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At Toronto's Fairview Nursing Home, seen on September 28, 2020, two residents have died. Another 49 residents of the 108-bed home have tested positive, along with 22 staff.Melissa Tait/The Globe and Mail

A surge of COVID-19 infections in Canada’s most populous province is spreading to elderly residents of nursing homes, with the number of facilities declaring an outbreak tripling over the past month.

Half of the homes with an outbreak are in Toronto, Ottawa and Peel Region, all hot spots in Ontario where community transmission of the virus is concentrated. Older homes with multibed ward rooms have been hit the hardest, a Globe and Mail analysis shows.

While the vast majority of Ontario’s 630 long-term care homes remain free of the virus, the spike in the number with outbreaks – to 57 from just 19 in early September – is alarming, medical experts say. What it shows, they say, is the vulnerability of residents living in homes in communities where the number of people testing positive for the virus is growing exponentially.

Ontario’s Chief Medical Officer of Health, David Williams, said on Thursday – the same day the province recorded a record-high 797 new COVID-19 cases – that the virus is spreading beyond hot spots to other areas in York Region, Halton, Muskoka and Durham, east of Toronto.

Most of the people testing positive are under the age of 40, but the virus is starting to spill over into older people, who are at higher risk of dying, and into congregate settings such as long-term care, Dr. Williams said.

“Alarm bells are ringing louder and louder,” he said.

Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto, said the greatest risk factor for a long-term care home is the prevalence of COVID-19 cases in the community. Many of the staff in these homes are racialized women who live in poorer neighbourhoods where the virus is particularly prevalent, he said, and they can unknowingly transmit it into their workplace.

“These are not hermetically sealed environments,” Dr. Stall said. “To prevent risk of outbreaks, we need stronger action to control community transmission.”

Ashley Verduyn, director of medical affairs at Unity Health’s Providence Healthcare in Toronto, said she is also frustrated that the provincial government has not put more restrictions in place to lower community spread of the virus.

“I think it’s heartbreaking,” Dr. Verduyn said. “It’s just a matter of time until more homes are infected.”

The province asked Unity Health on Wednesday to temporarily take over management of Norwood Nursing Home, a tiny 60-bed facility in Toronto where 19 residents and seven staff members have tested positive for COVID-19.

Norwood is the third long-term care home to come under management by a hospital since the onset of the second wave of the virus.

Ottawa’s Medical Officer of Health, Vera Etches, asked the Ottawa Hospital last month to manage two homes owned by Extendicare in the city to get major outbreaks under control.

At West End Villa, a 242-bed home in Ottawa, 19 residents have died since an outbreak of COVID-19 was declared on Aug. 30. Another 122 residents and staff members have become sickened with the virus, according to Ottawa Public Health.

At Laurier Manor, another 242-bed home owned by Extendicare, 25 residents died of the virus between April and June, according to Ottawa Public Health. Twenty residents and staff have tested positive since the onset of a second outbreak on Sept. 1.

Five of the homes Extendicare owns in Ontario have an outbreak. All five homes are in Ottawa. The for-profit chain operator attributed the outbreaks to the fact that Extendicare cannot test employees for the virus on a weekly basis in its Ottawa homes.

Because labs in the city are struggling to keep up with demand, they have asked Extendicare to test employees every two weeks. “The purpose of weekly testing is to identify and remove positive cases from our homes before they have an opportunity to infect others,” the company said in an e-mail response to The Globe.

All five of the Extendicare homes are older ones where residents sleep in the same room and share a bathroom with two or three other people. Two of the homes in Toronto with severe outbreaks, including Norwood, are also older ones with multibed wards, where separating residents who have tested positive from others is much more challenging.

At Fairview Nursing Home, two residents have died. Another 49 residents of the 108-bed home have tested positive, along with 22 staff. The home is working with infection prevention and control staff at a Toronto hospital, and expects to resolve a large number of cases in the next couple of days, said Jessica Trepanier, a spokesperson for Schlegel Villages Inc., a for-profit chain that owns the home.

“The outdated design makes a huge difference for containing these outbreaks,” Dr. Verduyn said.

In the spring, the virus tore through Canada’s two biggest provinces, killing 4,914 elderly residents of long-term care in Quebec and 1,848 in Ontario. This time around, the situation in Quebec homes is not as critical.

One long-term care home, CHSLD Champlain, has a significant outbreak, with 21 current cases. In total, 144 long-term care residents in Quebec have the disease.

With reports from Laura Stone and Tu Thanh Ha

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