Women of the Pandemic

by Lauren McKeon

  For Hinshaw, the hardest thing is knowing that, despite all the long hours and careful evaluation, she couldn’t protect everyone from COVID-19. The second hardest thing is knowing that the same wise decisions she made to protect Albertans rippled out and caused harm: mass unemployment; mass isolation; and, carried on those twin waves like flotsam, a national increase in drug overdoses and substance abuse, in suicide and self-harm, and in domestic violence. Hinshaw became the symbol of both sides of the pandemic—the protective shield and the unintentional wrecking ball. In many other provinces, she said, a few individuals assumed the public face of COVID-19. In Alberta, however, “it’s just been me.” Consequently, Hinshaw gets a lot of email. Strangers share their deep rage, their concern, their praise, their gratitude, their myriad definitive opinions on what she should do going forward (here, she lets out a sharp, self-deprecating laugh): “Resign.” She does read all the feedback, and sifts out everything she finds useful, even when it’s critical. In the first month, someone wrote to tell her that, while they appreciated her updates, the daily COVID-19 death toll made it seem like those losses were the only ones that mattered. Since then, Hinshaw has consciously acknowledged that many people are grieving in a time during which grief is especially complicated; she has extended her sympathies to them all. Another person wrote to say that when she was talking about following public safety measures, she only used the word you, which felt like a gigantic pointing finger. Hinshaw switched to we. She has checked her tone for lecturing, for shaming, for anything that does not suggest we are all in it together.

  “I always want to contextualize,” Hinshaw told me, “that I’m well aware not every Albertan loves me.” Mostly, it doesn’t matter. While she appreciates the accolades, she is not on the podium to make herself look good. She is not up there to elevate herself. She stands up there nearly every day simply to share the best information she has, and the best recommendations she can give based on it. If she’s wrong, she’ll say that too. It’s been strange for her to ascend into the public consciousness. When she took the job in January 2019, she knew that she’d have to speak with media. She knew there would be days she would stand at a podium in front of a background of alternating draped maple leaves and folded Rocky Mountains and share important public health information. Like everything else about the scale of the pandemic, though, this magnitude of visibility previously felt impossible. She’s had to learn how to express her natural compassion but still build boundaries—to accept she cannot solve everyone’s problems. Like other stars, she’s also had to learn to keep a part of herself tucked away from the public eye. “I feel like the way I cope with that attention is to recognize that all of that attention is on the Dr. Hinshaw role,” she said. “It’s almost like, in my own circle, I can then slip out of it and just be me.”

  The same calm, measured principles she exhibits in press conferences have likewise helped to guide her through the stratosphere. “I’ve committed to being honest and transparent,” she told me, “and to acknowledging when I make mistakes or when something doesn’t go well.” She thinks that this, more than anything, is what’s resonated with Albertans: her ability to concede imperfection. From a lot of people, such sentiments can sound strikingly like a line, a political platitude. And, admittedly, she’s said something similar in several other interviews. Coming from Hinshaw, though, it sounds as genuine and down to earth as a Sunday dinner.

  For starters, it’s true. On May 1, she opened one of her daily briefings with an apology. “In the announcement I made earlier this week regarding visitor restrictions in continuing care, I did not ensure that operators had been fully consulted or notified prior to the policy change,” she said. “I am sorry.” On the last day in August, she apologized for the confusion her back-to-school updates sparked. And it isn’t just that Hinshaw can admit a wrong step. It’s that she urges compassion instead of fear, community instead of blame. When she announced a new outbreak of fifty-seven cases at a Calgary-based Ethiopian church, she stressed that members of the church deserved support, not stigma. “An outbreak can occur anywhere,” she said, “and those involved need our compassion.” That’s just the type of leader Hinshaw is. On the day we chatted over video, she was at home. Reaching for a Kleenex, she explained that she had a runny nose and sore throat, so she’d done the responsible thing and self-isolated. She’s that kind of leader, too.

  “THERE WAS NOT ONE PERSON WHO DIED ALONE. I MADE SURE OF THAT.”

  Roisin O’Brien, care aide

  Eight

  A HIGH TOLL

  Death has always been a part of Roisin O’Brien’s job. The twenty-seven-year-old had been working at a Vancouver long-term care centre for nearly four years when COVID-19 hit in mid-March. She often sat with people who were in palliative care. She would hold their hand, stroke their hair, make sure they knew she was with them at the end. Many residents didn’t have family, either in the city or at all, and O’Brien never wanted them to look around at an empty room. So she’d sit and wait, whether the last breath came in half an hour or an entire shift later. Sometimes it was peaceful, and sometimes it wasn’t; no matter what, O’Brien was there. Her job as a care aide is rarely easy. There can be a lot of workplace violence: she’s been called names, and right off the top of her head, she can think of at least six times an angry or scared resident has hit her. But this part made it all worth it. O’Brien liked knowing she could spend time with her clients, offer a kind word. She liked knowing that nobody under her care would die alone. She liked knowing that, in that final moment, she did what she could.

  As the outbreak ripped through the country, hitting B.C. in late January, O’Brien began to stay home more and more. Her fiancé took over grocery-shopping duties. She didn’t want to be the person who brought the virus into her care home. At the same time, she knew that chronic short-staffing often meant people showed up to work sick. Maybe they guiltily dismissed their runny nose as a little sniffle, their sore throat as feeling just a bit scratchy. They didn’t want to leave their co-workers hanging. They couldn’t afford to pass up the hours. They could manage a shift, they reasoned; they just needed to wear a disposable mask. Before COVID-19, O’Brien had done it, too, figuring that skipping her shift would do more harm. That thinking changed on March 7 when Bonnie Henry announced a COVID-19 outbreak at Lynn Valley Care Centre in North Vancouver, confirming both residents and staff had tested positive. The next night, one of the facility’s residents, an eighty-three-year-old man, died, becoming Canada’s first COVID-19 death. O’Brien’s own care home called a mandatory staff meeting in response. Sixty people crammed into a 35-square-metre room. They decided to start restricting visitors from out of town. They would start asking questions about whether people had recently been abroad. There would be no more coming in sick.

  “It turns out, we didn’t really have to worry because the virus was already there,” said O’Brien. “In hindsight, over half of the people in that room had COVID.” Shortly after the meeting, she took an overtime shift on another floor. There was a man there who was vomiting and had diarrhea. O’Brien was worried because she knew his symptoms matched some of the more severe COVID-19 cases. She had no PPE because she hadn’t been provided with it, and so she entered his room without any. She breathed the same air and touched her fingertips to his skin. When his condition worsened, she called the ambulance. The paramedics arrived in full virus-armour, “completely gowned up.” O’Brien had one scalpel-sharp thought: What if this is our first case? The next day, she found out it was. She immediately took her temperature: 38.7 degrees Celsius. A moderate fever. She turned around and headed to a testing clinic. Two days later she got her results and, to her surprise, they were negative. She called her care centre right away and offered to take a shift. In the intervening days, the virus had played hopscotch through the centre. Both residents and facility healthcare workers were sick. She’d work the floor that housed all of the former, she told her superv
isors. Hours after offering, she was at work. “And that,” she said, “is when all hell broke loose.”

  Every resident who was sick lived on the dementia floor. Keeping them all quarantined in their rooms was impossible. If they were well enough, they wanted to walk around, they wanted to give O’Brien hugs, they wanted to be close. They touched everything because they didn’t understand why they shouldn’t. O’Brien would look at empty carts where the PPE was supposed to be and feel a helpless kind of anger boil. She wore the same surgical mask and worked double shift after double shift, from 3 p.m. right on through to 7 a.m. On a normal evening pre-COVID, there would be five care aides, including her, and one nurse. Now they were lucky to have three. Direction from management seemed to change from hour to hour. O’Brien was used to having a list of twelve residents to care for; she could check in several times a night with them, make sure they had everything they needed, stop and chat. Now, in one eight-hour shift, she had to look after forty—changing their adult diapers, sheets, and other incontinence products, washing their bodies and hair, feeding them. She couldn’t do it all to the standard she wanted. She didn’t have time to wash people’s faces. If someone needed changing, she’d do it once, then put them right to bed.

  O’Brien had never cried over her job before, but she did now, after every shift and sometimes during them. She’d come home, take a shower, cry, eat, sleep, and then do it all over again. She constantly felt sick to her stomach. Usually, she told me, she tries to distance herself from the tough stuff, summoning the grit to keep going with the mantra This is my job. But on the second or third day of working the designated COVID-19 floor, she stopped dissociating, stepped back, and let her brain take a big-picture snapshot of the scene around her. What she saw was horrific. Oh my god, she thought. This is neglect. This isn’t right at all.

  * * *

  —

  By May, the worst-case scenario everyone feared had silently engulfed long-term care facilities across Canada. Cleave them out, and it looked like the country had mainly managed to escape a full-on nightmare during the first wave. There was no broad shortage of PPE inside hospitals. No body bags trimming the hallways. Sirens did not play a soundtrack on the street. Masses of doctors had not been forced into gut-wrenching ethical decisions, choosing who would live and die. Inside care homes, however, a different narrative stretched into chaos. Staff in many facilities reported low or no PPE. In some places, management locked up protective equipment, fearing the staff would steal it, leaving them with nothing to wear on their shifts. New policy and training procedures were developed too slowly, and often, once they were in place, were poorly communicated. Fear and misinformation wormed through countless care centres. Plenty of people quit or got sick, and staffing schedules began to resemble emptied honeycombs. While Canada had a relatively low COVID-19 mortality rate compared to other developed countries, in the initial months of the pandemic it earned the dubious distinction of having the highest proportion of deaths occurring in long-term care. Here, long-term care residents accounted for 81 per cent of all COVID-19 deaths; the average in other countries stood at 38 per cent. More than 9,650 staff members had become infected, representing 10 per cent of all virus cases in Canada. Nine of those workers had died.

  The disaster rumbled under the radar until, that same month, the Canadian Armed Forces (CAF) released a report on five care homes in Ontario. The province had called on the military in April to help with the urgent staffing crisis—or, as the CAF put it, “to provide humanitarian relief and medical support.” The resulting report, which matter-of-factly detailed the distressed state of five homes in the province, was both devastating and nauseating. At one home in Etobicoke, residents with COVID-19 were not isolated and staff were given inadequate PPE and the (false) impression that PPE didn’t have to be changed between patients or rooms. New staff weren’t trained. Many personal support workers (PSWs) at the home couldn’t access supplies to properly care for the residents, and they feared for their jobs if they used too many. Expired medication stocked the shelves. Cockroaches and other insects, like flies and ants, infested at least two homes. At one, in North York, some residents hadn’t been bathed for weeks. Military staff observed patients crying for help with no response from PSWs or nurses for anywhere between thirty minutes to over two hours. At the other, in Pickering, patients were left in bed wearing soiled diapers. Food and belongings were kept out of reach. Mattresses were placed on floors, and walkers were hidden to prevent residents with mobility issues from wandering.

  Underfeeding, poor hygiene, and bed confinement were reported at several of the homes. At one, the smell of rotten food belched through the air. At others, evening shifts went completely unstaffed. Decontamination procedures often didn’t exist or weren’t followed. At a home in Brampton, PSWs didn’t wash their hands between patients. Workers in many homes were under the same misconception as those in Etobicoke: PPE wasn’t changed in between rooms, even when a resident was known to be COVID-positive; some wore scarves under their masks; equipment wasn’t disinfected and neither were rooms. Across the board, staff burnout was rife. People were bone-tired. Some staff hadn’t seen their families in months. In most cases, the lowered level of care wasn’t intentionally cruel, or even wilfully subpar. The vast majority of PSWs were doing the best they could with little direction or training, even less protection, and severe shortages. A lot of them were being asked to perform nurses’ duties beyond their skills or training. It was like trying to spread a tablespoon of jam over a dozen loaves of bread. As the CAF report noted, “The staffing is such that it is impossible to provide care at a pace that is appropriate to each resident or allow them any kind of independence.”

  The report was surprising, and it wasn’t. Laura Bulmer is a PSW advocate, registered nurse, and a full-time professor at a community college in Ontario. At first, she didn’t pay too much attention to the incoming pandemic—in fact, she “pooh-poohed” the virus at the beginning of 2020. She had, to put it lightly, other things to worry about. In July 2019, her younger sister died from ovarian cancer. Six months later, Bulmer herself was diagnosed with uterine cancer after contracting pneumonia. She had surgery to remove her tumours in January, then later left the city for her family lake house to recuperate. Once the WHO declared COVID-19 a pandemic, Bulmer began to feel guilty for not being able to join the front line. She knew her health put her at sky-high risk levels, but she badly wanted to help. She wanted to be slogging it out with her fellow nurses. In April, she returned to work at her college—here she uses air quotes around “returned” because, really, she stayed at the lake house, working from her makeshift desk.

  As she made her way from the summit of Email Mountain, she read note after note that made her “blood boil.” More than most, Bulmer knew the challenges PSWs faced: endemic short-staffing and scant resources, depressingly low pay, suffocating pressure to perform care that wasn’t in their job description and for which they hadn’t trained. For her entire career, Bulmer had worked to give PSWs the recognition they deserved—she’d created dedicated career fairs at her college, lobbied governments, and become chair of the Canadian Association of Continuing Care Educators—all so they wouldn’t be treated, as one former student put it during the pandemic, like “glorified shit cleaners.” Bulmer knew it would be far, far too easy to scapegoat them for the burgeoning long-term care crisis. She decided she wouldn’t let it happen. This was how she could help.

  In May, she wrote an op-ed in Maclean’s arguing that the national regulation of PSWs could have largely prevented the unfolding tragedy in long-term care facilities. The lack of standardization puts workers, residents, and the general public at risk, she told me, starting with an inconsistency in training and education. Training can take place in a high school, a community college, or a private career college. If they wanted to, she added, anyone, with or without experience, could join the bogus ranks and start their own school for training PSWs, luring new
Canadians with the promise of quick learning, and even quicker hiring—all for an exorbitant fee, of course. On top of this, there isn’t a singular name to describe such care work. A person may be called a PSW or a care aide, or they may be called a clinical assistant, a certified health aide, a home attendant, an orderly, or, as Bulmer put it, “tens of other names.” Attempting to standardize a profession that has no standard name can feel like a dog chasing its tail. Without such regulation, however, it isn’t only training that can vary wildly, but also pay and contract terms. As a result, many PSWs work at several homes at once to make ends meet. A pandemic like COVID-19, or an epidemic like SARS, forces them to pick one job site, creating a domino effect of short staff. The result of all this is a workforce that is majority women, many of whom are racialized or new to Canada.