GETTING RESULTS
One Toronto nursing home brought in a mobile testing team to swab every resident for coronavirus. What they found will save lives
Last Saturday, a team of doctors and staff from Women’s College Hospital pulled up in cabs to Kensington Gardens long-term-care home in downtown Toronto. They passed through a digital temperature checkpoint and other screening measures, and proceeded to the home’s family room.
Within minutes, the team converted the family room — a homey space furnished with a big dining table and overstuffed sofas, where in pre-pandemic times residents gathered with loved ones to celebrate birthdays and share meals — into a “clean room,” wiping down surfaces with medical-grade disinfectant.
The Women’s College team laid out their supplies for the day. For themselves, they brought full-body personal protective equipment, including masks, gowns, visors, gloves and booties. For the Kensington Gardens residents, they brought a huge box of swabs.
Over the next five hours, the team swabbed every resident from two floors of the facility’s South building and submitted the samples to public health to be tested for coronavirus. It was the hospital’s fourth mission to the long-term-care home, which — along with more than100 others in the province — is struggling with an outbreak of COVID-19.
Before the testing blitz, Kensington Gardens had four known cases, but there were worrying signs the disease had spread. The home is now one of a handful in the province that have undergone universal COVID-19 testing. Nearly all residents and more than 100 staff have been swabbed at Kensington Gardens, with the remaining staff to be tested in the coming days.
The results, while scary for families because of the jump in cases, have helped the home understand and control its outbreak. Among more than 25 new positives in residents and staff, the testing blitz found one resident who was then asymptomatic and who lived on a unit with no other known cases, so wasn’t under outbreak protocols — but now is.
John Yip, the CEO of Kensington Health, says the ability to test so widely with the hospital’s support is “saving lives.”
On Wednesday, the province released a new directive calling for all residents and staff in long-term-care homes to be tested for COVID-19. Public health officials acknowledged earlier this week that while the broader community epidemic has peaked, cases and deaths in vulnerable long-term care and other congregate settings are still accelerating.
Geriatricians and other experts praised Wednesday’s move, calling it long overdue. But opposition critics also noted that Premier Doug Ford had called for universal testing in long-term care two weeks ago. Ford said Wednesday there are 78,000 residents of long-term care in Ontario, and 56,000 staff: testing all of them will require a massive deployment of resources.
“It’s very difficult and sad what’s happening in some of the long-term-care facilities in the province right now,” said Dr. Danielle Martin, executive vice-president and chief medical executive at Women’s College Hospital. “And I think hospitals and health regions are all realizing this is where we need to be putting our effort and energy.
“Just because you don’t work in or run a long-term-care facility doesn’t mean that long-term care is not your problem: right now long-term care is everyone’s job.” Kensington Gardens and Women’s College Hospital were connected before the pandemic through a program at Women’s called LTC+, a program to provide virtual consultations and care to nursing homes and help avoid lengthy and unnecessary hospital stays.
“This is why organizational partnerships like this are so important,” says Martin. “When there is a crisis or a problem, you have these existing relationships you can draw on.”
Kensington Gardens discovered its first COVID-19 case in late March, a resident in its North building, one of two buildings the home operates on Brunswick Avenue. The resident was hospitalized but has since recovered.
Then, in April, three more residents and two staff tested positive on a North building unit that is home to residents with the most severe cognitive impairments. Nursing homes across the province have struggled to contain outbreaks in units like these, because it is difficult to ensure people with advanced dementia comply with social distancing and other isolation measures.
More residents on the unit were showing mild symptoms, says Yip.
“Public health, I don’t want to sound critical — they’re wellintended,” he says. “They just couldn’t move quickly enough. They’re dealing with a lot.”
At Women’s College, meanwhile, doctors running the hospital’s onsite COVID-19 assessment centre recognized the need for mobile testing teams, which could be deployed to high-risk settings that have become ground zero for Ontario’s epidemic, including long-termcare homes and shelters. (Danielle Martin notes that other hospitals, including Michael Garron in Toronto’s east end, have similar initiatives.)
Martin phoned John Yip and described their mobile assessment teams.
“She said, this is what we’re planning on doing. Do you need our help?” Yip recalls. “I said, ‘Yes.’ She said, ‘When?’ “I said, ‘Now.’ ” Within 24 hours, Women’s College had assembled a mobile testing team for Kensington. They staff these teams by sending an email blast to all physicians; neurologists, orthopedic surgeons, family doctors and more have volunteered for the mobile and the onsite assessment clinics.
On Easter Sunday, the Women’s College mobile team swabbed 43 residents and multiple staff from the affected floor. They came back two days later to swab the rest of the building’s 141 residents and 116 staff. (One resident declined; the doctors say they work hard to communicate that they are there to help even though their multiple layers of protective gear can seem scary.)
In total, 22 residents and eight staff in the building tested positive. One resident tested positive who lives on a different unit of the floor with the outbreak, and who was then not showing any symptoms. The positive result allowed the home to lock down that whole floor and put outbreak protocols in place early, limiting the chances of infecting others. Two residents of the other unit on that floor have since died.
Last Friday and Saturday, the Women’s College mobile team returned to test the other 195 residents of the home’s South building.
(That includes my father: I learned about Kensington Gardens’ partnership with Women’s College Hospital through an email update to family members. Both organizations agreed to let me join them for part of the process.)
Of those results, 126 have come back, and all have been negative. (My father’s results are pending.) Kensington Gardens limited the movement of staff between the two buildings weeks ago, long before a provincial order to ban staff from working at multiple institutions, which came into effect Wednesday.
Dr. Suvendrini Lena, a neurologist from Women’s College who volunteered with Saturday’s mobile testing team, noted that it can be hard to detect illness in elderly people with dementia at the best of times.
“It’s not always easy to pick up unusual presentations of illness,” Lena said. “And this illness is new. So how can personal support care workers be asked to pick up unusual symptoms of an illness they’ve never seen before? It can’t be left up to subtleties like that.
“This is why you need to have blanket screening.”
Martin notes, however, that “to swab a whole floor or a whole unit is a really big deal,” an enormous undertaking that requires both staff and resources like personal protective equipment and swabs. As residents are falling ill, so are staff; short-staffed units are working overtime to provide feeding, toileting and other basic care.
Yip says the care home’s preexisting partnership with the hospital has “paid dividends.”
”These partnerships that Women’s College has started should not go away, should only be expanded on post-COVID.”