As COVID-19 cases climb in long-term care homes, experts hope to avoid locking down residents
Thought of repeating spring's isolation is traumatizing for LTC residents and families, doctor says
As the number of people infected with COVID-19 continues to climb, the virus has crept back into long-term care and retirement homes across the country.
After spreading like wildfire through hundreds of facilities in the spring, killing thousands of seniors, health officials were able to bring it under control during the summer, said Dr. Samir Sinha, director of geriatrics at Sinai Health in Toronto.
But after Labour Day, as COVID-19 cases sharply rose among the general public, so too did the number of outbreaks in long-term care.
"It really reminds us that the outbreaks that we see in our nursing homes and our retirement homes across the country are really the product of community transmission," Sinha told Dr. Brian Goldman, host of the CBC podcast The Dose.
LISTEN | What have we learned about COVID-19 to keep my elderly loved one safe in long-term care this time around?
"What really worries me now going into the second wave is that as we're seeing the community transmission ramp up, we're seeing more and more homes get into outbreak," Sinha said.
"It's only going to be a matter of time before that translates into more deaths ... deaths that unfortunately, I think, many of us feel are just utterly preventable."
Based on data provided by provincial health ministries, CBC News estimates that as of Tuesday evening, there were active COVID-19 outbreaks in more than 120 long-term care homes in Canada's hardest-hit provinces alone: Ontario, Quebec, Alberta and British Columbia.
On top of the LTC count, there are close to 100 outbreaks in retirement homes in those provinces, primarily in Ontario and Quebec.
"Outbreaks" are defined differently in various provinces. In Ontario, only one case — either a resident or a staff member — triggers outbreak protocols. Other provinces count two or more cases as an outbreak.
Given how deadly COVID-19 has been among elderly Canadians, any resurgence of cases in long-term care facilities is concerning, experts say — but not surprising.
"It's very similar to the schools, in the sense that what we see in long-term care homes is going to reflect what we're seeing in the community," said Ashleigh Tuite, an infectious disease epidemiologist at the University of Toronto's Dalla Lana School of Public Health.
"So as we see community transmission increase, we expect to start seeing increases in long-term care homes and retirement homes because they're not sealed off from the rest of our community."
Staff who work in long-term care and retirement homes live in the community, Sinha said, so in places where there is a lot of coronavirus circulating — such as hot spots like Toronto, Ottawa and Montreal — it's much more likely they "are inadvertently getting COVID and then inadvertently bringing it into [care] homes."
Although it's "early days," Sinha sees some hope in the fact that the majority of outbreaks this fall appear to be much smaller than they were during COVID-19's first assault on long-term care homes last spring.
"Perhaps we have better systems in place that we can identify it early, isolate quickly and not let small outbreaks become massive outbreaks," Sinha said.
That's the big question, Tuite said, that will determine whether COVID-19 will be less catastrophic this time around.
"What do those outbreaks look like?" she said. "Are we able to nip them in the bud and, you know, basically find infected staff before they transmit to residents?"
Whether that happens will reveal if the changes governments and long-term care homes have pledged since the spring are enough to combat this round of COVID-19, said Dr. Isaac Bogoch, an infectious disease specialist at Toronto's University Health Network.
"What is disappointing is how much of it we're seeing this early in the fall, knowing there's a long fall and winter ahead," Bogoch said.
"It's not like we don't know what we're doing now," he said. "We have a very good idea of how this virus spreads, who's vulnerable, and we saw the tremendous vulnerabilities of our long-term facilities during the first wave."
Some vital policy changes were promised as a result, he said, including fixing the problem of underpaid care workers moving between homes, ensuring access to personal protective equipment and integrating infection prevention and control measures in long-term care homes.
"This has theoretically been done, but has it actually been implemented to an extent that will protect the long-term care facilities throughout the course of the fall and the winter? The answer remains to be seen."
Long-term care lockdowns 'last resort'
In addition to protecting seniors from COVID-19 infection, Sinha emphasized the importance of protecting them from re-living the lockdown of long-term care and retirement homes that happened in the spring.
The thought of going through that fear, loneliness and isolation again is traumatizing, he said.
"I can't imagine the emotions that people are feeling right now," Sinha said. "[But] I think we're going to do a better job this round ... about making sure we're not shutting families out completely."
Even as COVID-19 cases rise, some provinces, including Ontario, have recognized that and aren't locking long-term care homes down completely, allowing residents to have at least one designated "family caregiver."
That caregiver not only provides much-needed emotional support, but also helps understaffed homes with tasks such as feeding and bathing their elderly family member, Sinha said.
In addition, it's important for people to consider their loved one's wishes when weighing the risks and benefits of seeing them in long-term care, he said. Many of his patients tell him the value of family visits overrides their worries about getting COVID-19.
The way to visit as safely as possible, he said, is to make sure that you're following public health guidelines in all other aspects of your life, including avoiding crowds, physically distancing, wearing a mask and handwashing.
"If you know that you're doing the right things yourself personally to protect yourself against COVID and then you're following all the protocols and precautions [at the long-term care home]," then it's likely pretty safe, Sinha said.
Tuite agrees that access to family visits should be maintained during this next phase of COVID-19.
"I think lockdowns should be a measure of last resort," she said.
"At this point we know enough about the virus, we have enough tools that we can control it," Tuite said.
"The fact that there's COVID circulating doesn't mean that we need to lock these homes down. It means that we need to have really strong infection prevention and control measures in place. It means that people who are going into the homes need to be screened."
And, Tuite said, it means flattening the COVID-19 curve once again.
"The best way to protect people living in long-term care homes is to keep community transmission low," she said.
With files from Dr. Brian Goldman, Dawna Dingwall and CBC Montreal