Analysis explores why fewer long-term care residents died from COVID-19 in BC compared to Ontario

By Hayley Mick

British Columbia suffered far fewer deaths of long-term care residents than Ontario due in part to key differences in their response to the pandemic, according to an analysis published Wednesday in the CMAJ.

The analysis, co-authored by Unity Health Toronto’s Dr. Irfan Dhalla, showed that even before the pandemic, long-term care (LTC) facilities in BC benefitted from more funding, less crowding, more inspections, more non-profit ownership and a more integrated system between public health, LTC homes and hospitals. As the virus spread into the homes, BC officials were faster to respond, limiting transmission and preventing deaths with clear communication, staffing supports and infection and prevention control measures, the authors said.

“BC was better prepared for the pandemic, and elected leaders and public health officials responded faster and more decisively with measures to limit transmission of SARS-CoV-2 into long-term care homes,” said Dr. Dhalla, a physician at St. Michael’s Hospital and Unity Health Toronto’s Vice President of Physician Quality. The paper’s lead author was Michael Liu, medical and graduate student at Harvard University and the University of Oxford.

People living in LTC homes in Canada have suffered disproportionately from COVID-19, and the impact across provinces and territories has not been equal. As of September 10, according to public data cited in the report, there were 5,965 resident cases and 1,817 resident deaths in Ontario LTC facilities compared to 466 cases and 156 deaths in BC care facilities.

The authors highlighted strategies that could prevent more deaths in long-term care as Canada enters a second wave, and also for future infectious disease outbreaks. These include clear, consistent communication from officials; a rapid and proactive response to outbreaks; the move to single rooms from more crowded conditions; the mobilization of infection prevention and control teams to support LTC homes during outbreaks; and organizational structures to support integration between LTC, public health and hospitals.

While BC benefitted from better integration between hospitals and LTC residences, so did some homes in Ontario. One example is at Providence Healthcare, a hospital site within Unity Health Toronto. The hospital’s campus is home to 288 long-term care residents at the Cardinal Ambrozic Houses of Providence.

“Having a hospital network attached to the Houses of Providence was integral in our successful response to COVID-19,” said Dr. Ashley Verduyn, medical director of the houses, who was not involved in the study.

Dr. Verduyn said those benefits included access to PPE through the Unity Health PPE procurement team, assistance and coaching from infection prevention and control and occupational health clinicians for frontline staff on how to don and doff PPE, and support from microbiology and infectious disease experts in outbreak management. During staffing shortages, staff were redeployed from other parts of the network, and an Incident Management Team was quickly put in place to manage the outbreak.

Most critical, said Dr. Verduyn, was Providence’s ability to turn to St. Michael’s Hospital microbiology lab to do widespread testing of all of the residents in affected units at a time when provincial guidelines limited testing to a small number of swabs per long-term care home. They discovered 11 asymptomatic residents that would not have otherwise been identified. These residents, if not isolated, could have unknowingly transmitted the virus to other residents or staff. Ultimately, Providence Healthcare contained its outbreak to 13 residents, with three deaths.

The CMAJ authors cited other reports with extensive recommendations on how deaths in long-term care can be prevented, including the recent report from The Royal Society on COVID-19 and the future of long-term care, co-authored by Unity Health Toronto’s Sharon Straus, a geriatrician and clinical epidemiologist at St. Michael’s Hospital.

“Residents of long-term care homes will always be susceptible to infections,” said Dr. Dhalla. “Our analysis highlights policies and practices that, if implemented, could help protect these vulnerable seniors from a second wave of COVID-19 as well as other infectious diseases.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.