the COVID-19 pandemic.

On March 19 last year, California became the first state in the U.S. to implement a stay-at-home order. It subsequently endured the longest lockdown of any state in the country.

The pandemic and accompanying lockdowns are believed to be partly responsible for the soaring number of drug deaths for obvious reasons. Lockdowns have badly disrupted the social services in the city, including drug addiction treatment. Drug experts say the isolation of the past 12 months is causing vulnerable residents to turn to opioids.

“We see the death and devastation getting worse right in front of us,” said Matt Haney, San Francisco Board of Supervisors member. “It’s an unprecedented spiraling, directly connected to the introduction of fentanyl in our city.”

Fentanyl first appeared on the streets of San Francisco in 2015. There were just six deaths from the synthetic opioid that year, 12 deaths in 2016 and 37 deaths in 2017. The figure skyrocketed when the drugs became widely available in the city in 2018.

Kristen Marshall, manager of the national drug harm reduction DOPE Project, noted the grim irony that while social isolation could save lives from COVID-19, it had undoubtedly contributed to the number of overdose deaths.

“Isolation is also the thing that puts people at the absolute highest risk of overdose death,” she said.

Pandemic exacerbates rise in deaths from drug overdose

The number of deaths from drug overdose started rising in the months leading up to the coronavirus pandemic, making it hard to gauge how closely the two phenomena are linked. But the pandemic unquestionably exacerbated the trend. The biggest jump in overdose deaths took place in April and May when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect.

Many treatment programs closed during that time while drop-in centers, which provide support, clean syringes and naloxone, cut back services.

The data released by the CDC shows a 29 percent rise in overdose deaths from October 2019 through September 2020 compared with the previous 12-month period. Illicitly manufactured fentanyl and other synthetic opioids were the primary drivers, although many fatal overdoses have also involved stimulant drugs like methamphetamine.

Unlike in the early years of the opioid epidemic, when deaths were largely among white Americans in rural and suburban areas, the current crisis is affecting Black Americans disproportionately.

“The highest increase in mortality from opioids, predominantly driven by fentanyl, is now among Black Americans,” Dr. Nora Volkow, the director of the National Institute on Drug Abuse, said at a national addiction conference last week.

“And when you look at mortality from methamphetamine, it’s chilling to realize that the risk of dying from methamphetamine overdose is 12-fold higher among American Indians and Alaskan Natives than other groups.”

Dr. Volkow added that more deaths than ever involved drug combinations, typically of fentanyl or heroin with stimulants.

“Dealers are lacing these non-opioid drugs with cheaper, yet potent, opioids to make a larger profit,” she said. “Someone who’s addicted to a stimulant drug like cocaine or methamphetamine is not tolerant to opioids, which means they are going to be at high risk of overdose if they get a stimulant drug that’s laced with an opioid like fentanyl.”

The Drug Enforcement Administration (DEA) supported Dr. Volkow’s claim, saying that transnational criminal organizations cause a spike in overdoses by mixing fentanyl into illicit narcotics.

According to the DEA, Mexican cartels often purchase the drug components in China and use human mules to smuggle the narcotics to lucrative drug markets north of the border.

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