B.C. Seniors Advocate Isobel Mackenzie

Image Credit: FACEBOOK/BC Government

A new study from B.C.'s seniors advocate says better sick pay provisions and more registered nurses working in long-term care and assisted living homes would go a long ways toward reducing COVID-19 or any infectious disease outbreak.

Seniors advocate Isobel Mackenzie made those and five other recommendations after studying 365 outbreaks in 210 B.C. care facilities (including 40 in the Interior Health region) from March 2020 to February 2021.

“As we review this information, it is important to remember that it represents more than numbers on a page,” she wrote in a report released today, Oct. 6. “It represents people — families, seniors, and the staff who care for them. This pandemic has disrupted lives everywhere, especially in long-term care and assisted living.”

During that time period, residents and staff of long-term care homes contracted 4,484 cases of COVID, or 6% of the total in B.C., yet they accounted for 782 COVID deaths, 57% of all deaths during that time.

All of those who died were residents.

Of the 365 outbreaks, most were small and 75% had no fatalities. While the Lower Mainland has 45% of B.C.’s long-term care and assisted living beds, it accounted for 84% of the outbreaks.

The study found that, in 76% of the outbreaks, the first person to test positive was a staff person but the chances of there been a larger outbreak (more than four cases) was four times greater if the first case detected was in a resident.

“Residents, for the most part, contracted the virus from staff,” Mackenzie said during today's press briefing. “What you’re seeing here is the effect, to a large extent, of asymptomatic staff unaware that they are infected and transmitting the virus to a resident. The resident is tested because they’re beginning to show symptoms. The outbreak is declared. We come in with our control measures but it’s already spreading.”

If the first case was detected in night workers, the chance of a larger outbreak was five times greater than if it was in day workers. That’s because day workers normally work with about 25 residents in one unit while night workers may have to look after 100 residents on multiple floors and in different units, Mackenzie said.

How the facility operator was notified about a staff member having COVID also had an impact on the size of the outbreak.

If a worker got a positive test and contacted the operator right away, then the operator knew who that person had been in contact with and could respond appropriately.

If the operator had to wait for public health authorities to contact them, that could take as much as a day longer and then would only say there was a positive test, not who it was, so the operator’s response would be different.

The most effective way of protecting residents was to stop family from visiting and making sure staff only worked at one site. That was effective since only one outbreak was linked to a visitor and there were no documented cases of a staff person taking the virus from one site to another.

But 40% of the staff went to work when they didn’t feel well, mostly because of their concern for the workload staying home would leave for others, but 20% did so for financial reasons.

Only 61% of staff are full time and get sick leave. Those in facilities operated by public health all got the maximum of 18 paid sick days but only 44% of those in not-for-profit sites got 18 days and only 7% in for profit facilities.

“We did find that lower amounts of paid sick leave was much more likely to lead to larger outbreaks,” Mackenzie said.

Mackenzie looked at the history of other outbreaks in care homes and found they were more likely to have larger outbreaks if they had outbreaks in the past. The same was true for those facilities that had been subject to multiple inspections from health authorities.

Publicly operated care homes also had a higher proportion of nurses on staff, which translated into fewer large outbreaks.

“The people with the highest level of clinic training, assessment capabilities, are really found in your registered nursing staff,” Mackenzie said. “On a day-to-day basis it’s not as apparent that those skills are needed but, when there’s a crisis – and I don’t think anybody will argue that this wasn’t a crisis – that’s when you see the value of that additional level of training.”

That’s why she’s recommending not only higher nurse staffing levels but also for the province to open up more nurse training seats as there are waiting lists to get in.

The B.C. Nurses’ Union has been calling for that change for years.

READ MORE: Mandatory vaccines for nurses making hospitals even more unsafe: union

The other five recommendations in the report include increasing staff levels, increasing testing and eliminating shared rooms.

– This story was updated at 11:20 a.m. Wednesday, Oct. 6, 2021, to add more information.

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