As COVID-19 races through Alberta long-term care homes, one of Canada’s largest private operators is calling on the province to immediately make weekly testing of staff mandatory.
“We must act now. There is no time to waste,” said Extendicare Inc. chief medical officer Matthew Morgan.
Extendicare said it has made the request to officials at Alberta Health Services (AHS) and Alberta Health Minister Tyler Shandro’s office several times this fall, and most recently this week. Dr. Morgan said Alberta has not yet embraced the idea of mandatory testing of staff, a “proven strategy for preventing outbreak.”
“Testing of staff on a regular basis is required to identify sources of the virus and remove them from the home before residents become infected. We can’t fight the virus if we don’t know where it is, or who might be carrying it.”
Alberta has seen a rapid rise in outbreaks at long-term care facilities in the past two months. The province now has outbreaks – reported to the public in Alberta when there are two or more cases – at 53 long-term care facilities. At Revera Inc.’s South Terrace Continuing Care in Edmonton, one of the hardest-hit homes, 27 residents have died of COVID-19 as of Dec. 3.
Premier Jason Kenney has said the people in long-term care built the province and “we need to do everything we can to protect them.” Alberta has tested widely for COVID-19, and is giving tens of millions of dollars to continuing-care operators for enhanced staffing, cleaning and revenue loss.
However, the province now leads the country when it comes to new COVID-19 cases, and is facing the near-term prospect of a surge of sick patients that could overwhelm hospitals. Mr. Kenney has faced continued criticism for not implementing more aggressive COVID-19 restrictions earlier this fall to prevent wide community spread of the disease that has hit already-stressed continuing-care facilities hard.
So far, as is the case in other jurisdictions, people in congregate-care facilities have suffered the most. There have been 367 deaths in those facilities – which include long-term care and supportive/home living sites – making up 64 per cent of all of Alberta’s COVID-19 deaths. There are also 70 outbreaks at supportive/home living sites.
Revera, a private, for-profit chain operator, also says it has been advocating for asymptomatic testing for staff. “We have approached the governments of provinces where we operate to advocate for mandatory surveillance testing,” spokesman Larry Roberts said this week.
Mr. Shandro’s press secretary, Steve Buick, said the minister is open to suggestions, but Alberta’s current practices are based on the advice of Chief Medical Officer of Health Deena Hinshaw. “He would rely on [Dr. Hinshaw] for advice as to whether any change is needed, and up until now, she has not recommended a change.”
Alberta Health spokesman Tom McMillan said all continuing-care staff who are identified as a close contact of someone with COVID-19 or are symptomatic, are instructed to get tested and to follow return-to-work guidelines. “If an outbreak is declared, all symptomatic staff and residents are tested.”
But as The Globe and Mail reported last month, provinces including Alberta, British Columbia and Manitoba do not require routine, surveillance testing of staff in long-term care homes. Those provincial governments also don’t require all staff to be tested for the virus, even after a home declares an outbreak. The protocol is to screen staff for symptoms at the beginning and end of their shifts.
Extendicare said five of its 14 Alberta homes are currently in outbreak status. Transmission by asymptomatic individuals is a major source of spread, Dr. Morgan said, and screening for fever and other symptoms is not enough to keep coronavirus away from vulnerable residents.
Extendicare operates homes in Alberta, Manitoba, Saskatchewan and Ontario. The company said it has learned from its experience in Ontario, where the government is requiring nursing homes in communities hit hard by coronavirus to test all staff and visitors once a week for COVID-19.
Under a directive issued by Ontario Long-Term Care Minister Merrilee Fullerton on Nov. 23, homes in regions the province has classified as orange, red and grey zones – including Toronto, Peel Region and Hamilton – must test staff weekly. Prior to the new directive, nursing homes in Ontario were routinely doing surveillance testing of staff every two weeks.
Dr. Morgan also said Extendicare is participating in rapid-test pilot programs for long-term care staff in Ontario and Saskatchewan. “This pilot is particularly important for our rural homes, which experience challenges in receiving timely test results.”
In Alberta, Mr. McMillan said that Alberta Health will soon begin piloting rapid testing at select sites across the province, including at some continuing-care facilities.
Wayne Morishita, executive director of the Alberta Continuing Care Association, said some Alberta operators are already doing regular testing of asymptomatic staff – and he believes mandatory testing for staff might work in some long-term care facilities, but not others.
Mr. Morishita said visitors to facilities are also a source of new infections. “No matter how much the operators are following all of the orders, and screening people as best they can … if the community infection rate increases, it gets into our homes.”
Physician Daisy Fung has been working at CapitalCare Lynnwood in Edmonton the past two weeks, where there now are about 56 residents and 31 staff with COVID-19. It’s heartbreaking work. She has witnessed some patients’ last moments of communication with their families, only over FaceTime.
“We are incredibly short-staffed with nurses, due to the number who are positive or isolating,” Dr. Fung said in an e-mail.
Everyone is working full out, she added. Staff are being asked to come in outside of their regular shifts. The site director is wiping down high-touch surfaces and feeding patients.
“I have a wonderful nurse practitioner, sometimes two, to help us deal with the ever-increasing number of sick residents. I see community paramedics who work hard, and come quickly to ensure our residents are treated on-site – avoiding the hospital transfer we know is not best for the patient, nor the system.”
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Kelly Cryderman
Karen Howlett