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COVID-19 outbreak at B.C. nursing home must be met with compassion and caution, experts say

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B.C. Provincial Health Officer Dr. Bonnie Henry addressed the media on Saturday in Vancouver where she confirmed six new cases of COVID-19 had been reported in B.C.

The announcement of an outbreak of the new coronavirus at a North Vancouver nursing home marks a turning point in the spread of the virus in British Columbia, and experts say how officials respond next is crucial.

Two residents and a worker at the Lynn Valley Care Centre have tested positive for COVID-19, health officials announced Saturday. The worker had previously been announced as Canada’s first case of possible transmission within the community.

Chief medical health officer Dr. Bonnie Henry said the centre is under an “outbreak protocol,” meaning visitors are restricted and measures are being taken to ensure staff and residents are kept safe.

READ MORE: B.C. declares COVID-19 outbreak at North Vancouver care home, 6 new cases announced

But experts say while clamping down on the potential spread of the virus is critical for such facilities that can quickly become a hotbed for infectious diseases, it’s just as important to balance those measures with compassion.

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“Research has shown us that with people living in nursing homes and other institutionalized people, social interaction and connection is very strongly related to lifespan and life expectancy,” said Colin Furness, an assistant professor in the faculty of information at the University of Toronto.

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Coronavirus outbreak: B.C. health minister stresses importance of combating COVID-19 misinformation

“You can literally change the length of someone’s life through companionship. And we should never forget that because yes, locking everyone down, that would be great. But how do you strike a balance with compassion? That’s awfully difficult.”

Furness — who specializes partly in the risk that diseases pose to long-term care facilities — says the potential for the outbreak to quickly escalate and spread to other care homes is high, despite the best efforts of health officials.

“It would do what any respiratory virus does: it will wreak havoc and it will kill a lot of people,” he warned. “The exact percentage is going to depend on a lot of things.”

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Elderly most at risk

The new cases announced in B.C. echo the much larger outbreak at the Life Care Center in the Seattle suburb of Kirkland, where 13 deaths have been linked to the virus and dozens of workers and residents are showing symptoms.

That home is the epicentre of the disease in Washington state at large, which reported a total of 16 deaths Saturday and 102 total cases. More than 70 of those cases are believed to be linked to Life Care.

READ MORE: Coronavirus: Few precautions taken at nursing home now ground zero of U.S. outbreak

Kerry Bowman, a bioethicist in the Institute of Medical Science at the University of Toronto, says the risk of COVID-19 to the elderly is particularly high, and nursing homes — where the average age is around 80 years old, with most residents exhibiting pre-existing conditions and weakened immune systems — are a prime incubator.

“We need to be making sure that we are protecting the most vulnerable people in our society, and right now that’s the elderly,” he said. “So we may have to start changing direction.”

While the World Health Organization has pegged the overall fatality rate for COVID-19 at 3.4 per cent, studies show it’s far higher for older populations.

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Coronavirus outbreak: World Health Organization stresses mortality rate increases with age

In a study last month of the more than 72,000 cases of coronavirus in mainland China as of Feb. 11, the Chinese Center for Disease Control found the fatality rate is 14.8 per cent for people 80 and older, and eight per cent for those in their 70s.

While the first impulse would be to isolate care home residents and other elderly people to protect them, Furness says it’s not that easy, and could lead to other problems like depression.

READ MORE: Coronavirus: Do Canadians really need to stockpile household items?

He says he’s seen policies in hospitals like health care staff sanitizing patients’ hands for them, which could help make up for the cancellations of parties and other gatherings that are a key social feature of nursing homes.

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“They should absolutely stop large gatherings, but if you lock people down and don’t have human contact, you’re creating damage of a different sort,” he said. “I would hope that [staff] are finding that balance.”

Worker concerns

Beyond the residents, Furness and Bowman say they were particularly concerned when Henry and Health Minister Adrian Dix noted care home workers often work at multiple facilities just to make a “family-supporting” wage.

While officials say they are working to identify where the infected Lynn Valley worker is also employed to prevent spread at those facilities, Bowman says the case highlights a flaw in the health-care system.

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COVID-19: Washington state health officials anticipate more cases from nursing home
“They identified this with [the] SARS [outbreak in 2003],” Bowman said. He became infected with that disease while working at a Toronto hospital, where he observed a similar practice.
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“I do not blame these people. I mean, these are people that can barely scratch together a living. But this was identified as a risk factor [during the SARS outbreak], and I find it surprising that even with COVID-19 preparations, this wasn’t addressed.”

Furness says it’s also likely that workers aren’t properly trained to deal with infectious disease management, and that policies and training can often vary between care homes, particularly within the private and public sectors.

READ MORE: Coronavirus: What to know about the 1st Canadian ‘community case’ of COVID-19

“I would definitely be in favour of professionalizing the workforce so that, among other things, their training is balanced and they’re paid equitable wages so they don’t have to work multiple jobs,” he said.

Henry and Dix said it’s common for health care workers to be employed at multiple facilities, but did not speak to whether the practice should be a concern.

Dr. Michael Curry, a clinical associate professor in the department of emergency medicine at the University of British Columbia, says many health care staff actually enjoy working as much as possible and didn’t see working multiple jobs as a problem.

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“People move around, and it’s common not just for low-level staff and caregivers but doctors and nurses as well,” he said. “It may need to be looked at more closely in this instance and it may have to be put on hold, but I wouldn’t call it an issue.”

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How Canadian long-term care homes are preparing for COVID-19

Furness says while long-term care homes present a host of issues for the new coronavirus, that shouldn’t stand in the way of younger people and families also practicing a mix of compassion and caution.

“It’s a perfect example of where we can take smart steps to still allow social interaction and to do it safely,” he said, adding wearing personal protective equipment while visiting residents could become common practice.

“But of course, if you’re sick yourself, stay home. Don’t visit, and don’t immerse yourself somewhere where you can get even more sick.”

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