Investigators look into catastrophic outbreak that infected all residents of TMR seniors' home, killing 70
100% of residents at CHSLD Vigi Mont-Royal, 96% at CHSLD Vigi DDO infected, along with scores of workers
Public health, as well as health and workplace safety investigators, don't know exactly how all 226 residents and some 148 employees of a private seniors' home in the Town of Mount Royal became infected with COVID-19 — a catastrophic outbreak that has killed at least 70 residents.
Quebec Public Health Director Dr. Horacio Arruda said Thursday that the CHSLD Vigi Mont-Royal appears not to have been managed with the level of infection prevention controls in place at hospitals.
With too few employees on duty, the seniors' home may not have been kept as clean as it should have been, or people may even have been dining together, contributing to the spread of the novel coronavirus, he said.
It is possible a faulty ventilation system was a source of transmission.
With staff getting infected despite wearing appropriate personal protective equipment, the health agency that oversees the home, the CIUSSS Centre-Ouest-de-l'Île-de-Montréal, conducted an air-quality study, and experts found virus particles in the air in some rooms.
Could ventilations systems be a factor?
An infectious disease specialist at Sainte-Justine Hospital, Caroline Quach, said studies done elsewhere have found particles, known as virus RNA, in the air of patients' rooms — although not in ventilation systems — but whether those airborne particles are capable of infecting people is inconclusive.
Air filtration is important for filtering out all kinds of diseases and allergens, said Arruda, but it is "perhaps a very low factor in transmission" of COVID-19.
Dr. Mylène Drouin, the public health director for the Montreal region, agreed with Arruda. However, she said there is still much to learn about the spread of COVID-19 in long-term care homes and hospitals.
Ventilation may be one factor, Drouin said, but a multitude of possibilities for the spread of the coronavirus make it hard to control outbreaks like the one at Vigi Mont-Royal.
Dr. Cécile Tremblay, a microbiologist and infectious disease specialist at the Centre hospitalier de l'Université de Montréal, told CBC News that ventilation systems have little to do with the transmission of COVID-19, as the disease is mainly spread through droplets.
However, the virus can stay suspended in the air a "little longer" in a closed environment that lacks adequate air circulation, she said.
Staff, military now in hazmat-like gear
Even without conclusive studies about how ventilation systems affect the spread of COVID-19, the CIUSSS Centre-Ouest-de-l'Île-de-Montréal ordered tests of the air quality at the TMR residence, due to problems with the ventilation system there dating back to late April.
"We were concerned that our staff members deployed to Vigi Mont-Royal had contracted the virus despite wearing the appropriate personal protective equipment," said CIUSSS spokesperson Carl Thériault.
Quebec's workplace health and safety board, the CNESST, has launched its own investigation into the home, where staff and military personnel are now wearing equipment not usually required in long-term care homes.
That protective gear includes waterproof gowns, N95 masks, visors, hoods, gloves that end at the elbows and shoe covers. Workers continue to wear it, despite the fact that inspectors have now said the air quality is now safe.
The home is owned by Vigi Santé, a company that operates 15 long-term care homes in Quebec. The company's assistant director, Jean Hébert, said a crew was sent to repair the ventilation system on April 30 — the day after the health board raised concerns.
Some 50 Vigi-Santé employees have returned to work after testing negative, Hébert said, and every precaution has been taken to ensure their safety and to protect residents.
Air quality was tested Wednesday and was found to be excellent, he said, and the facility is being disinfected to meet standards set by public health authorities. He said all staff have been provided the proper personal protective equipment, as well.
FIQ seeks court order to ensure nurses' safety
Quebec's largest nurses' federation, the Fédération interprofessionnelle de la santé du Québec (FIQ), disagrees with Hébert's assessment.
"People were [testing] positive at a phenomenal speed," said Sonia Mancier, president of the FIQ wing representing private-sector nurses.
Mancier said she believes the disorganization at Vigi Santé, including the mixing of hot and cold zones, encouraged the spread of the virus in several of the company's homes. She is also concerned about similar problems with ventilation systems at other homes owned by the company.
For example, 96 per cent of residents of CHSLD Vigi Dollard-des-Ormeaux, also owned by Vigi Santé, have tested positive, and 66 of them have died, according to internal documents obtained by Radio-Canada.
That same investigation shows 116 employees of that West Island facility also became infected.
The CIUSSS de l'Ouest-de-l'Île-de-Montréal sent a team of workers to Vigi Dollard-des-Ormeaux, and a spokesperson said the situation is difficult but stable.
Other documents addressed to Quebec's minister responsible for seniors, Marguerite Blais, and obtained by Radio-Canada show there are two other homes owned by Vigi Santé with "significant" outbreaks: Vigi Pierrefonds and Vigi Reine-Élizabeth.
Earlier this week, the FIQ obtained a court order from the Quebec Superior Court to compel Vigi Santé to carry out air-quality inspections at Vigi Dollard-des-Ormeaux and Vigi Reine-Élizabeth and to provide protective equipment to all employees.
Even before the judge ordered the air testing on Wednesday, Vigi Santé said under oath that it had appointed three expert firms to carry out tests. The judge demanded that the results be sent to the union.
With files from Radio-Canada's Thomas Gerbet and CBC's Sudha Krishnan