MISSISSAUGA, Ontario — It was not how Mary Witkowski pictured celebrating her birthday. But with visits to her nursing home suspended to keep the coronavirus out, she turned 90 on April 13 without family, in the room at the Camilla Care Community that she shared with three others.

That week, Witkowski tested positive for COVID-19. On April 27, doctors told her family her body was “starting” to shut down. The next day, she died – the latest victim of one of the hundreds of outbreaks that have blazed through Canada’s long-term care facilities. Nursing homes account for 81 percent of the country’s COVID-19 deaths, according to Theresa Tam, Canada’s chief public health officer, a far greater proportion than in the United States.

The outbreak at the 236-bed Camilla Care Community in this Toronto suburb has been one of Canada’s deadliest. One hundred people, including 40 staff members, are sick with COVID-19, according to parent company Sienna Senior Living. Fifty-seven residents have died.

“On the day my grandmother passed away, my mom asked how many deaths there had been, and they said … not very many, there’s not that much of an outbreak,” said Michele Kranjcevic, Witkowski’s granddaughter. “But it wasn’t like that, and that’s what got me so angry.”

Officials say there are encouraging signs that the virus’ spread is slowing in many parts of Canada. But its ruthless whip through long-term care facilities continues – prompting calls for public inquiries, the deployment of military troops to hard-hit homes in Ontario and Quebec and an admission from Prime Minister Justin Trudeau that Canada is “failing” its elderly.

“We shouldn’t have soldiers taking care of seniors,” he said last month. “In the weeks and months to come, we will all have to ask tough questions about how it came to this.”

Advocates say the answers are not any secret.

“I’ve been ringing the alarm bells for two decades on this industry,” said Sharleen Stewart, president of Service Employees International Union Healthcare, which represents 60,000 health care workers. “The crisis was already here.”

Several factors – a frail and elderly resident population, old buildings with little space for separating the sick from the healthy, cramped living quarters and frequent contact between residents and caregivers – make long-term care facilities petri dishes.

That was clear in early March, when Canada’s first coronavirus outbreak and death occurred at North Vancouver’s Lynn Valley Care Center, grimly foreshadowing the devastation to come.

But officials were focused on buttressing hospitals – they scrambled to stock ventilators and critical care beds. Nathan Stall, a geriatrician at Toronto’s Sinai Health System, said long-term care was mostly overlooked.

“It wasn’t inevitable that this had to happen, and that’s the most troubling thing,” Stall said. “The decision-makers’ fear was driven by young people on ventilators in New York City, and it didn’t move the societal needle that people were dying in nursing homes elsewhere or even in our own country.”

Analysts say the sector has been chronically understaffed. Many employees, including health aides, are paid low wages and earn a living by working part-time shifts at several facilities without sick pay, making them possible vectors of transmission between homes.

“We’ve actually created a system that’s designed to fail,” said Samir Sinha, head of geriatrics at Toronto’s Sinai Health System and the University Health Network.

In Ontario, public health officials, faced with limited testing kits, initially advised against testing all long-term care residents. They also said health aides needed personal protective equipment only if their facilities had outbreaks. This left many in danger, given asymptomatic spread and the fact elderly people often present with atypical symptoms.

It was not until mid-April that the province banned staff from working at multiple facilities, required everyone to wear a mask, recommended widespread testing and topped up workers’ pay. By then, many residents had died, and many workers were ill, exacerbating staffing shortages. Now soldiers, librarians, school board staff and hospital workers have been enlisted to fill those gaps.

Stall’s hospital is helping. Many homes, he said, are in the middle of a “humanitarian crisis where the basic needs of residents cannot be met.” Colleagues have reported walking by rooms and hearing residents screaming for water.

Jarred Rosenberg, a geriatrician at Toronto’s Michael Garron Hospital, has also been assisting. He said many facilities were lacking PPE, so his hospital has shared its own.

“Staff were really stressed,” Rosenberg said. “They were fearful, and they were overburdened.”

A worker at Camilla Care, who spoke on the condition of anonymity to avoid retribution, said the home initially gave those who have direct contact with residents more PPE than those who do not. One colleague, who dropped her mask, was told to reuse it. The employee was told to reuse her gown and had one mask for an entire shift.

She later tested positive for COVID-19 – “a horrible experience,” she said, particularly because she had to isolate herself from her young children. Her youngest has awakened up in the middle of the night, crying “I want my mommy. I love my mommy. I miss her.”

For decades, expert panels and public inquiries have reported systemic deficiencies in long-term care. Lawmakers promised changes, but few materialized.

Canada is far from the only country with calamitous outbreaks in long-term care homes. The World Health Organization said half of Europe’s COVID-19 deaths occurred in such facilities. Nearly 40 percent of all U.S. deaths have occurred in nursing homes, according to the Kaiser Family Foundation. At least 1 in 10 U.S. nursing homes have reported outbreaks, according to a Washington Post analysis.

Canada’s national health insurance does not cover long-term care. A mix of public, nonprofit and for-profit entities run the homes.

This week, the Ontario government adopted an emergency order granting it the power to take over facilities that are struggling with outbreaks.

Sienna Senior Living, a publicly traded company that owns and operates 70 seniors’ residences in Canada, pays shareholders an annualized dividend of $0.67. It did not mention COVID-19 during a Feb. 20 quarterly earnings call. Lawmakers have delivered donated PPE to the home during the outbreak.

A spokeswoman for the company responded to questions with a statement saying it was “grieving the loss” of57residents at Camilla Care, but noted that 71 residents and 15 staff members had recovered.

“Thanks to the hard work of our team and health partners, we are now seeing positive progress in the fight against COVID-19,” spokeswoman Natalie Gokchenian said.

It is unclear how the coronavirus got into the 50-year-old facility. Health care workers from a neighboring hospital have been dispatched to help.

Families say they have struggled to get basic answers.

A May 8 voice message to families obtained by The Post made no mention of deaths. Reporting lags meant the number of positive cases it reported conflicted with figures posted by the regional health body, which were different from those reported by the province.

Lily Irwin’s 49-year-old sister, who has multiple sclerosis, tested positive for COVID-19 last month. Her sister’s health aide has not been working, Irwin said; there was a two-week period when she was not bathed. She has called Irwin in tears because she needed help cutting her meat, and no one was around.

Irwin said the staff aiding her sister have been “so caring and loving” and “are doing everything they can.” She blames the management for its response to the outbreak.

“It has been tough on [my sister] to know that all of these people are passing away,” Irwin said. “She said to me the other day, ‘There’s just two of us left on this side.’ ”

When Carol Francis heard there was a COVID-19 case in her 94-year-old mother’s room last month, she asked if the sick would be isolated from the healthy. She was told everyone was being treated as if they were sick.

Francis planned to drop off a radio for her mother on Mother’s Day. It would be set to a country music station for the woman who loves Patsy Cline and getting her hair done. That morning, she got bad news: Her mother had tested positive.

She is grateful for the workers caring for her mom: “The word hero just doesn’t cut it.” She knows she could not have cared for her mother on her own, she said, but still, she has struggled with thoughts of “I put her there.”

Ellen Hurley-Guy suspected something was wrong with Mary Guy, her 83-year-old mother-in-law, when she looked ill during a video call. The New York Yankees fanatic was moved into her own room because she regularly traveled to a Mississauga hospital for dialysis. During one of those visits, she was admitted with several infections. She tested positive for the virus and died in hospital on May 4.

Hurley-Guy said it is not clear what caused her mother-in-law’s death. She said the only call she received from Camilla Care was to ask when she would pick up Guy’s belongings.

“It snowballed and went so fast and then she’s gone,” she said. “There’s no closure.”

Kranjcevic is grieving the loss of her grandmother – and fighting for answers.

“I know my grandma’s not there and some people tell me it’s not my fight anymore,” she said. “But it is my fight because I have two parents that are baby boomers, and if, God forbid, either of them ever had to go into a nursing home, I don’t want any nursing home being like this.”

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