New variant strikes Barrie LTC home
COVID outbreak that has killed 32 people has now spread to all but two residents
The top doctor of the Simcoe Muskoka District Health Unit believes that all residents and staff infected with COVID-19 at a Barrie long-term-care home have the fast-spreading U.K. variant of the virus.
Dr. Charles Gardner, medical officer of health for the unit, confirmed Saturday that genome-sequencing tests involving five residents and one staff member at Roberta Place had found the B.1.1.7 variant that was first reported in the United Kingdom.
A COVID-19 outbreak was declared at the long-term-care home on Jan. 8 and has now spread to all but two of its 127 residents, as well as 84 staff. So far, 32 people have died.
“We’ve had test results on six individuals but I do not doubt that all of the (residents and staff ) have the variant. There’s no reason to believe that a second variety was introduced onto the site at the same time coincidentally,” Gardner said in a virtual press conference. “I don’t have any reason to believe that it’s anything other than this U.K. variant.”
The dire situation at Roberta Place underlines the challenges that could be facing other long-term-care homes if the B.1.1.7 variant — thought to be 56 per cent more transmissible than the current form of the virus — gains a stronger foothold in Ontario.
The press conference heard that infections spread rapidly at Roberta Place and there was a lack of cohorting, with positive and non-positive residents and staff sharing rooms even after the outbreak.
Cohorting is the practice of grouping residents based on their infection status.
In response to outbreaks in congregate living settings, Toronto Public Health advises residents to be cohorted or grouped based on their risk of infection.
Gardner admitted that proper cohorting was never implemented because of how quickly the virus spread and the home’s inability to maintain “adequate staffing.”
“You do need a very strong contingent of staffing to be able to do cohorting properly at a time when you’re losing staffing to a deadly virus,” he said. “We had 40 cases in just one weekend.”
Officials with the health unit have not confirmed the source of the outbreak, but said in a press release that a staff member who had close contact with someone who travelled abroad was one of the first to be suspected of carrying the variant into the home.
Since there is no requirement to be in isolation after contact with an asymptomatic traveller, the health unit said no rules were violated by allowing this staff member to continue working on the site. Two other visitors and three “external partners” have now tested positive.
Todd Coleman, an epidemiologist at Wilfrid Laurier University, said public health prevention measures, such as contact tracing and isolation, must be ramped up given the added transmissibility that the variant is suspected to have.
“We already know that the original variant is easy to catch and easy to lose track of, and the easier transmissibility of this one means that it could easily blow out of proportion very quickly,” he said.
Commenting on the extraordinary speed at which the new variant spreads, Gardner said he doesn’t believe that other organizations in the country are prepared or equipped to handle an outbreak involving B.1.1.7.
“This progressed so rapidly … it really speaks to the nature of this virus. That makes it a challenge in this situation, and I’m very concerned it will make it a challenge in future outbreaks,” he said.
Only five per cent of virus samples in Canada are tested for coronavirus variants. There have been 34 cases of variants confirmed in Canada in recent weeks, with 15 of them in Ontario, not including the now-confirmed cases at Roberta Place.
As of Jan. 16, eligible residents of all long-term-care facilities in Simcoe Muskoka had received their first dose of the COVID-19 vaccine.
It’s possible that some residents of Roberta Place who were already infected may have been inadvertently vaccinated, noted Dr. Samir Sinha, director of geriatrics at the Sinai Health System and University Health Network in Toronto. This is because it can take several days after infection for a positive test to show up, he said.
“Right now, our rule is to say that if we think you have COVID, or you do have it, we wouldn’t actually vaccinate you. We’d wait to vaccinate you until after you’ve cleared the infection. That’s what the official guidance says,” Sinha said.
He added that even if residents and staff received the vaccine early in the outbreak, it takes time for immunity to build up.
“You’re not going to be protected as soon as you’re vaccinated.”
Raywat Deonandan, an associate professor and epidemiologist at the University of Ottawa, said it takes about two weeks after the first shot to build up enough of a response to make one immune.
He noted that all signs point to the mRNA vaccines (made by Pfizer-BioNTech and Moderna) being effective against the B.1.1.7 variant, based on testing of the variant’s behaviour when placed in blood samples of people who were given the vaccine.
“The vaccines work by targeting the spike protein, which is also where the new mutations are happening. However, the protein is comparatively very large compared to the small number of mutations happening on it, so the vaccine-enabled immune system can still recognize it,” Deonandan said.
“Vaccination is still our second-best bet to harden longterm-care centres against the U.K. variant. But the best tool is to prevent infection in the first place by driving community transmission as low as possible.”