COVID-19 in Long-Term Care: A Two-Part Commentary

Abstract

Part One: Examining the Definition of DisasterThe coronavirus disease 2019 (COVID-19) pandemic has had a major impact on health, economic, political, and social systems, exacerbated existing inequity, stretched systems to the point of failure, and exposed vulnerabilities globally. We will present a case study of COVID-19's impact in long-term care (LTC) in Canada's most populous province, Ontario. Originally, COVID-19 in LTC was called a crisis by politicians and mainstream media, but the situation and response were comparable to major disasters and wartime. Governments, health systems, and emergency agencies have disaster preparedness plans, however COVD-19's size and duration exposed the limits of these plans. This paper is the first of a two-part commentary that will begin by demonstrating that COVID-19 in LTC meets the definition of disaster by examining existing definitions and comparing COVID-19 in LTC to other disasters. The second paper will apply the case study of COVID-19 in LTC to a disaster framework to identify key contributing factors. The rationale of this discussion is to learn lessons from the experience of COVID-19 in LTC by expanding our perspective of what is a disaster, while identifying what factors contributed, in order to improve preparedness for all types of disaster.The word "disaster" comes from the Greek word "dis" meaning bad or ill-favored, and "aster" meaning star. 1 This coincides with the belief that disasters were from an external force, and the Judeo-Christian view as an "act of God," 2 which frames disasters as: "tragic situations over which persons, groups, or communities have no controlsituations which are imposed by an outside force too great to resist." 3(p733) However, more recently, perspectives related to the definition have shifted from event-centric to human-centric; 4 a complex interaction of environment and human agency, 5 and social phenomenaas Stallings stated: "'Social' separates disasters from tragedies that befall individuals or small groups such as a family. Disasters are collective in nature." 6(p263) Thus, the focus of disaster theory has expanded from the "what" hazard that could impact a community -or event that has occurred -to the "how" and "why" it could or did impact a community.The definition continues to evolve, shifting with dominant socio-political forces. 7-9 Similarities can be found in contemporary definitions and systems of classification. The International Federation of the Red Cross and Red Crescent Societies (Geneva, Switzerland) defines disaster as: " : : : serious disruptions to the functioning of a community that exceed its capacity to cope using its own resources. Disasters can be caused by natural,