Funerals: Not The Events To Attend

"We were all in a period of adjustment and learning new things about how to cope with the coronavirus and containing its spread. It's become a mini-epicentre here."

"Everyone comes in and they're all over each other and everyone is calling out to each other and slapping each other on the back and hugging. Normally I'd shake hands and hug half the people there."

"I was very careful not to shake hands with any of the people who came, including with the family themselves. They understood. They were just grateful they were able to gather and have a funeral."

Father Paul Lundrigan, St. John’s on March 16. (CBC)

"We need to now make sure families understand this is so necessary for their protection, especially families who are grieving."

"They're so emotionally charged, they're just not thinking about keeping physical distance and washing hands and they're crying over each other. That's the quickest way to spread this disease, people who have wet noses and wet eyes and wiping their eyes and then touching each other, holding each other and kissing each other."

"It's probably one of the most dangerous places to be [at a funeral]."

Reverend Paul Lundrigan, Catholic priest, St.John's Newfoundland

There were two funerals in St.John's on March 15 and 16, at the W.J.Caul Funeral Home, overlooking the city harbour. Over 60 of the province's 82 cases of COVID-19 have been traced to the funeral home. Someone among the funeral attendees had an active, infectious case of the novel coronavirus and had attended both funerals. Someone who had returned from a trip abroad. Newfoundlanders are emotional, demonstrative people, somewhat in that regard, like Italians, where in Italy COVID-19 has devastated the country.

As a result of the fact that a lot of people are very neighbourly in Newfoundland in a way not quite seen elsewhere in the country, it seems obvious now that funerals and funeral wakes are just the places where viral transmission can very readily take place. Reverend Paul Lundrigan presided over one of the funerals and himself visited during the wakes that overlapped at the funeral home. And where he would on normal occasions take part in physical contact as a way to offer comfort at such times of grief and stress, on this particular occasion he withheld that contact.

That was in view of the fact that a health emergency had been declared. At the present time Father Lundrigan is in self-isolation. He was not among those who contracted the novel coronavirus. He has no symptoms of COVID-19, no coughing, no fever, and most certainly has not experienced any difficulty breathing. Unlike many others who attended the funerals and wakes. Where between March 15 and 17 transmission of the virus took place, at the funeral home. At the time, health regulations had limited the number of people at gatherings to 50.

Out of both services that overlapped, the theory was that among the funeral staff someone may have been a vector, but people in the community felt that someone who arrived for one funeral, knowing members of the second family's funeral stayed behind for both even though people were making an effort to avoid close contact. People would move back a row of pews if someone else sat in front of them, or they would move to the other end of a pew. But there was evidently sufficient contact to spread the virus.

And some of those who tested positive for COVID-19 after attending the funerals also spread the virus to health-care workers, including paramedics. Several days later the funeral home posted a public notice denying chatter of any problems at its facilities: "We have been in touch with the Department of Health and have been advised that no COVID-19 infection has been linked in any way to staff, family, or visitors."

The following day the health department advised the home that an individual who tested positive for COVID-19 had attended services for both funerals, which led the home to contact all involved, including musicians and pastors, including Reverend Lundrigan. The home is now closed until at least April 1. "The health of those we serve, and the greater community, is of utmost importance", the funeral home stated. 

And the Archdiocese of St.John's has stopped public funeral services altogether for the present. Should a burial be required, a brief graveside blessing is to be held in the company of a few immediate family members, only. At some future date, 'celebrations of life' ceremonies may be resumed.

A letter from Archbishop Peter Hundt on Monday to the Archdiocese of St. John's stated clergy will no longer preside over public funeral services, amid the COVID-19 pandemic. (Shutterstock/GreenAppleNZ)

"It has had an impact on workers in the health-care system."

"We are following in the footsteps, in some respects, of other jurisdictions. There have been outbreak clusters around a retirement home in B.C., there was a convention of professionals in Vancouver and a bonspiel in [Edmonton] that have all generated similar concerns."

John Haggie, Newfoundland Health Minister

Do As I Say : Don't Look At Me!

"A bonspiel is not an essential activity."

"I know our health-care providers are under a lot of pressure and scrutiny right now, but hard not to wonder why this event took place."

Timothy Caulfield, Canada Research Chair in health law and policy, professor, faculties of law and public health, University of Alberta

"There have been no deaths linked to this bonspiel. No patients have tested positive with COVID-19 to date."

"At this time, no other patients appear to have been exposed from cases to the bonspiel."

"[Any disciplinary action would be from the provincial physicians' colleges; the focus is on] caring for patients."

"It is not on disciplining physicians, particularly at a time when we need them the most."

Alberta government statement

Curling rocks are shown Friday, Feb. 10, 2017, during a media demonstration the day before the opening ceremonies of the USA Curling Nationals in Everett, Wash. (THE CANADIAN PRESS/AP, Ted S. Warren)

We are so hugely -- as a public faced with the fears of an infectious global pandemic that has skulked its way into Canada from its emergent home in Wuhan, China -- dependent on the army of skilled medical professionals to care for us in illness and restore us to health, if and when possible. Physicians, secure in their professional knowledge, their practised experience, their diagnostic and healing skills, are the most trusted group of professionals the world over. For the most part, they earn that trust.

But as humans with all the failings of any human being they can at times spectacularly fail that trust.

And this is precisely what occurred when a decision was made to proceed with an annual curling event that brings together health professionals from the Western provinces of Canada. Where, despite knowing that COVID-19 has a swift and deadly spread, and to deter that spread as much as possible people should maintain a safe distance from others to self-protect and protect others from the highly infectious novel coronavirus, 72 people with medical degrees chose to attend the event.

Now three of the attendees from Alberta are known to have become infected with the virus at the tournament that took place in Edmonton. Before they became aware that they were infected, and thus vectors, they had contact with patients and with their colleagues. Twelve in fact, of the 47 Alberta health care workers at the bonspiel which took place between March 11 and 14, tested positive for COVID-19. A situation that calls for them to self-isolate for at least two weeks, placing them outside the health-care system as patients, not as badly-needed practitioners.

Three of the twelve -- physicians in Red Deer, Alberta -- had physical contact with patients and co-workers so that 58 patients were attended to during the course of normal medical business by the doctors involved before they became symptomatic. Add other possible infections counting the 97 other health professionals these doctors' indiscretion may have contaminated. And if so, unbeknownst to those 97, their contact with their own patients would have rippled beyond the initial contact. This is how contamination spirals.

This situation was first brought to light when Dr.Allan Woo, head of the Saskatchewan Medical Association publicly revealed that he had been infected with the novel coronavirus due to his attendance at the bonspiel in Edmonton. Now, Saskatchewan has announced that 11 of their 22 health professionals attending the event also tested positive for COVID-19. Three doctors in Manitoba are self-isolating, having attended the event. 

Well, so much for the wisdom of doctors. And wait, other medical professionals as well have proven to be as unwary -- as when earlier in the month the Pacific Dental Conference that took place in Vancouver at which close to 15,000 dentists and hygienists attended also appears to have resulted in a COVID-19 outbreak. Reports of infections are beginning to emerge, one in particular, the death of a dentist who attended that event.

Two people from the University of Calgary’s Cumming School of Medicine tested positive for COVID-19 after attending an Edmonton curling bonspiel that played host to more than 50 physicians last weekend, the university said in an email to faculty and students Friday. The University of Calgary is pictured on Tuesday February 26, 2019. Gavin Young/Postmedia

COVID-19, Canada? Not to Worry!

"We have scenarios where there are more people requiring ICU beds than there are acute care beds [all hospital beds] in Ontario at peak."
"We see in Italy that G7 countries can have total collapse of health systems under the strain of this, even early in the epidemic."
"[If we add modest control it would take] aggressive social distancing and large scale quarantine] to reduce [numbers of people affected by coronavirus]. That's still a huge number of people ill, and critically ill people are a large fraction in this disease."
"I'm not going to share more specific numbers because I think they will scare people to no particular end."
Dr.David Fisman, professor in epidemiology, Dalla Lana School of Public Health, University of Toronto

"[Ottawa] is very alive to the fact that some provinces are indicating they have deficits [dwindling medical supplies of face masks, eye shields, other protective equipment]."
"We are gathering that information and we have said all along that we will be there as the federal government to support them with the resources they need, whether those are financial resources or practical resources."
Federal Health Minister Patty Hajdu

"You're working at 120 percent capacity and now you have this on top of  your normal work."
"We need to scale up the testing of these viruses. It's taking far too long in some centres to get the results."
"They're [front-liners] worried because they've only seen the beginning and they think that if there is a pandemic it's going to be extraordinarily difficult to manage the capacity of the needs of our patients coming through the system."
"What are you going to do with those patients that are already in hospital? Are you going to ask them to leave? What happens if it's a patient [who needs] home care, and there's no capacity?"
Paul-Emile Cloutier, president, CEO, HealthCareCan 

Pedestrians wear protective masks as they walk in Toronto on Monday, January 27, 2020. THE CANADIAN PRESS/Frank Gunn

The novel coronavirus called COVID-19 which began its deadly presence in Wuhan, China and caused Beijing to isolate the entire province of some 60 million people, has now spread to over 100 countries, infecting over 110,000 people worldwide, and resulting in over 3,800 deaths. China's isolation of entire cities and its alacrity in building instant new hospitals dedicated to the control and care of thousands of coronavirus-stricken people has resulted in the current situation where Beijing has reported to the World Health Organization that the situation is under control.

The number of new cases has been diminishing steadily over the past week. Ironically enough, some of the new cases that have been identified belong to Chinese citizens returning home from vacations abroad to Iran and Italy, bringing the novel coronavirus back with them from two of the hardest-hit countries to date outside China (besides South Korea). It remains to be seen whether China will discover it is being re-infected with a new, more stringent and deadlier strain of the virus that originated in China but regenerated abroad.

Canada still has a relatively modest number of people diagnosed with coronavirus and most of them brought it with them from trips to China and Iran and Italy, and a good number returning from infected cruise ships. But given the swift spread of this virus and its consequences, experts in  virology at University of Toronto have come up with a scenario where they predict that from 30 to 70 percent of Canadians could end up stricken with the virus, potentially requiring makeshift hospitals and quarantine centres to relieve an overburdened public health system.

At the best of times, Canada has a critical shortage of hospital beds available. This is flu season time where shortages become acute, and with the prospect of hospitals filling up further with coronavirus patients, added emergency measures will be required which a disease-transmission model that researchers from U.of T. developed. In Canada 71 known confirmed and presumed cases of the virus have arisen, with one death. Six cases have been linked to a cruise ship which had on an earlier cruise been implicated in virus transmission.

Paramedics leave the Lynn Valley Care Centre, a seniors care home which housed a man who was the first in Canada to die after contracting novel coronavirus, in North Vancouver, B.C., March 9, 2020. Jennifer Gauthier/Reuters

A second repatriation of Canadians on a virus-infected ocean liner is underway. In Alberta, doctors complain of a "lack of forward thinking", and lax communication on emergency planning, while nurses in British Columbia warn they are already short-handed, amidst concerns relating to dire shortages of needed protective supplies. Supplies of hospital gowns, gloves, masks, oxygen, drugs, ventilators and laboratory capacity of virus testing all representative of concerns relating to hospitals' capacity to cope with an emerging pandemic.

A new study recently published in The Lancet, based on 191 patients from two hospitals in Wuhan the outbreak epicentre, found that people continued to shed the virus for longer periods than expected; on average 20 days in survivors and up to 37 days -- not the mere 14 days that were previously assumed to be sufficient, meaning that isolation will have to be more prolonged to be effective. Shedding relates to pathogen spreading capacities.

"The extended viral shedding noted in our study has important implications for guiding decisions around isolation precautions and antiviral treatment in patients with confirmed COVID-19", reported the Chinese researchers. Rooms, wards and entire floors in hospitals will be required to be set aside to separate the presence of those infected with the coronavirus from other patients. "I'm not saying you need to build new hospitals", cautioned Mr. Cloutier whose position is representative of hospitals and other medical facilities country-wide.

Dr.Fisman, from his perspective as a epidemiologist, stresses that planners should prepare for makeshift hospitals -- recognizing virtually zero hospital spare bed capacity -- with designated hospitals for coronavirus patients and registries of health care workers who have had the virus and recovered, who can work safely with patients. "The risk to the general population within Canada is still low, but this could change rapidly" warned Theresa Tam, Canada's chief medical officer.

And more reason for Canadians to have confidence in their leaders in the health care community has emerged with the news that millions of face masks that had been stockpiled to protect health care workers during a future epidemic, have expired.

Preparations underway Monday for disembarkation at the Port of Oakland, Calif., of the Grand Princess cruise ship carrying passengers and crew who have tested positive for coronavirus. Kate Munsch/Reuters