The lives of elderly people should not be accepted as the cost of doing business, but that's the message Premier Doug Ford is sending when he publicly empathizes with the plight of small business owners and resists implementing restrictions that would prevent deaths in long-term care, a leading geriatrician said Friday.

Dr. Nathan Stall of Mount Sinai Hospital and Doris Grinspun, CEO of the Registered Nurses' Association, held a virtual press conference Friday morning.

Stall made the case that it's not possible to protect vulnerable seniors when COVID-19 is running rampant in the community, and it's not ethical to isolate them either.

An emphasis on walling off the elderly and vulnerable is at the heart of strategies such as the controversial Great Barrington Declaration, as well as Ontario's own failed plans to put an "iron ring" around long-term care homes in the first wave. It also lives in the premier's repeated comments about needing a "balanced" approach between protecting the livelihood of small business owners and protecting Ontarians' health, said Stall.

The iron ring approach failed in the first wave. Stall's research, which the minister of long-term care has cited, found that the extent of local community spread of the virus was the greatest predictor of a long-term care home going into outbreak in the first wave.

"We also know that empirical evidence from other countries shows that it just doesn't work, trying to restrict uncontrolled outbreaks to particular sections of society," he said. "If you let COVID-19 run rampant, you're going to have deaths among our most vulnerable."

Stall explained that's because the staff who work in those homes live in those communities, many of them in lower-income hotspots and multigenerational homes. Putting a ring around vulnerable Ontarians would mean not only isolating the 100,000 of them who live in congregate care settings, but also the 100,000 or so workers who care for them.

Stall and Grinspun emphasized that isolating seniors, even in efforts to protect them from COVID-19 is also very harmful, leading to loneliness, depression and declining health.

"This is heartbreaking, what's happening to our older adults, not only the deaths but also the conditions that we are imposing on them because we are not taking action to suppress community transmission and really get this under control," said Stall.

Stall said the continued tolerance of the crisis in long-term care stems from the "identifiable lives bias," a theory that says people respond more aggressively to threats to lives that they can easily imagine being their own or belonging to people they care about.

"The reality is, most people don't identify with the lives in long-term care homes and if you look at the language that's being used to drive public health policy, the language of balance, there's a lot of identifying with small business owners and not as much identification with the vulnerable," he said.

Stall said there are layers of structural discrimination, noting not only ageism in the muted responses to the plights of the elderly, but also that the majority of long-term care workers are women and many are people of colour, and that may be preventing permanent changes to their compensation and working conditions.

He said it has been hard to watch the ongoing loss of life and suffering in long-term care homes be met with complacency.

"If older adults were valued equally, arguments to compromise public health for economic reasons or resist small sacrifices of personal autonomy would ring hollow," he said. "I really question, if that's what's driving the inaction we're seeing with, the numbers that are being presented by multiple different sources and why we are failing to act to protect older adults and those long-term care settings."

Stall noted that business owners have political power while long-term care residents do not and said that showed in the premier's daily press conferences, which are often held at small businesses but not in front of long-term care homes.

"It seems to me when they continue to say, 'We need balance,' that they accept the deaths of these long-term care residents as somewhat of an acceptable cost of doing business," said Stall. "And that's very provocative to say but I'm starting to believe that, and I see no evidence to the contrary."

But Stall didn't blame business owners for that. Acknowledging that closures take a terrible toll, he called on them to be compensated financially. Both Stall and Grinspun said the economy can only be healthy when the population is.

"If you don't suffocate the virus soon, you're only going to prolong the suffering of the economy," said Grinspun. "And in the process, we will have more illness, and more death, not only in nursing homes. If we don't act now, nursing homes will be the worst no doubt [but] we will see death in our own communities amongst people aged 50, 60, 70. It will be a disaster."

At his afternoon press conference, Ford was asked why he often mentions that his heart breaks for struggling small business owners but doesn't talk about it breaking for the families of those who have died.

"Nothing weighs more on me than when I talk to family members on the phone," he replied. "I met a lady the other day that came up to me and said, 'I want to thank you for doing a great job and I lost both my parents and long-term care, a week apart, two weeks ago.'"

"If you don't think this weighs on me, you don't know me very well," he told the reporter. "It weighs on me. Believe me."

Long-term care is ‘our provincial shame’: Geriatrician teams up with nurses’ association to call out Ontario’s ageism

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