WORK-IN-ONE-PLACE IDEA NOT BORN OF PANDEMIC

Health Minister Adrian Dix provided an update this week on the effort to fix a staffing problem that has contributed to COVID -19 outbreaks in a number of long-term care and assisted living facilities.

The problem arises with staff working in more than one facility and possibly carrying the infection with them when they move around.

Provincial health officer Dr. Bonnie Henry flagged the risk publicly as far back as her daily media briefing on March 9.

A month later she and Dix announced a “transition framework ... to make it possible for health-care workers of all kinds to work at a single site only.”

Though the April 9 framework was backed by orders from Dr. Henry herself, single-site plans are in place in only about half of the targeted facilities, Dix disclosed Thursday.

The framework applied to 7,350 employees with jobs at multiple long-term care facilities of one kind or another.

All in, 545 such facilities, including assisted living and mental health facilities, as well as private and extended care hospitals, hosted multiple-workplace employees.

“Of those 545 facilities, 276 have completed their single-site plan — that’s just over half,” said Dix.

“We expect more, significant progress next week,” he continued. “These are the ones that are completed, we’re not releasing partly completed, but all 545 are underway.”

While Dix was sharing those numbers, Dr. Henry provided an update on how the outbreak had progressed in the facilities themselves.

“We continue to have 21 active outbreaks in long-term care and assisted living,” she said. “We have a number of new cases in long-term care, bringing our total to 256 residents and 153 staff who have been affected. And 12 of these outbreaks have been declared over.”

So 33 facility outbreaks, 21 of them still active, and 409 cases, current and former, associated with those outbreaks.

Back when she and Dix announced the framework, the comparative tallies were 20 active facilities and 253 cases entailing 142 residents and 92 staff.

So while the framework was being implemented, the number of cases in long-term care grew by 60 per cent.

Dix and Dr. Henry have also reported that about twothirds of those who’ve died of COVID-19 in B.C. are associated with long-term care. On April 9 the death toll was 50. Three weeks later, it stands at 112.

The centre for disease control does contact-tracing with every case and every cluster of cases. I wondered how many of the long-term care outbreaks were tracked to one or more staffers moving between one or more facilities?

“A good proportion of them have been related to staff,” replied Dr. Henry. “And (with) many of them, it’s a single staff person who’s been identified that we declared the outbreak regarding.”

But that was as precise as she could be, not having the exact number at hand.

“I can’t really answer that question for you except to say that it has been an important consideration in at least a number of them, particularly early on, which is what triggered us to enact this single-site protocol.”

She also cautioned that “it’s sometimes very difficult to know because the first person who might be identified may not be the person who’s moving.”

Still, she has already ruled out the infection being carried between facilities by patients who were moved from one place to another, or between hospital and longterm care.

“I’m not aware that any of our outbreaks are as a result of transfers either from the community or from acute care into long-term care,” she said earlier in the week.

With the facilities mostly closed to visitors, that would presumably leave staff as the most likely source of the spread.

But in the absence of specific information, it should be noted that two long-term facilities were overrun with the virus early on and later outbreaks have been caught and confined to just a few cases. The problem of health-care workers moving between multiple facilities is one the New Democrats inherited from the previous B.C. Liberal government.

It is also a problem that was well known before the COVID-19 outbreak, according to Dr. Henry.

“This is not something new to this pandemic,” she said

“Every year we have outbreaks of respiratory illness in our long-term care sector. It has been something that we have recognized for many years as a challenge.”

However long it takes to implement the work-in-oneplace framework, she sees it as “important, not only for this pandemic, but as we consider how we best protect our seniors and elders in our long-term care sector going forward.”

While not being implemented as quickly as some might have expected, the framework doesn’t lack support within the health-care system, according to Dix.

He paid tribute to health officials, private employers and several unions “for working to implement this complex, necessary change.”

Nor will the single-site framework fail for lack of funding. The new regime includes salary top-ups to ensure that none of the 7,350 workers has to take a pay cut for being confined to a single workplace.

Dix estimates the salary equalization will cost $10 million a month, which works out to an average of $1,360 per employee.

Though the increase is billed as only temporary, more likely the salary equalization will become a permanent fixture of the sector, adding $120 million to the health-care budget annually.

While the framework was being implemented, the number of cases in long-term care grew by 60 per cent.