Seniors home COVID plan falls short, says Hirji
New isolation, testing rules don’t account for how virus testing works
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.