Risk of COVID-19 is ‘skyrocketing’ in long-term care facilities. Advocates say governments aren’t doing enough
OTTAWA-The new coronavirus will keep killing people in long-term care facilities even after the overall spread of COVID-19 starts to slow, Canada's top public health officer warns.
The federal government responded to the stark caveat from Dr. Theresa Tam with voluntary safety guidelines for the provinces Monday, while Ontario faced more questions on how it has managed the pandemic wreaking havoc in the province's nursing homes, with outbreaks in at least 89.
Tam said "close to half" the country's 724 COVID-19 deaths as of midday Monday were in long-term care, where aging and vulnerable residents live and eat in close proximity to each other and where staff have been carriers or become infected.
"This is driving the severe outcomes in Canada," she added.
The risk to seniors in nursing homes is "skyrocketing" at the same time risk in the general community is coming under better control, said Dr. David Fisman, an epidemiologist at the University of Toronto's Dalla Lana School of Public Health.
"The rate of death in long-term care is somewhere between 10 and 20 times higher than the same cohort outside long-term care," he told the Star, based on computer modelling with recent data.
There is no time to waste in fixing the problem, said a senior Ontario hospital executive who spoke on condition of anonymity to speak freely.
"It's a tragedy in the making."
The federal guidelines to better protect nursing home residents comes amid widespread reports detailing the horrors of a private-care home in Dorval, Que., where 31 residents died over the past month. In what Quebec Premier Franiois Legault called "gross negligence," residents were abandoned by staff during the outbreak, prompting a criminal investigation by Montreal police.
One volunteer nurse told the Star she arrived at the home on March 29 to find residents begging for water and soaked in urine and feces.
The pandemic has hit other long-term care facilities hard. In Bobcaygeon, Ont., 29 residents have died at the Pinecrest Nursing Home. In North Vancouver, more than a dozen people died at the Lynn Valley Care Centre - an outbreak that raised the alarm last month about the vulnerability of elderly Canadians to this new virus.
Ontario Premier Doug Ford acknowledged workers who hold down jobs in more than one nursing home have helped spread the potentially deadly infection even as visitors have been restricted.
"I agree. You can't be jumping from home-to-home," said Ford, whose Progressive Conservatives have, nevertheless, not banned the practice despite repeated calls from critics to do so.
A recommendation from Ontario's chief medical officer, Dr. David Williams, that personal support workers and other staff work solely in one nursing home has failed seniors and their families who are "terrified" of the rising number of COVID-19 casualties, said NDP Leader Andrea Horwath.
"Facilities often schedule each staffer for only part-time hours. Until the government requires that to change, staff will continue to be forced to work at several facilities to cobble together enough wages to get by," she added.
The hospital executive called on Ford to take firm action.
"It's clear the government's overall response is rudderless and the premier needs to take responsibility like he did with getting supplies of PPE (personal protective equipment)," the health- care industry veteran added.
Deb Schulte, the seniors' minister in Justin Trudeau's Liberal government, said Monday that long-term care - like health care in general - falls under provincial jurisdiction, but that new federal advice to prevent infections of people most vulnerable to the deadly coronavirus will be "exceedingly helpful."
The new guidelines include: limiting visitors and volunteers to these facilities; screening workers and visitors for COVID-19 symptoms; requiring people entering the facilities to wear masks at all times; more training on infection control; limiting the number of locations where health-care providers work; and implementing routine additional cleaning practices.
While Ottawa has earmarked $2 billion to procure new medical equipment for all health-care providers - including in nursing homes - the federal government is leaving it to the provinces to fund measures designed specifically to protect people in long-term care facilities.
"The initiative at this point is to work co-operatively across the country and not spend all our time fighting over jurisdiction," Schulte told reporters when asked why Ottawa isn't devoting resources to help enact its new guidelines for long-term care facilities.
She pointed to recently announced spending in British Columbia, Ontario and Quebec that amounts to $386 million.
Ontario took similar restrictive measures to protecting long-term care residents weeks ago but infections and deaths have continued to climb in nursing homes, with at least 120 dead.
"Some of the workers were working in two or three different care settings and they inadvertently brought the virus into the homes," Ontario Health Minister Christine Elliott said Monday.
Ford acknowledged it's "common sense you don't want to have people going from home to home to home."
But he warned suddenly ending the practice would leave nursing homes short of staff at a time when they're struggling to keep up with patient care.
"How do you fill those gaps? There's going to be gaps if we start requiring that," the premier said.
Ontario's associate medical officer, Dr. Barbara Yaffe, agreed that changing the staffing rules is "not a simple thing" but it said it has been discussed several times recently at pandemic meetings of federal and provincial officials across the country.
"I know it is being strongly considered," she told a news conference Monday. "Others are thinking about it. I think it could still have an effect."
The federal government's collection of national pandemic data, while incomplete, also indicates older Canadians are more vulnerable to the disease. Of the 9,292 cases for which hospitalization data is available as of April 12, people who are over 59 years old accounted for 63 per cent of patients admitted to intensive care and 94 per cent of deaths, according to data published by the federal government.
Even as widespread health measures like isolation and social distancing start reducing the spread of the virus, Tam said deaths will continue to climb because of outbreaks in these care facilities.
"We cannot prevent every death, but we must prevent every death we can. We need to protect our seniors," she said.
Rob Ferguson is a Toronto-based reporter covering Ontario politics. Follow him on Twitter: @robferguson1
Alex Ballingall is an Ottawa-based reporter covering national politics. Follow him on Twitter: @aballinga