When they found out a resident at the Markhaven Home for Seniors had tested positive for COVID-19, Maggie Gittens’ children begged her not to care for the woman.
A personal support worker at Markhaven, Gittens was 60 and had health issues of her own that put her at risk.
But when she got to work, she ended up taking care of the 74-year-old.
She recalled thinking the woman should have been sent to the hospital so the Markham, Ont., nursing home and its staff wouldn’t have to contend with the deadly virus.
“But she was there and I had to deal with it,” Gittens said in an interview. “And as a result of that, I almost lost my life.”
Gittens had been at Markhaven for 30 years.
As COVID-19 appeared in Canada, it was “work as usual,” she said. “And then when it got to the home, it was like panic inside.”
Staff were worried about the residents, but also for themselves and their families.
Gittens said that while staff had gloves, they were only allowed to wear full personal protective equipment (PPE) when caring for the resident with COVID-19. A source provided Global News with a photo of a locked room where the PPE was allegedly stored.
“We wasn’t allowed to just wear it outside, only when we go in to give care to that individual,” Gittens said.
After that, the PPE came off. And she still had to care for the other residents and go into common areas like the dining room.
“So it was a concern,” she said.
Staff were told to wash their hands, but she said it wasn’t always clear what they were supposed to do to prevent the virus from spreading.
“We was getting mixed messages, if I could put it that way,” she said. “One minute you’re told you’re not supposed to do this, one minute you’re told do this, you know? So you don’t know which way you’re going.
“I would say in a way we was walking blind.”
Markhaven declined to be interviewed but said in a written statement it had “strictly followed the guidelines mandated by health authorities.”
March 23: ‘Damage control’
Just three days after the first Markhaven resident tested positive for COVID-19, one of Gittens’ colleagues became the first staff member confirmed to have the virus.
“Client was symptomatic on March 17, 2020 with headache and cough; March 20 with SOB (shortness of breath) and fever,” according to York Region Public Health records obtained by Global News.
“Contact made with Kevin,” the local health records indicate, referring to Markhaven’s director of care. “Kevin states that he is doing damage control now as staff … jumps off shift.”
York Health wanted all staff who were ill to be tested. No staff with symptoms — even if they had resolved — were to return to work until they had tested negative for COVID-19.
“Kevin’s role is to decrease staff anxiety,” the records read. “Kevin needs to mend the building.”
Now that a staff member had tested positive, public health officers needed to trace the PSW’s movements. Which residents had she cared for? Which staff had she interacted with? What shifts had she worked? Where else had she worked?
Complicating the contact tracing, the Markhaven worker with COVID-19 worked at another home as well. Health officers also learned that a different Markhaven staff member worked at a nearby retirement community. The worker was interviewed and told to get tested at Markham Stouffville Hospital.
Meanwhile, a report came into York public health that a resident at the Rouge Valley home in Toronto had a care worker who also worked at Markhaven and had tested positive, according to the public health records.
“The issue of staff going back and forth between a variety of different kinds of institutions, or going from long-term care home to long-term care home has been a known vector for these illnesses for many, many years,” Jane Meadus, a lawyer at the Advocacy Centre for the Elderly, told Global News.
“Trying to stop this has been a big problem,” she said. “Part of the problem is the lack of staff and people willing to work in the area. Part of the problem is not having proper wages or full-time work for people so that they’re required to go and work in more than one place.”
March 24: ‘Make sure they have enough PPEs’
Markhaven staff continued to fall ill. Another tested positive for COVID-19, and more were showing symptoms. One was sent home and went for testing, and another called in sick, records show.
“Provided strong recommendation of full PPEs because of the staff mix,” read York Health’s records of a phone call with the home’s management. “Facilities need to make sure they have enough PPEs.”
The email sent to families that night was upbeat.
“Today there was a tangible change of mood in the home,” Markhaven’s executive director Mike Bakewell wrote, “and I believe a great deal of it is due to all the touching emails we received from you cheering us on!”
Staff were entering the building to “applause and cheers,” and whenever a negative test result was received, it was announced in the building, the email said.
Because several staff and residents with symptoms had been tested and cleared of COVID-19, the home suspected that “we have multiple illnesses in the building.”
“This gives us hope that most who are currently exhibiting symptoms are positive of something other than COVID-19 (i.e. common cold or flu),” the email read.
March 26: Contact Tracing
Almost a week into the outbreak, York Region Public Health was continuing to ask Markhaven’s management for a visitor list so it could trace those who had been exposed to the virus.
“Can you please provide a list of ALL health care providers (physicians, chiropodists, hair dressers, physiotherapists and other service providers) who were in your facility since March 1, 2020,” the region’s manager of health protection, Ewilla Castellan-Wong, wrote in an email to the home’s care director.
“If possible, please indicate the last date on which these providers were in the facility, along with contact numbers so they can be reached.”
To make sure he got the message, she texted it to him as well.
March 27: Exposed
The first resident with COVID-19 was supposed to stay in her room, but when she climbed out of bed and appeared in the hallway, Gittens took her back to her room.
Gittens was wearing PPE, but she helped her use the toilet and had to clean her up and change her. “And so it took me longer in there, exposed to all this, by myself,” she said.
Her shift ended at 2 p.m.
“I started coughing after work,” she said. “It was just a slight cough.”
“During the night, the cough progressed.”
March 28: Getting tested
The cough didn’t improve overnight, and in the morning, her daughter called the public health line and was told that her mother should go to Markham Stouffville Hospital to get swabbed.
While she was waiting for the results at home, a second Markhaven resident tested positive. Eight staff members now had the virus. And a resident with no COVID-19 symptoms had died.
Although Lynda Jean Duncan was not among those listed by Markhaven as having respiratory symptoms, a test conducted following her death confirmed she had the virus.
At 68, she was among the younger residents of Markhaven. Her family was told in October she had six months to live. The cause of death was a pulmonary anabolism, her family said.
“I feel like she was treated very well at the home and the staff and administration did a great job of keeping the families updated throughout the outbreak,” her son Scott said.
March 29: ‘Kevin is requesting more death certificates’
Public health nurse Candace Wong sent an email to Markhaven’s director of care early in the morning, again asking for information needed for contact tracing.
She also wanted the names of vendors who had been at the home for a March 7 entertainment event, as well as physicians and other health-care providers who had been to Markhaven.
An entry in Markaven’s client record that afternoon referred to Connecting Ontario, the online portal that provides access to digital health records, including laboratory results. According to the York Health notes, the care director was “not able to remember how to use it.”
At 7:15 p.m. that night, Markhaven’s care director phoned York Health. “Kevin is requesting more death certificates as office has locked them up,” according to the public health records.
“Kevin informed group that there is a second death.”
March 30: ‘It’s destroyed her’
The phone call that Gittens had been waiting for came on the morning of Monday, March 30.
She had tested positive.
“My heart dropped and I thought, ‘Oh my God. My kids, my grandkids, the residents, the ones that I worked with,’” she said. “And I thought, ‘Oh my God, I hope that they don’t get it.’”
She was still processing the news when the home, which was struggling with a staffing crisis, asked her to work a double shift. “And I said, ‘I just got the call and I’m positive.’”
Her daughter Nerona was upset. She understood the staff had to do their jobs, but felt that, given her mother’s age and health issues, she should not have been caring for a resident with the virus.
“I’m not saying that she should have special treatment, but … I think they could have gotten somebody a bit younger, more healthy that could have taken on that assignment,” she said.
Nor was she impressed with the procedures the home had in place to deal with the pandemic.
“They were basically just being told what you would hear on TV: Wash your hands, wear your mask,” Nerona said. “But they weren’t wearing masks at all times.
“They weren’t properly protected.”
March 31: ‘What is happening now is not sustainable’
With six residents and 10 staff members now ill with the virus, Markhaven asked York Health about getting more PPE and staff training, according to notes from that day. “Family is getting more concerned with what’s going on.”
At 4:20 p.m., health officials phoned back to speak to the director of care about getting more swab tests done, but the conversation took a turn. The director Kevin McKay said the home could not carry on.
“Kevin explained that what is going on now is not sustainable. Inquired if there is any guidance that will sustain what is going on,” according to the health board’s record of the call.
“Requesting for something realistic to work on. What is happening now is not sustainable, otherwise they will shut the facility down and transfer the patients out.”
He said there were no vendors to supply Markhaven with PPE, and “no plan that has longevity,” according to the call notes.
“Writer (the public health officer who wrote the entry in Markhaven’s client record) stated that she will bring it back to senior management team.”
The same theme continued in a phone call that evening. The director of care said he was “very concerned” that the rules on PPE use were “not sustainable to the facility.”
The home was “really short of masks and gowns,” according to the call notes.
That sense of urgency was not apparent in the email sent to families that night.
“I’m feeling a little more upbeat today,” the home’s management wrote, “and it’s helpful that we received negative test results for one employee and 4 more residents!”
Twelve staff now had COVID-19.
Gittens stayed in her room at home after getting her positive test result. Her daughters left meals outside her door and listened as she coughed. They asked if she was all right and she insisted she was fine.
The family expected to get a phone call asking for the names of those Gittens had come into contact with, the residents and staff she may have inadvertently exposed to the virus. But the call never came.
“Until now, no one asked,” she said.
After two days, Nerona saw her mother out of bed and staggering. Gittens downplayed it, saying she had just been sitting too long, but her children called 911 and the paramedics took her to the hospital.
“I know I was coughing lots, coughing non-stop, because I thought, ‘I’m going to die from coughing.’ I called the nurse and asked for medication for the cough,” she said.
Gittens was still coughing the next day and hospital staff put her on oxygen. But her condition declined and she was transferred to the intensive care unit and hooked up to a ventilator.
She doesn’t remember what happened after that, but her family does. They weren’t allowed to visit because of COVID-19 restrictions, but the hospital used iPads to let them check up on her. They recorded some of those calls.
“So it was nice, we got to see her, but it was hard seeing my mom like, in a coma, basically, she was in a medically-induced coma,” Nerona said. “She was on the ventilator for 17 days.”
The daily progress reports from the hospital seemed to be nothing but bad news. They had upped her sedation and increased the ventilator. She couldn’t take her meals, so they were feeding her through a tube.
“One day the doctor called. He was very stern, very. I would never forget that day. Oh, my God. It was a Saturday morning. My sister and I were sitting on my bed and the doctor called and he said, you know, I’m doctor — I don’t remember his name,” Nerona said.
“And he said, ‘Your mom’s not doing so good. She’s very sick. She’s developed ARDS (acute respiratory distress syndrome).’ At the point, I didn’t even know what that was.
“He said she’s developed another ventilator-related pneumonia, so she already had pneumonia and then she developed a ventilator-related pneumonia and then she developed ARDS.
“She had fevers, like, her fever just kept spiking because of all the infections. And, you know, they were trying different treatments and antibiotics,” she said. “My sister and I were just in tears.”
Nerona watched television church services and prayed. Friends prayed with her over the phone. A doctor gave them hope, reassuring the family that Gittens was in good hands.
Then the fever broke, her lungs were looking better. The hospital began to wean her off sedatives, and she seemed to respond well. When she was strong enough, she was taken off the ventilator.
“We just burst into tears, couldn’t believe it. It was like the best day of my life,” Nerona said.
“I was so happy.”
Once she awoke, a doctor told Gittens she was a “strong woman.” She had no idea what he was talking about. She didn’t realize she’d been at the hospital for three weeks. She thought it was still day one.
“All I know, I woke up in diapers,” Gittens said.
“Can you imagine? With bedrails, hooked up to a tube, tube in my nose, the pain in my throat, in my nose. I was so scared.”
Gittens had to learn how to swallow again. She used a walker and a cane until she regained her strength.
She has trouble sleeping now.
It scares her to go outside. She doesn’t think people are taking the virus seriously enough.
“My mom was one of the strongest people, always out there on the go,” Nerona said. “And now she’s just, I think she’s crying a lot. She cries all the time and she feels bad, having to depend on us. But what can you do? I just tell her, it’s not a problem for us.
“But it’s destroyed her.”
Nerona said the home should have done more to protect the staff and prevent the virus from spreading.
“I think had the home taken a more proactive approach, this wouldn’t have ever gone that far,” she said.
“We’re so mad at Markhaven, my brother, my sister and I,” she said. “We’re just so upset with the way things played out and the reason why my mom is the way she is now.
“It’s just so upsetting, you know.”
Seven months later, Gittens has not returned to work, and may never be able to. She goes to therapy twice a week.
“I worked through all the outbreaks and that’s the one that got me. That’s the one that break me,” she said.
If she had to do it over again, she said she’d make sure she was properly protected.
“In my opinion, I don’t think it was handled right,” she said of the outbreak. “I think it could have been handled better and I think if they did, it would not have been so bad.”