Long-term care outbreaks are rising, and provinces have different strategies for keeping COVID-19 out

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TORONTO – As the fourth wave continues in Canada and community spread, outbreaks are on the rise even inside Canada’s long-term care homes, leading experts stress the importance of vaccinating staff – an issue that spreads from province to province. varies.

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While many provinces are introducing vaccine mandates for health care workers and other workers in long-term care homes, other regions are allowing unvaccinated workers to continue working if they get tested regularly. are, or, in the case of Ontario, provide evidence that they have seen an educational video.

Ontario’s long-term care minister Rod Phillips said at a news conference Thursday that the province would soon publicize vaccination rates in Ontario nursing homes, but stopped short of promising a vaccine mandate for workers.

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“It reminds us how vulnerable this population is, because when we say, ‘Wow, you know, almost a hundred percent of long-term care residents across Canada are vaccinated,’ we’re having outbreaks in these homes, Dr. Samir Sinha, a specialist in geriatrics, told Granthshala.ca in a phone interview.

“These residents are still getting sick, they’re still dying.”

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After residents received the vaccine over the winter, the number of outbreaks – which peaked at 1,000 nationally in long-term care in January, Sinha said – showed the vaccine’s positive impact.

But in this fourth wave, as the more permeable delta version takes hold, long-term care is once again seeing a surge in outbreaks.

According to A tracker of outbreaks in long-term care and retirement homes Put together by the National Institute of Aging (NIA), more than 200 facilities across Canada are currently coping with outbreaks – although it’s important to note that outbreaks may be, in some cases, only in some cases. .

Even a small outbreak can throw a care home into complete or partial lockdown, cutting off essential visits from family.

Sinha said that despite the size of the outbreak, their numbers are clearly increasing rapidly during this fourth wave. Earlier in the summer, there were about 10 homes with outbreaks across Canada, he explained.

“It’s growing at a rapid, rapid pace, and it’s especially happening in places where there’s significant community spread,” Sinha said.

“However one of the ongoing challenges is that we see outbreaks from time to time that are happening in homes where there is still a significant portion of staff who have not vaccinated.”

In August, families of residents at a Toronto nursing home who were in the middle of an outbreak told Granthshala News that they are surprised that workers do not need vaccinations. The families learned during a board meeting in July that the vaccination rate among employees was only 37 percent.

Eight residents have died at Hillsdale Estates in Oshawa, where the first positive test came from a staff member whose infection was discovered through daily screening in late August.

According for provincial dataThere are currently 13 outbreaks in long-term care facilities in Ontario.

Earlier this month, outbreaks in long-term care centers in the Calgary zone in Alberta doubled over a period of four days. Sinha said Alberta has the most active outbreak in long-term care.

Alberta currently has 104 outbreaks in long-term care and retirement homes as of Thursday, more than all other provinces, according to the NIA Long-Term Care COVID-19 Tracker.

provincial data Lists more than 100 outbreaks in long-term care and assisted living facilities, with outbreaks classified as two or more cases.

Expected, but still worried

It should come as no surprise that as cases continue to rise across Canada, we will see outbreaks start again in long-term care, experts say.

Kwok Dinh Nguyen, a geriatrics and assistant clinical professor at the University of Montreal, told Granthshala.ca in a phone interview that while community transmission is “expected” to see an increase in cases in long-term care, it is still concerning.

“Because still, even with vaccines, even with two doses, if you compare people who have two doses young, and two people who have two doses, and especially in nursing homes, they will still have the same highest risk of death and hospitalization,” Nguyen said. “So, although this is expected, it is something that we need to follow closely. Is.”

Completely preventing COVID-19 in long-term care homes just cannot be done completely, Allison McGeer, an infectious disease specialist and professor at the University of Toronto, told Granthshala.ca in a phone interview.

One reason is the lack of a broad vaccine mandate for employees.

“There are good reasons why mandates are treacherous, but even so, if you have employees working in long-term care, it increases the risk, no question,” she said.

“We have, and again, for good reason, allowing visitors and essential caregivers greater access to long-term care. This is a good thing for a variety of reasons, but it is certainly one of the reasons for outbreaks in long-term care. increases the risk of onset.”

Sinha explained, vaccination rates among residents in long-term care homes are very high, but vaccines are not infallible, especially when it comes to the elderly and vulnerable. Studies have shown that these populations do not produce as strong an immune response as younger people, making it important to keep COVID-19 out of long-term care settings.

And the delta version itself makes it difficult.

McGeer said that if the original strain and the alpha version were infected, “you shed less virus and you’re less likely to transmit, but that’s not true for Delta.” She added that “even people who have been twice vaccinated can transmit Delta.”

How provinces are trying to protect long-term care

Ontario was one of the first regions to announce that they would require care homes to have vaccine policies. But he specified that while care homes can make their own policy, minimum requirement will allow them Those who have not been vaccinated either to present a medical reason, or provide evidence of “completion of a COVID-19 vaccination academic session”.

“It’s basically saying they want to make sure everyone either gets vaccinated or watches an educational video if they don’t want to be vaccinated,” Sinha said. “At the end of the day it’s not really a true, meaningful result. Now that we have more than enough information to tell that vaccines work, vaccines are incredibly safe.

“There is no excuse why a person choosing to work in this environment should be allowed to potentially put their residents at risk.”

Many provinces have moved to require health care workers and even other long-term care workers to be fully vaccinated.

in early August, British Columbia announced it would be mandatory All health care workers in care homes are to be fully immunized by 12 October.

Quebec followed this month, specifying that by October 15, all health and social service workers will be fully vaccinated. The rule covers public long-term care facilities as well as private ones.

“Quebec has taken a strong stand on this,” Nguyen said. “It’s not really just health care workers who are facing patients, it’s every single employee of the health care system in Quebec. [that] Vaccination is required by October 15.”

Workers who do not provide proof that they have been vaccinated by the deadline in Quebec will be reassigned to other duties if possible, or “will not be allowed to return to work and receive no compensation. “

Nguyen said, “As a health care worker, you’re going to be working with some people who can’t get vaccinated and overall there are people who are at higher risk than the general population who don’t come to the hospital.” Huh.” “So I think it’s up to people to have a responsibility to vaccinate.”

He said that the vaccines have been proven to be safe and we have vaccinated millions of people and have seen only rare side effects.

Alberta Health Services announced in late August that health care providers Requires to be fully immunized by October 31, including contracted continuing care providers.

Some retirement homes are making the decisions themselves. In late August, a coalition of long-term care providers announced that they would make COVID-19 vaccines mandatory for their employees in all of their homes, saying in a press release that by October 12, unvaccinated workers would be placed. An unpaid leave of absence.

Daily test vs. Vaccines

Other provinces have given workers the option of being repeatedly tested if they are not vaccinated in the hope that if they do fall ill, they will be caught by tests before spreading it to a long-term care home.

In Manitoba, people who work with vulnerable populations, including long-term care settings, must be fully immunized or “Regularly undergo COVID-19 testing.”

in New Brunswick, nursing home staff And adult residential facilities should be fully vaccinated or tested regularly for COVID-19.

And Ontario’s current policy states that workers in high-risk settings who do not provide proof of vaccination must undergo regular rapid tests.

McGeer said the test is better than nothing, but it doesn’t provide the same protection as the vaccine.

“When you have a rapid test, it tells you that you’re not shedding a lot of virus at the moment — it doesn’t mean that eight hours from now, the end of your shift, that you’re not,” she said. ..

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