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**LONG THREAD. I have realized that something has been bothering me the past couple of days as the horror of #Herron has been exposed as well as the very dire conditions in which live many elderly patients in #LongTermCare (LTC) in #Quebec and the rest of #Canada 1/
First, I am not a medical #doctor but a #community #psychologist so my analysis is based on this expertise, not on #epidemiology nor on the #medical #patient centered #disease model, as I know next to nothing about these fields. 2/
The #data collected (see below) by @NoLore (thank you!) as well as recent news articles seems to show that an important proportion of #COVID19 related deaths occur in #LTC (and have been underestimated) 3/ https://docs.google.com/spreadsheets/d/1M_RzojK0vwF9nAozI7aoyLpPU8EA1JEqO6rq0g1iebU/edit#gid=0
I have read here on #Twitter and in various news outlets, #doctors saying that the elderly patients in #LTC are very ill and fragile to begin with so it may be expected that they bear the brunt of #covid19 deaths . Makes sense (to an extent, as I will explain) 4/
As I said, I am not an #MD . However, I would like to contribute to this discussion using a more "macro" view, rather than a clinical, medical one based on individual patient characteristics (or those of a group of individual patients, in this case: the #elderly in #LTC ). 5/
To do this, I will use #Bronfenbrenner ecological model (see link below for a description) 6/ https://en.wikipedia.org/wiki/Social_ecological_model#Bronfenbrenner's_ecological_framework_for_human_development
In a nutshell, Bronfenbrenner’s theory considers the #individual as evolving within different #contexts with which they interact and which impact their #development (see image in previous tweet) . I will give a concrete albeit fictional example to illustrate. 8/
X is an 85 year-old woman with #Alzheimers and various other physical ailments living for the past 5 years in Y a #LTC publicly-managed facility in #Quebec as she needs a lot of care. 9/
Her #family cannot take her in as they live in a cramped 4 1/2 with their 2 young children. They used to visit her weekly and make sure all was well with X. 10/
They haven’t been able to visit her for weeks and just found out she had contracted #covid19 and died. Yes of course X was very old and very ill (patient-centered view), so it is not surprising she got #covid19 covid19 and died. Or is it? 11/
Using Bronfenbrenner’s model, we need to consider the systems in which X ( #ontosystem ) was evolving. First Y ( #microsystem ), the #LTC facility which has had a chronic shortage of human resources for at least 10 years which was exacerbated by the #pandemic . 12/
Y also did not have enough #protective #material for its workers who, when displayed symptoms of COVID19, were sent back to work after less than 7 days of quarantine. #Isolation procedures were not respected by the managers of Y, because of lack of space and resources. 13/
Also, X’s family (microsystem) was barred from visiting and thus overseeing Y’s services to their mother. The relationship between those 2 microsystems ( #mesosystem ) was disrupted by the provincial law ( #macrosystem ). 14/
