FOUR-BED ROOMS AT HEART OF SPREAD

Deaths dou­ble in shared rooms at care homes

Calgary Herald - - NP - TOM BLACKWELL

A new study points to a dis­turbingly sim­ple ex­pla­na­tion for some of the havoc wrought by COVID-19 in Canada’s nursing homes: keep­ing res­i­dents in ward-like shared ac­com­mo­da­tion can be lethal.

The deaths of close to 300 long-term care res­i­dents in just one prov­ince could have been pre­vented if those in­di­vid­u­als were housed in two-bed in­stead of four-bed rooms, sug­gests the re­search.

The study by Univer­sity of Toronto, Mc­mas­ter Univer­sity and Public Health On­tario sci­en­tists found a clear as­so­ci­a­tion be­tween the de­gree of crowd­ing in homes — how many peo­ple share a room and lava­tory — and the virus’s spread.

Res­i­dents of the most tightly packed fa­cil­i­ties were twice as likely to get in­fected and to die as those in the least-crowded homes, con­cluded their paper.

And yet, one in four longterm-care res­i­dents were in four-bed rooms when the pan­demic hit, they say.

“Too of­ten, the build­ing and the phys­i­cal in­fra­struc­ture gets for­got­ten in this con­ver­sa­tion,” said Dr. Nathan Stall, a geri­a­tri­cian at Toronto’s Mt. Si­nai hos­pi­tal and one of the au­thors. “(But) public health ex­perts … would know on face value that that’s sort of in­fec­tion-preven­tion 101: crowded rooms are bad.”

He noted that On­tario stan­dards in­tro­duced in 1999 said new fa­cil­i­ties could have no more than two peo­ple per room. Older homes, most of them for-profit, were en­cour­aged to retro­fit to those stan­dards but few have done so, said Stall.

COVID-19’S dis­as­trous toll on nursing homes has been the cen­tral story of the pan­demic in Canada, ac­count­ing for about 80 per cent of the coun­try’s 8,500 deaths. A new re­port by the Cana­dian In­sti­tute for Health In­for­ma­tion un­der­scores that fact.

Canada’s per-capita num­ber of long-term-care deaths has been about aver­age among sim­i­lar in­dus­tri­al­ized coun­tries, the in­sti­tute found.

But as a per­cent­age of a na­tion’s to­tal COVID-19 mor­tal­ity, Canada’s deaths far ex­ceed those of other Or­ga­ni­za­tion of Eco­nomic Co-op­er­a­tion and De­vel­op­ment mem­bers, the in­sti­tute found. Deaths in long-term­care in OECD coun­tries av­er­aged 42 per cent, and ranged from less than 10 per cent in Slove­nia and Hun­gary, to 66 per cent in Spain.

Af­ter get­ting an early pre­view of the On­tario re­searchers’ find­ings, the prov­ince has al­ready acted, man­dat­ing that newly ad­mit­ted res­i­dents have no more than one room­mate.

The in­dus­try agrees such set­ups are one of the root causes of the dev­as­tat­ing out­breaks, said Donna Dun­can, CEO of the On­tario Long Term Care As­so­ci­a­tion. But mov­ing away from four-bed ac­com­mo­da­tion will have a ma­jor im­pact, she said.

Though the as­so­ci­a­tion says only about 10 per cent of res­i­dents, not 25, live in those rooms, con­vert­ing them to two beds now would take 4,300 places out of the sys­tem, adding to a wait­ing list for nursing home places that al­ready stands at 36,000, said Dun­can.

“We saw the num­bers … then shared that in­for­ma­tion with gov­ern­ment and said, ‘We have a very large prob­lem here,’” she said. “We need to pre­pare to­day to look at al­ter­nate ac­com­mo­da­tions and so­lu­tions … We have to move very quickly.”

With a sec­ond pan­demic wave ex­pected, Dun­can said the prov­ince should con­sider con­vert­ing ex­ist­ing, un­used build­ings, like va­cant hos­pi­tals, ho­tels or are­nas, into long-term care hous­ing.

The study, by Stall and col­leagues, pub­lished on an aca­demic “pre­print” site with­out hav­ing un­der­gone peer review, ranked fa­cil­i­ties based on the den­sity of hous­ing, rang­ing from those with mostly sin­gle rooms to homes with only four-per­son rooms.

That data was then cor­re­lated with COVID-19 in­fec­tions and deaths.

The type of ac­com­mo­da­tion didn’t af­fect whether a fa­cil­ity had an out­break. But its spread was higher in crowded homes — 9.7 per cent in­fected ver­sus 4.5 per cent in the least crowded — while deaths were 2.7 per cent and 1.3 per cent re­spec­tively.

The re­searchers used their find­ings to cre­ate a sim­u­la­tion, which in­di­cated that putting all the res­i­dents who were in four-bed rooms into two-bed rooms would have pre­vented 988 COVID-19 cases, and 271 deaths.

It’s what res­i­dents pre­fer, as well. Past sur­veys in­di­cate that 80 per cent of res­i­dents would choose to have a pri­vate room over a shared one, noted the paper.

Most of the four-bed rooms that the study high­lights are in older fa­cil­i­ties, said Dun­can. The higher oc­cu­pancy rooms have cur­tains to sep­a­rate the res­i­dents but “cur­tains are no match for this,” she said.

A pre­vi­ous paper by Stall and col­leagues, also not yet peer-re­viewed, found that out­breaks were sig­nif­i­cantly big­ger in for-profit homes.

PETER J THOMP­SON/NA­TIONAL POST/FILES

Crosses stand out­side the Camilla Care Com­mu­nity, a long-term care fa­cil­ity in Mis­sis­sauga, Ont., where 50 peo­ple died of COVID-19.

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