FEAR AND WORRY IN ALMONTE
COVID-19 kills 10 at nursing home
When Eileen Watt spoke to her 80-year-old mother over the phone earlier this week, she sounded like she always did. Except for the cough.
It wasn’t persistent, but it was memorable. “Phlegmy, loose, crackly,” Watt described it.
Even six weeks ago, it wouldn’t have been much cause for alarm, but right now both of Watt’s parents — Marjorie and James Watt — are living in the middle of Eastern Ontario’s deadliest institutional outbreak of COVID -19.
Twelve residents at Almonte Country Haven, an 82-bed longterm care facility in Mississippi Mills, have died there since March 29, including 10 from COVID -19-related complications, while 20 have tested positive for the disease caused by the novel coronavirus.
The Leeds, Grenville and Lanark District Health Unit announced March 29 there were three confirmed infections among residents and one among staff.
“Infection control measures have been put in place to manage the outbreak and are being monitored by the health unit. All staff have been instructed to wear personal protective equipment at all times and to self-monitor for symptoms, and to self-isolate at home when not working.”
Unable to see for themselves what’s happening inside the home or to comfort their loved ones in person, families with relatives at Almonte Country Haven are left to watch and worry from afar. While many speak in glowing terms about the facility and its staff, they worry those staffers will be overwhelmed by the virus that has proven to be rapid and indiscriminate.
According to Friday’s update by the Ontario health ministry, Almonte Country Haven is one of 73 long-term care homes in the province battling COVID -19 outbreaks in which 366 staff members and 560 residents have tested positive and 98 residents have died.
Those numbers are almost certainly underestimates. The province’s worst-hit LTC facility, Bobcaygeon’s 65-bed Pinecrest Nursing Home, had recorded 29 COVID-19-related deaths as of Thursday.
Even the Leeds, Grenville & Lanark District Health Unit is only officially reporting eight deaths among its long-term care homes, including the one in Almonte, where the facility administrator has confirmed the 10 COVID-19 deaths.
On Friday, Watt was waiting to see if her mother and father would join the ranks of the infected. Both were tested for COVID-19 after Marjorie developed that worrisome cough. Results were expected soon.
“Sometimes I’m extremely stressed over it, but I’m really, really trying to stay positive,” Watt said. “I’m hoping that it really is just a cold. It could be. That’s what I’m telling myself until I hear otherwise.”
Compounding the strain of her family’s situation is the worry she feels for the staff at their home. A former personal-support worker, Watt knows the toll losing a patient can take.
“It’s super hard to be with somebody at the end of their life and not be affected. With this crisis, they are watching people die over and over again.”
Staff also have to worry about protecting their own health and the health of loved ones in their own homes.
Dr. Paula Stewart, medical officer of health for the Leeds, Grenville and Lanark district, says that’s one of the challenges her team hears about during daily calls with all six local long-term care facilities dealing with COVID -19 outbreaks.
Faced with staffing shortages and the need to maintain stringent infection control measures — twice-daily temperature taking for residents, enhanced cleaning — “the homes are working hard, they’re working long hours, it’s a challenge,” she said.
It’s hard to pinpoint how COVID-19 found its way into Almonte Country Haven and other affected facilities. A visitor could have been carrying the virus, Stewart said, since they were still allowed into homes until a provincial directive on March 14 barred anyone considered non-essential.
A staff member could also be the unwitting source of an outbreak, Stewart said. Only recently has the transmissibility of the virus in asymptomatic or pre-symptomatic cases been well understood, leading to directives such as the one Ontario issued Thursday making masks mandatory at all times in LTC homes.
“It’s one of those things where we’re learning as we go,” Stewart said. “I don’t think we can totally reduce the risk of it coming into the home.” What’s essential, she said, is detecting the virus as quickly as possible.
The province Friday announced it would proactively test people in several priority groups for COVID-19, including long-term care and retirement home residents. Later, Almonte Country Haven administrator Carolyn Della Foresta released a statement noting that 20 more asymptomatic residents of the home had been tested, with those results to be shared when available.
The speed at which COVID-19 infections are identified can determine how deadly an outbreak becomes, Stewart said. So, too, can the ability to isolate healthy residents from the sick, which is more difficult in a home like Almonte Country Haven, where some rooms house four people.
Once the virus infects an elderly person, the risk of a deadly outcome is significant. Ontario data show a fatality ratio of 16 per cent for those aged 80 and older.
“What’s different about this virus is that it settles way down into the bronchial tubes, into the lung itself, and it attacks the lungs, basically,” Stewart said. “Their immune systems can’t cope with this overwhelming assault on their lungs. They just gradually drift off and die.”
Eryn Dixon, 45, has been in longterm care for about five years with advanced multiple sclerosis. Last spring parents Rick and Leona Spencer arranged for her to move into the Almonte home because it was directly across the street from their house.
“She needs full-time care. We’re both senior citizens and it’s beyond our capability,” Rick Spencer said. They walk past the Country Haven home several times a day and often pop in to say hello. They know most staff members by first names.
“They didn’t get test kits until last Friday night,” Leona Spencer said. “We got called Sunday morning (to say) that our daughter tested positive.
Eryn was sharing a room with three other women, one of whom was sick early on, Leona said. That sick woman remained in the room. Since then two of the women are no longer there, and she wonders whether they are among those who have died.
The Spencers suspect there may have been even more COVID deaths not reported as such because the home had almost no test kits in the early days of the pandemic, but they remain supportive of the home.
“The staff have been great,” Leona said.
In a Thursday announcement discussing measures to limit the spread of the outbreak — all residents isolated in their rooms, meal carts disinfected between each use — home management also noted that people in the community had donated personal protective gear to staff, hung bird feeders on the lawn and arranged for clergy to read scripture and lead prayers over the internal intercom system.
“We will never forget the outpouring of love from families and our community. We will remain forever grateful.”
Rod Currie, owner of a local construction company, recently parked a camping trailer in the home’s parking lot, hoping it could provide refuge for staff who need a break from the crisis.
“They can go out there and rest,” said Currie, whose sister works at Almonte Country Haven. “It’s a pretty minor contribution … I feel bad for what they’re going through.”
It has been more than a month since Eileen Coyle, 97, has been able to visit with any of her four children, nine grandchildren and seven great-grandchildren. Family members have had to content themselves with what Jane Coyle, one of three daughters living in the area, describes as daily “window visits,” tapping on the glass of Eileen’s ground-floor private room and, if the window happens to be open a crack, engaging in conversation from a safe distance.
“Like all families in long-term care, we’re all very concerned,” Jane Coyle said, “and it feels very much as though our most vulnerable people are at the doorstep of the pandemic.
“And the long-term care facilities, just by the very nature of long-term care, are not set up to handle this crisis. They’re so shortstaffed even in normal times and right now they’re incredibly challenged. The staff at (Almonte) are going to heroic lengths to ensure that people are cared for as best as they can, but it’s not sustainable.
“They’ve been doing this for a month now, and I can’t imagine they’re getting much relief. It’s all hands on deck.”
To that end, Jane Coyle has written letters to Dr. Theresa Tam, Canada’s chief public health officer, and Stewart to urge stronger measures. She has received replies from both offices, but hasn’t seen the action she feels is necessary.
“I know there are lots of discussions happening, and everybody at all levels are working hard to try and come up with strategies and protocols and ensure that infection-control measures and PPE are in place at the front line. But the reality is that right now, today, our long-term-care facilities across the country are dealing with this, and deaths in nursing homes account for about half of COVID deaths so far. It’s a significant crisis and I feel there needs to be an immediate response, on the ground, today.”
Jan Carter Lea’s 82-year-old mother, Gail Attfield, is at the Almonte home. She is a former emergency department nurse who has Parkinson’s disease and dementia and cannot communicate by phone, but her three daughters were regular visitors until the home banned all visits in March.
“It is very tough because we cannot speak to her on the phone and we cannot comfort her, so that’s hard. I’m sure she wonders why we’re not visiting ” Carter Lea said.
In the early weeks of the lockdown, it was difficult to get information from the home, she said. She emphasized that she and her family were “in awe” of care at the home, but it was difficult not to have information about how many people were infected.
“We could call in usually once a day and get a little update on my mother, but not numbers,” she said.
That changed this past week after residents’ families started going to the media. Almonte Country Haven now provides daily updates about the outbreak.
Having clear information helps people control anxiety, Carter Lea said.
“The not knowing is so much harder than knowing,” she said. “We invent things in our heads about the worst-case scenario. Even though the numbers (of deaths) were so sobering, we actually felt less anxious because we knew the story. We knew what was happening.
“We’re not trying to judge the care, the residence, the owners, anything like that. It’s really just to give ourselves some peace of mind actually knowing what’s happening and to prepare ourselves.”