LONG-TERM CARE CRISIS
Rapid tests needed now: doctor
After the shock and worry, the rush to support patients with intravenous lines and steroids, the bodies and the calls to family — it's the emptiness that gets to Dr. Daisy Fung.
“The emptiness is apocalyptic,” said the family doctor, who cares for patients at Capital
Care Lynnwood, where at least 22 residents have died from COVID-19 on her floor alone. “It's heartbreaking ... the empty binders and charts that used to be patients.”
The first vaccine shots this week were a hopeful step. But it's not coming fast enough — not for the 61 long-term care homes experiencing outbreaks right now.
We do have another tool — rapid antigen or molecular testing for COVID-19 — and it should be deployed to long-term care facilities immediately.
It's not perfect; it's a stop-gap that can help.
In Alberta, one in four longterm care residents who get this disease are dying from it and it can spread rapidly through an entire floor. That's what happened in Parker 2, the floor Fung serves on at Lynnwood. Officials believe it slipped into the facility undetected with an asymptomatic staff member or visitor.
The outbreak was impossible to control before staff even realized what happened.
In the public long-term care facility, most rooms have two beds. Before the outbreak, people ate together at large tables in the shared dining room. The floor went from zero cases to two on Nov. 20. That jumped to 20 cases within days, and the lab tests take so long to come back, it's impossible to properly isolate the sick and exposed.
Residents watch their roommates start to show symptoms, and are terrified. They're in the same room and can see it coming.
“Almost all of them on our floor tested positive eventually,” said Fung. “I've never felt so helpless in my life.”
But doctors don't have to be so helpless. Alberta now has access to several kinds of COVID-19 tests. The basic test, polymerase chain reaction or PCR, is the one used at testing centres where nurses take a swab from the throat or nose and send it to a lab for analysis. It takes at least several hours and usually days to get results back.
That test is highly sensitive. It picks up even trace amounts of genetic material from the virus, and can confirm people are positive even if they are past being contagious, which helps with contact tracing.
The two new tests are more like a pregnancy test. A medical professional still takes a swab from a respiratory system, but the results come back in as little as 15 minutes and the test is done out in the community.
The tests are less sensitive. They catch positive cases only when there are higher numbers of the virus in the nose and throat. But since that's also when people pose the greatest danger of infecting others, many experts argue this makes it ideal for long-term care and community applications.
While other jurisdictions are already using these in long-term care, Alberta decided to first test them in testing centres, giving some patients two tests at once to measure sensitivity rate. It announced this Nov. 26, when officials said they had 100,000 tests.
Detailed results from that trial have not been released. But at the end of last week, the rapid tests were expanded to help with the homeless population at Calgary's drop-in centre and Edmonton's isolation facility,
said Kerry Williamson, spokesman for Alberta Health Services.
They'll be expanding to longterm care within days, Williamson said. He could not say how they will be deployed.
Health Minister Tyler Shandro has a news conference scheduled for 9 a.m. Thursday.
The only surefire way to reduce outbreaks it to reduce the rate of COVID-19 infection in the community.
But in the meantime, Fung wants to use the tests to screen visitors and staff, at least as a pilot project to try to catch an asymptomatic spreader before they come in contact with residents. In lab scenarios, the test is less sensitive, but it might catch those most infectious, she said.
“If we could catch one person even, we've saved how many lives?”
Dr. Brian Sereda, medical director for Capital Care, said the danger is creating a false sense of security from a less reliable test. But there are ways to mitigate that danger. Results from the current tests are taking up to five days, he said, and he would love to pilot the rapid tests.
I'm still confused as to why Alberta would put such a valuable tool at a testing site, where people have already come to be swabbed, rather than deploying to long-term care immediately, where it could start to do good as it's being verified.
In Alberta, 476 of the 744 deaths from COVID-19, 64 per cent, have been in long-term care facilities or supportive living sites.
We'll need a post-mortem after the crisis to better understand how this happened. This wasn't the first, and won't be the last infectious disease to rip through the centres. Would improved ventilation and design help, or a change in standards and approach?
In the meantime, parents, grandparents and loved ones are dying, sometimes without even the chance to say goodbye.
The floor went from zero cases to two on Nov. 20. That jumped to 20 cases within days, and the lab tests take so long to come back, it's impossible to properly isolate the sick and exposed.