Social Distancing in Closed Environments

"Very early on, we wrote two letters that we posted on social media that got tonnes of attention."
"Our method of protecting ourselves and the public from being infected is social distancing. And if  you can't social distance ... you're just inviting disaster to strike."
"If you've got two people who are in a stadium and you tell them, close your eyes and just start walking around, the odds that they're going to walk into each other are pretty small. But if you have those same two people doing that in a room that's six-by-six metres, there's a pretty good chance that they're going to knock into each other. It's a simple function of the ability or the inability to distance." 
"One of the advantages we have with long-term care facilities is at least we've been able to understand some degree of the problem. Someone's peeled back the scab, so to speak, to look under the bandage and we can see how absolutely horrific what was going on has been."
"The residents in these populations, we're just going to lose them. And that's a scar upon us if we can't protect our vulnerable."
"These are not closed systems. There are people who go and work there. And if we can't protect the healthcare workers, then almost certainly we're not protecting the health-care workers' families and therefore we're not protecting the public that is in contact with the health-care worker and their families and therefore we're not going to be able to get a hold of this whole problem."
Dr.Andrew Morris, professor of medicine, University of Toronto

"I think we're starting to see very quickly that hospitals are not really the front line of this pandemic in Canada."
"I think now people are almost playing a game of catch-up when you start looking at these settings [care homes for the elderly or disabled]."
Dr.Samir Sinha, director of geriatrics, Mount Sinai Hospital, Toronto

The Quebec coronor's office has launched an investigation into a long-term care home in a suburb of Montreal where 31 people have died in a conditions the premier has called "deplorable"

It has now been six weeks and ongoing, where Canadians across the country have been counselled that it is up to everyone to 'flatten the curve'. To remain sequestered in their homes, to go out only on rare occasions when it's absolutely necessary, to remain distant physically from others. Schools closed, non-essential businesses shuttered, public spaces and events off limits, borders closed, travel plans nixed. All well and good, but none of this affected long-term care homes, yet fully 78 percent of all COVID-linked deaths have occurred in long-term care homes.

All of these measures to try to control a hugely infectious and sometimes morbidly-threatening new cornavirus were predicted before the virus entered North America. Dr. Morris, for one, was alert early on that COVID-19 would present an enormous problem to Canada when it arrived, as it surely would. But even he and colleagues of his whose thoughts took a similar track, were unable to visualize just how dramatically the Canadian reality of life-normalcy would ultimately be affected.

The Eatonville Care Centre, where multiple deaths from COVID-19 have occurred, is shown in Toronto on Tuesday, April 14, 2020. THE CANADIAN PRESS/Nathan Denette

He and his colleagues got together to draft several letters outlining the situation that would unfold and their recommendations for an early response to the situation before it became a reality. At the time it seemed so difficult to believe that the country would swiftly be engulfed in a seemingly unstoppable epidemic they scarcely thought their communications would be given the serious consideration it required. Later, it would occur to them that though that attention was forthcoming, they had themselves failed to communicate the extent of the dire conditions that would ensue.

Now that Canadians have embarked on a voyage of countradicting the basic human impulse of sociability in an effort to halt the spread of the virus causing COVID-19, the very enormity of the threat takes on new proportions to our understanding of just how vulnerable we are as a population. But it is a readily identifiable demographic of the population that has borne the brunt of the infections.

Precautions were taken to close schools and daycares to shield children from the SARS-CoV-2 virus, the most readily identifiable group within any population that is given first thought. Fears of overwhelmed hospital emergencies failed to materialize, with hospital admissions and ICU capacity at not only manageable levels, but anxiously awaiting the arrivals of other emergency situations more commonly making use of those facilities that have suddenly disappeared.

People are withholding their presence at Hospital Emergencies, hoping that their worrying symptoms of heart problems, stroke, appendicitis, accidental injuries will somehow abate, rather than subject themselves to the possibility of appearing at a hospital teeming with infectious agents and find themselves infected with the dread virus. And then there is another casualty that few had given prior thought to, but several of Dr. Morris's colleagues had.

The virus that thrives in the company of groups of people in close communion, and sees its opportunities dwindling when people exercise caution to keep physical distances, found its metier when it entered the confines of closed gatherings, where people are placed in situations with tight physical spaces and an abundance of potential targets. Places like nursing homes and long-term care homes, prisons and shelters for the homeless. "Congregate settings", perfect for a virus to thrive.

If more isn’t done to protect shelters, prisons and in other so-called “congregate settings,” advocates warn more mass outbreaks are inevitable. Francis Georgian/Postmedia/File

And in long-term and nursing homes the virus has done precisely that. Shelters and prisons next on the list. "I think we're going to see numbers jump dramatically", Cathy Crowe, a nurse with decades of working with the homeless in Toronto, stated. While many shelters are attempting to implement some elements of social distancing, in their limited spaces it is beyond difficult to adequately achieve.

"It's pretty much impossible to maintain social distancing in pretty much every congregate setting of a shelter or a drop-in, to be perfectly honest", Diana McNally, with her years working in Toronto shelters, offered. "The diagnostic differentiation of COVID among people experiencing homelessness is very challenging", Dr. Naheed Dossani, palliative care physician who often works with the homeless, pointed out.

In prisons and jails outbreaks are beginning to occur. "I'm speaking to senior citizens who are serving prison sentences and telling me, I didn't know this was going to be a death sentence", Paul Champ, a lawyer in Ottawa stated. As for long-term care homes where well over fifty percent of the COVID deaths not only in Canada but globally, have been taking place, the sheer vulnerability of the aged, infirm and health-compromised has shocked the world.

As the coronavirus outbreak continues, Los Angeles has been providing unhoused people with motorhomes and RVs, which allow them to maintain social distance.  Photograph: APU GOMES/Getty Images