Se­niors home COVID plan falls short, says Hirji

New iso­la­tion, test­ing rules don’t ac­count for how virus test­ing works

The Standard (St. Catharines) - - Front Page - GRANT LAFLECHE THE ST. CATHARINES STAN­DARD

New rules de­signed to pro­tect res­i­dents of re­gion­ally op­er­ated longterm-care homes from COVID-19 may do lit­tle to iden­tify cases and pre­vent the spread of the novel coro­n­avirus among the el­derly, says Niagara’s top pub­lic health of­fi­cial.

Dr. Mustafa Hirji, Niagara’s act­ing med­i­cal of­fi­cer of health, said the new re­quire­ment of a res­i­dent of a Niagara Re­gion home to be iso­lated for 72 hours af­ter an out­ing and then be tested for COVID-19 has the po­ten­tial to miss cases and in­creases the risk of the virus spread­ing among res­i­dents.

“This is not some­thing I would en­dorse,” said Hirji in a Wed­nes­day in­ter­view of the rules that will come into ef­fect Thurs­day. “Seventy-two hours may not be long enough for a test to be ef­fec­tive.”

In a let­ter sent to the fam­ily of res­i­dents, first re­ported Wed­nes­day by CKTB 610 AM, a per­son at a re­gional home who leaves for a day trip will be iso­lated for three days upon their re­turn. This in­cludes vis­its with fam­ily, meals out, shop­ping or any trip off the home’s prop­erty.

Af­ter that 72 hours, that res­i­dent will be tested and will not be al­lowed out of iso­la­tion un­til a nega­tive test re­sult comes back.

In the let­ter, the Re­gion is ask­ing fam­i­lies not to take their loved ones on out­ings while COVID-19 cases are ris­ing else­where in On­tario.

The re­gional di­rec­tor of se­nior ser­vices, Henri Kon­ing was not im­me­di­ately avail­able for com­ment.

The is­sue with the new plan, Hirji said, is that it ig­nores how COVID-19 test­ing works and as a con­se­quence, may fail to iden­tify cases in the homes.

Cur­rently, the test for COVID-19 — called a PCR test — iden­ti­fies the ge­netic ma­te­rial of the novel coro­n­avirus in a sam­ple. If the level of that ma­te­rial reaches a cer­tain thresh­old, the per­son is found to be pos­i­tive for COVID-19. Although there have been a small num­ber of false neg­a­tives, and some pos­i­tive tests re­called by a lab early in the pan­demic, the tests are very ac­cu­rate, Hirji said.

How­ever, for the PCR test to be ef­fec­tive, there has to be enough of the virus in a per­son for it to be de­tectable. If an in­fected per­son is tested too soon, or tested if they are not show­ing symp­toms, the test will likely come back nega­tive.

Hirji high­lighted two cases con­firmed Tues­day that showed how tests done at the wrong time can miss an in­fec­tion.

In one case, a per­son’s em­ployer had their staff tested when an­other worker was found to have CO

VID-19. But the test was taken be­fore any­one had symp­toms.

“So the test came back nega­tive. But the day this per­son got their re­sult, they started to ex­hibit symp­toms. They were retested which came back pos­i­tive,” Hirji said.

In the other case, an em­ployer is hav­ing work­ers tested ev­ery two weeks. One em­ployee tested nega­tive, but dur­ing that two-week span de­vel­oped symp­toms.

Hirji, who did not de­cide or ad­vise on the re­gional longterm care home pol­icy, said non-symp­to­matic test­ing car­ries some risks.

They can miss an in­fec­tion and a per­son could then end up ex­pos­ing others to the virus and can also over­whelm lab­o­ra­to­ries with tests that won’t ac­tu­ally pro­duce help­ful re­sults.

On­tario is cur­rently ex­pe­ri­enc­ing a back­log in pro­cess­ing COVID-19 tests. While the pro­vin­cial gov­ern­ment is fo­cused on re­duc­ing wait times to get a COVID-19 test, lab ca­pac­ity hasn’t ex­panded to meet the ris­ing de­mand.

“That is why the test­ing is most ef­fec­tive when a per­son has symp­toms,” Hirji said. “It is hard to make a gen­eral state­ment be­cause every­one will show symp­toms at dif­fer­ent times. It could be two days, it could be two weeks. Around 50 per cent of the time seven-toeight days is enough for a per­son to show symp­toms and have enough virus in their symp­toms to be de­tected in the test.”

This is why Hirji is skep­ti­cal about so-called “rapid” anti­gen tests that pur­port to be able to pro­duce a re­sult in 20 min­utes. These tests, which are be­ing ex­am­ined by Health Canada, could dras­ti­cally speed up the de­tec­tion of cases if they work.

How­ever, Hirji said they are far less ac­cu­rate than the cur­rent PCR test­ing.

“Some of them are only 10 per cent ac­cu­rate. On the high end, they are only about 60 per cent ac­cu­rate,” Hirji said. “That is not ac­cu­rate enough to be use­ful.”

Nev­er­the­less, Hirji said when a long-term care res­i­dent, a mem­ber of a more vul­ner­a­ble pop­u­la­tion, ven­tures out, they are at more risk of ex­po­sure to the virus. Given the ex­treme toll the first wave of COVID-19 had on On­tario long term care homes, it will be im­por­tant to take steps to pre­vent the virus from spread­ing in those homes. But those mea­sures have to be rooted in science, Hirji ex­plained.

The ma­jor­ity of Niagara’s 64 known COVID-19 re­lated deaths were long-term care res­i­dents.

Hirji said while Niagara’s case count re­mains rel­a­tively low — there was only one con­firmed case iden­ti­fied Wed­nes­day — the virus is surg­ing in the neigh­bour­ing com­mu­ni­ties of Hamil­ton, Hal­ton, Peel and Toronto.

He rec­om­mended Niagara res­i­dents avoid out­ings like shop­ping or eat­ing out in those com­mu­ni­ties un­til the surge is over. Vis­it­ing fam­ily in their homes in those com­mu­ni­ties may be safer, he said.

There are cur­rently two Niagara long-term care homes with COVID-19 out­breaks — Pioneer Elder Care in St. Catharines, which is run by the re­gion, and the pri­vately op­er­ated Deer Park Villa in Grimsby.

The num­ber of cases at each home has not been dis­closed. How­ever, the health depart­ment can de­clare an out­break in a home with a sin­gle case.


If an in­fected per­son is tested too soon, or tested if they are not show­ing symp­toms, the test will likely come back nega­tive.

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