A tale of two pandemics: protecting
GLACIER MEDIA SPECIAL REPORT | High death toll in care facilities for
Test, trace, isolate. Test, trace, isolate.
It was the first week of March and Dr. Michael Schwandt and his team were in the midst of what would soon feel like an endless cycle.
The outbreak control team was huddled in their Vancouver offices, poring over another case of COVID-19.
But when those lab results came over the phone, everyone knew it was something different: SARSCoV-2 positive. The novel coronavirus had made it into Lynn Valley Care Centre.
“There was a lot of concern, the knowledge that this could be a very serious situation,” said Schwandt. “It was a feeling of going to work.”
That work would balloon in the coming weeks, as the outbreak claimed the first COVID-19 death in Canada –an 80-year-old resident – and morph into the health authority’s deadliest outbreak, taking 20 lives and infecting a further 59.
The latest tallies find between 81% and 85% of deaths in Canada occurred in seniors’ homes, compared to an Organization for Economic Co-operation and Development
(OECD) average of 42%. Of the roughly 8,700 deaths due to COVID-19 in the country, about 7,000 have been in seniors’ homes.
These are often the frailest of Canadians, caught in a system experts say has long been neglected, where unregulated government transfers make up only two-thirds of the OECD average and often fail to ensure adequate care.
“We failed long-term care in
‘A lucky break’
Canada,” said Dr. Samir Sinha, director of geriatrics at Toronto’s Sinai Hospital.
Four months into Canada’s pandemic, just what went wrong in those early days and how B.C. turned around what looked to be an impending disaster serve as lessons.
But B.C.’s window of relative calm also begs the more pressing question: are we doing enough to protect our seniors in the face of a second wave? Not long after Schwandt got the first lab results, it became clear the virus had been circulating in the population at Lynn Valley for days.
“You’re looking at not controlling one or two branches, but multiple branches all at once, which means at that point you’re playing catch-up,” he said.
Fear over the new virus led many staff at Lynn Valley Care Centre to abandon their posts in the early days of the outbreak.
“We were helping to give meals to residents and doing basic care for our own parents because nobody showed up to work that weekend,” said Althea Gibb-Carsley, whose mother-inlaw, 94-year-old Isabelle Mikhail, would later die of COVID-19 at Lynn Valley.
“We realized … that the help was not there. And so we made a decision to go every day. We took time off work and we realized we had to be in there.”
There was little communication, said family members, because nobody was even answering the phones at the nursing home.
“B.C. had some of the same sins that all the other provinces had too: they had people who were being paid poorly working in these homes, and working between multiple homes to try and make ends meet,” said Sinha, who in addition to his clinical work, also heads of the National Institute on Ageing think tank and advises the Ontario government.
At the time, some of the most emblematic images of the virus overseas were of the construction of a field hospital in Wuhan and of an Italian health system in free fall as ICUs overflowed with patients unable to find a ventilator.
“We drank the Kool-Aid,” Sinha said. “We said, ‘Let’s shore up our hospitals, let’s do everything we can, let’s buy ventilators.’ Money was flowing like nobody’s business to make sure our hospitals were protected.”
He added, “Was there an overemphasis around acute care? Absolutely. We never figured out our systemic vulnerabilities.”
In the weeks leading up to the first cases at Lynn Valley, health officials in B.C. had been closely watching the rising death toll across the border at a care home in suburban Seattle. So when the U.S. Centers for Disease Control and Prevention came out with a day-by-day study of the outbreak at the Kirkland home, Schwandt and his colleagues took note.
They were some of the first in North America to apply a playbook known outside of B.C. as the “Iron Ring” protocol, a set of outbreak measures first implemented in B.C. and designed to suffocate COVID-19 in a nursing home.
Provincial health officer Dr. Bonnie Henry issued a B.C.-wide single-site work order, followed by bumps in pay for over 7,000 care aides to go along with strong infection control measures and universal masking for all frontline workers.
The more the virus spread, the more infection control experts realized COVID-19 was like nothing they had seen before. Unlike SARS, it soon become clear that COVID-19 was an asymptomatic predator, and a simple change of a bandage could spark a cluster.
Inside B.C.’s seniors’ homes, health teams were testing residents and staff who seemed fine, and outbreaks went from dozens of deaths down to single digits or none at all.
It’s what B.C. Seniors Advocate