How the coronavirus took North Vancouver’s Lynn Valley Care Centre

Open this photo in gallery:

Ruth was outraged when the colleague she was driving to work told her rumours were flying that a nurse at their North Vancouver care home had tested positive for COVID-19.

“I said, ‘What? They have coronavirus here? Why didn’t they let us know? What are we going to do now?’”

Ruth, an aide at the facility, recalls her conversation as they pulled into the facility for the graveyard shift on the night of Thursday, March 5.

Ruth immediately asked her supervisor of the wing of the Lynn Valley Care Centre known as “the lodge” about the concerning rumour. Ruth says she received no special instructions for the next eight hours.

As the sun rose on Friday, March 6, a half dozen concerned aides and nurses waited around after their shift to press the director of care about whether COVID-19 had arrived at the North Vancouver nursing home.

The director confirmed that, the day before, their co-worker had tested positive. The staff, almost all middle-aged Filipina-Canadians, were shocked and then angered.

“'The only thing you need to do is wash your hands – wash your hands,'” is what Ruth recalls the director telling everyone. Ruth seethed.

“Why didn’t you let us know?” she asked.

To mitigate any potential spread of the virus, staff cut out the communal breakfast on the second floor of the lodge and began “tray service,” delivering meals to rooms there, according to Ruth, a staff member who would later test positive for the virus, told The Globe. She spoke on the condition of using a pseudonym because she was worried about losing her job and ashamed of the stigma associated with the virus.

As panic set in among staff at the 200-bed facility, nurses scrambled to swab three residents showing symptoms of the virus that day and sent the samples off to be tested, according to other staff members who spoke with The Globe. After the morning shift was done around 2 p.m., the director of care held a more formal meeting and told a larger group of employees that their co-worker, whose last day at Lynn Valley was a week earlier on Feb. 29, had just tested positive.

Anyone with flu-like symptoms needed to stop working and get tested, she added.

Two days after receiving word that the virus had reached the care home, British Columbia’s Provincial Health Officer Bonnie Henry stood before a scrum of reporters on March 7 to declare an outbreak at the facility due to the novel coronavirus. Two residents and one health-care worker had tested positive for COVID-19.

“This is one of the scenarios that we have been, of course, most concerned about,” Dr. Henry said.

The next day, March 8, one of the residents would die, becoming the first person in Canada to succumb to COVID-19. In the ensuing two weeks, another seven would die, and 36 residents of the facility and 18 health-care workers linked to it would be infected by the virus.​

All but five of Canada’s 13 coronavirus deaths as of Friday afternoon can be traced to Lynn Valley, where the average age of residents is roughly 87 years old.

The fatal outbreak marked a grim turning point in the country’s battle against COVID-19. The province reacted by prohibiting all but essential visits to long-term care homes while acknowledging that the increased isolation could damage the delicate mental health of many seniors.

The local health authority, which has direct oversight of the provincially funded facility, is still piecing together how and when the virus was introduced into Lynn Valley and why it spread so quickly.

To understand what was happening there in the days before Canada’s deadliest outbreak, The Globe reached out to workers and families of people either killed by the virus or still living at Lynn Valley. Five workers spoke to The Globe, but all of them, like Ruth, did so on the condition of using a pseudonym. Their accounts offer a glimpse into how easily the highly contagious virus can devastate a nursing home, the form of housing in Canada that appears most vulnerable in this global pandemic.

The local Sherkat family has long owned the nursing home, and their company North Shore Private Hospital Ltd. was incorporated in 1985 to run the facility.

In a full-page letter sent from the nursing home’s e-mail account, an unnamed representative detailed how heartbroken everyone at the facility is at the mounting death toll.

“We are deeply thankful to each and every member of our staff, and their families, for their tireless and continued efforts to keep residents safe, and ensure we get through this difficult time together," the letter stated. "The Lynn Valley Care Centre has been in operation since 1963, and under the same ownership since the mid 1980s.

"Our residents, their families, our staff, and their families feel like part of our family.”

The letter stated the centre is meeting daily with local health officials and is concentrating all its efforts on stopping the current outbreak and minimizing its harms. Once the world is “on the other side of the COVID-19 emergency,” the centre said it is committed to commissioning an independent review into how events unfolded on its property and sharing as much as possible of the resulting report into the outbreak.

The crisis in North Vancouver has revealed the devastating toll that the virus is having on the elderly, as well as those who care for them. The precarious nature of employment in many private nursing homes may have also contributed to the spread of the coronavirus.

Many employees in the sector supplement their low wages by working at multiple facilities – an arrangement that has already led to one Lynn Valley employee being suspected of spreading the virus to a second long-term care home in nearby West Vancouver. This week, the province announced the virus has also infected a resident at a third nursing home, Haro Park Centre in Vancouver.

The workers who spoke with The Globe worry that the weak initial response by management and the health authority will inflate the ultimate death toll.

Lynn Valley Care Centre sits midway up the striking North Shore, nestled in between Grouse and Seymour mountains, which attract hikers, mountain bikers and skiers throughout the year.

The private facility houses 139 government-subsidized beds and 65 private pay rooms and suites in a wood-framed lodge and a newer and much larger concrete tower called “the manor.” The outbreak has so far been contained to the lodge, which contains roughly half the units at Lynn Valley.

The Sherkat family has had no recent complaints or outbreaks of any kind, according to an October, 2019, report from the province’s seniors advocate, whose role is to monitor seniors services and make recommendations to government and service providers to address systemic issues.

Two-thirds of Lynn Valley’s residents live with some degree of dementia and about 58 per cent receive medication for depression, which is 10 per cent higher than the B.C. average, according to the 2018-19 annual report from the independent provincial watchdog.

A third of B.C.’s 27,000 provincially funded nursing-home units are owned and operated by the various health authorities in the province. The rest are run by non-profit organizations and for-profit companies contracted by these health authorities.

The wages and working conditions in the sector vary greatly between the different homes.

Long-time workers at Lynn Valley say they once were unionized, but over the past decade or so have been rehired by subcontractors that offered less money and rolled back benefits for the people who clean the facility, prep and bus meals in the communal dining room, and feed and bathe residents.

Nurses in the province’s long-term care homes have stayed unionized over the past 20 years, as stipulated under provincial legislation that opened up the possibility of privatizing those services.

Lena, a long-time aide at Lynn Valley, says management there ditched an agreement with her union several years ago and the private firm that rehired her to do the same job paid her $2 less an hour and cut the number of sick days she was allowed each year from 10 to three. Vacation days – a potential buffer for sickness – were also cut from 22 days a year to 10, according to Lena.

The chief executive of her Vancouver-based employer, Carecorp Seniors Services, deferred any comment to Vancouver Coastal Health (VCH), the Lower Mainland health authority.

She has three sick days a year, which is why, when she finished her shift on Feb. 29 and felt a cold coming on strong, she decided to take just two days off before returning to work.

“We don’t have enough sick time,” Lena said. “Even if people are sick, we are still working, and that’s the truth.”

Open this photo in gallery:

After working the first day with a stubborn fever, Lena visited a North Vancouver walk-in clinic, where a doctor checked her lungs, ears, throat and temperature before diagnosing her with the flu.

Lena, who regularly remits money back to her family in the Philippines, continued working, but her illness kept getting worse. Her fever was paired with a dry, nagging cough and a troubling shortness of breath.

It was apparent residents were sick as well: Those on the second floor of the lodge were asked to stay in their rooms on the evening of Thursday, March 5, according to several workers.

There were whispers among them that the coronavirus had reached Lynn Valley, but Lena wasn’t notified formally until the Friday afternoon meeting with the director of care.

Lena’s heart sank. She suspected she had been infected, too. The following day, she went to a hospital close to her home, where she explained her situation and was given a nasopharyngeal test – an uncomfortable swab of the nose and upper throat – for the coronavirus. At that point, the virus was confirmed to have infected around 20 people in B.C.

“Deep inside my heart, I knew I was positive because I had pneumonia and pneumonia is one of the serious symptoms,” said Lena, whose test later proved her hunch correct.

She was afraid for her friends and co-workers, some of whom she carpooled with. When Lena called in sick that weekend, she was joined by several other colleagues now self-isolating with symptoms consistent with COVID-19.

On Saturday, Dr. Henry, the province’s top health official, declared an outbreak at the Lynn Valley Care Centre. Two residents and one health-care worker had tested positive.

“This is one of the scenarios that we have been, of course, most concerned about,” Dr. Henry said.

Short-staffed, some subcontractors offered double wages to entice people to come back to work, but there were few takers and the facility limped along without a full complement of workers that weekend, according to several staff members and relatives of residents who spoke with The Globe.

As signs were posted to the care home’s doors warning of an outbreak and a team from VCH arrived on site to assess everyone on Saturday, March 7, worried family members of residents helped frazzled health-care workers with feeding and other duties.

Open this photo in gallery:

VCH personnel helped the nursing home try to stop the spread of the virus by implementing an outbreak protocol that ended communal meals in the lodge’s dining room and suspended recreational exercises.

In a letter sent to residents and their families that day, VCH’s deputy medical health officer, Mark Lysyshyn, said those with COVID-19 had been isolated to their rooms. The facility would still accept visitors as long as they were not sick, restricted their visits to one room or resident and obeyed all infection-control signage posted around the facility.

Bold letters emphasized a promise: “Residents who develop symptoms will receive the care that they need.”

At Dr. Henry’s news conference, it was revealed that the facility first appeared on health investigators’ radar two days earlier, after a woman with no recent travel history was confirmed to have COVID-19 – the first confirmed case of community spread in B.C. She had earlier visited her physician, complaining of flu-like symptoms, and was administered a COVID-19 test, which had recently been added to the province’s regular influenza surveillance in efforts to pro-actively detect cases of the new disease.

The health investigators then learned she was a health-care worker at Lynn Valley.

That Sunday, March 8, staff reported the situation getting increasingly dire.

Around 1 p.m., Janine, an aide, brought an egg salad sandwich into the room of an elderly woman and was startled to see a tray of toast and scrambled eggs laying untouched and out of reach. The bedridden woman beamed up at her with gratitude, but Janine couldn’t help bursting into tears as she began feeding her lunch.

After, in the dining room of the lodge, Janine and the two other workers on shift confronted their manager as to what the plan was for dealing with the nearly 50 residents on one floor of the building, some of whom hadn’t been fed or helped to the bathroom for many hours.

“I don’t know,” her boss said as she herself wept. She explained that their subcontracted company had not received any guidance from management. Janine thought that was strange, given that she had seen an official with the local health authority buzzing around earlier that Sunday with a public health nurse and the home’s director of care.

Another sign of the chaos, she noticed, was that a trio of relatives were pitching in to help feed the remaining guests of the lodge, despite VCH’s warning that any guests needed to restrict their visits to a single room or resident. Still, she was grateful for their help that Sunday because many of her co-workers stayed home battling symptoms of the virus.

That Sunday evening, a resident of the facility, an 83-year-old liked by everyone, became the first in Canada to die of COVID-19.

His daughter Kelly, who asked that her real name not be used to protect her deceased father’s wish for privacy, said her dad loved nothing more than gardening in the acidic soil of North Vancouver or strolling through the local mountain paths with their family dog. Though he was frail and often battling one ailment or another, he was lucid enough to understand what was going on around him.

“He was very weak, but he still said ‘please’ and ‘thank you,’ ” Kelly told The Globe last week in a phone interview.

Her mother knew something was wrong at the nursing home when she went to visit her husband that Friday and was told now may not be the best time.

On Saturday, someone at VCH called Kelly, her dad’s second family contact, to tell them he had tested positive.

By Sunday afternoon, his condition had deteriorated rapidly. When Kelly and her brother donned full protective gear to enter his room, they saw him connected to a ventilator struggling to breathe, hours away from death.

She said the exhausted staff on site at the lodge that Sunday were incredible in their attempts to help the residents, but the understaffing gave the building the feeling of a ghost town.

“If you’re trying to serve more people than they really can and every time they have to go into that particular room and another you’ve got to suit all up to give them some water – it’s just not happening,” Kelly said of the overwhelmed facility.

For a while, she had known the next common cold could fell their father, so his death at the hands of the coronavirus was not inconceivable.

“The saddest part, given his age, given his frailty, is just thinking there was any fear or discomfort that was unnecessary because of the lack of levels of care,” Kelly said. “But maybe he can be the one contribution to improving the level of care in these homes. … [Staff] are run off their feet, there’s not enough of them.”

The next day, Monday, March 10, Dr. Lysyshyn of VCH issued another letter to families of residents at the centre’s lodge, expressing sadness over the death.

“As a family member to one of the residents at the lodge, we understand that this is concerning information,” he wrote.

He explained that the lodge was under outbreak precautions and that a medical health officer was working with staff to ensure appropriate infection-control precautions were in place.

By that point, health officials had revealed that two more residents and an additional health-care worker at the facility had tested positive. Friends and family of the nurse who first tested positive also were notified that they had the virus. Medical officials are working to determine how the virus was introduced into the care home.

Open this photo in gallery:

When word that a Lynn Valley staffer had tested positive began circulating in the community, people began speculating about how it happened, said Christine Sorensen, president of the BC Nurses’ Union, which represents several licensed practical nurses at the care home.

“There were some criticisms from members of the public about whether the nurse had brought it in, or if they were bringing it out into the community,” she said.

“Some of [the nurses] couldn’t get rides to work. Taxis wouldn’t pick them up to go to Lynn Valley, or come to pick them up from Lynn Valley to go home. Some members had difficulty finding child care because once they were known that they worked at Lynn Valley, then their children were asked to be excluded from child care.”

On March 12, Dr. Henry delivered further bad news. “Most concerning for us is we do now have a second long-term care home that has an outbreak that is involved with COVID-19,” she said.

A resident of the Hollyburn House Retirement Residence in West Vancouver, a man in his 90s, had tested positive for the disease, she said. A health-care worker who worked shifts at both facilities had accidentally spread the virus.

The day after the first resident died, Gordo Bone pulled his anxious 85-year-old mother out of Lynn Valley after a short stint recuperating from a bad fall. He brought her back to his home in Pender Harbour on B.C.’s Sunshine Coast, where she is isolating now without symptoms. His dad is also asymptomatic, but the 87-year-old remains in the care home, where he has been staying on a more long-term basis.

Both were living in the newer and larger manor building.

Mr. Bone said that when he visited his parents at the outset of the outbreak, the centre seemed short-staffed with care providers working double shifts, but that has since improved. Additional safety protocols have been put in place – visitors are restricted and meals are taken to all residents’ rooms to avoid communal dining, he said.

And the front-line staff – or “heroes” as he calls them – are doing their best to stop the potential spread of the virus among the remaining residents. But that is hard because many residents are suffering dementia and other debilitating conditions, he said.

Open this photo in gallery:

Roger Wong, a clinical professor in geriatric medicine at the University of British Columbia, said seniors are more vulnerable to developing infections in part because immune function declines with age. As well, underlying health conditions may predispose them to developing infections more easily.

“Seniors who live in seniors homes are intrinsically more at risk,” Dr. Wong said.

The outbreak at Lynn Valley had one other impact on the health-care workers. A directive, confirmed by Dr. Henry, to only work at one facility – a measure aimed at mitigating the spread of the virus – meant that those who worked casual shifts in more than one setting suddenly had their income slashed.

“We’re looking at the impacts at that,” said Ms. Sorensen, of the nurses’ union, “not only on staffing numbers – because if you don’t get to work in the other facility, that reduces the number of nurses in that other facility, which could compromise patient care – but also the financial impacts if nurses aren’t able to work in both of their facilities.”

For Lena, the Lynn Valley staffer still battling the virus while quarantined in her own home, this crisis shows how urgently the sector needs to be reformed to improve wages and benefits such as sick days and vacation time. That would cut down on workers travelling to multiple facilities in a day, she said.

“This is the right time for us to come together so the government will see the situation of the health-care workers who are the front-liners who work hard,” she said.

Carecorp Seniors Services, a dietary aide subcontractor, directed all media queries to Vancouver Coastal Health. Pro Vita Care Management Inc., a care aide subcontractor, and WestCana Services Inc., the company contracted for housekeeping duties at Lynn Valley, did not respond to interview requests.

In a statement to The Globe, VCH said Lynn Valley is operating “very near target staffing levels” and that the health authority is working with the operator to add additional staff as needed. “We recognize the stepped-up outbreak response precautions delayed the delivery of some services, including meals,” the statement said. “We’re committed to providing residents the care they need and we thank the families for their patience, kindness and understanding.”

Open this photo in gallery:

Janine, an aide at Lynn Valley, said she has more pressing concerns than whether her pay will one day increase.

Her husband also has tested positive for COVID-19 and the couple is now trying their best to stop their seven-year-old son from contracting the virus while isolating him to a separate room of their two-bedroom basement suite.

“No one is helping my son,” she wrote in a text message exchange Wednesday. “I’m still preparing his food. I just washed my hand and don’t talk without mask on.

“I’m just thankful my son has a good immune system.”

A timeline of the COVID-19 outbreak at Lynn Valley Care Centre

February 29: Nurse who would later test positive works her last shift at the North Vancouver facility known as Lynn Valley Care Centre.

March 5: Provincial Health Officer Bonnie Henry announces that a woman in her 50s with no recent travel history or known links to confirmed cases has tested positive for the new coronavirus. This makes her the first confirmed case of community transmission in B.C. – and evidence that the virus is spreading undetected. That evening, rumours swirl among staff at Lynn Valley that the virus had arrived at the facility.

March 6: A half-dozen concerned aides and nurses at Lynn Valley confront the centre’s director of care at the end of the graveyard shift. The director confirms that one of their co-workers had tested positive. The others are shocked and angered to learn the news this way. A more formal meeting is held that afternoon.

March 7: Dr. Henry announces an outbreak at Lynn Valley Care Centre. Health officials tracing the contacts of the woman who tested positive two days earlier had learned she was a health-care worker at the centre. There, they find two residents are also positive for the virus. The local health authority dispatches a team to assess people on site and implement outbreak protocol.

March 8: One of those residents, an 83-year-old man, dies. He is the first person in Canada to die of COVID-19.

March 9: Dr. Henry announces the man’s death at a news conference. Another health-care worker at Lynn Valley tests positive, as well as two close contacts of the initial health-care worker.

March 10: Two more health-care workers at Lynn Valley test positive: a woman in her 40s, and a woman in her 50s.

March 11: Another two health-workers are confirmed to have the virus. They are a man in his 20s and a woman in her 50s.

March 12: An outbreak is declared at Hollyburn House Retirement Residence in West Vancouver, where one resident and one health-care worker have tested positive. Health officials confirm it is linked to the outbreak at Lynn Valley.

March 13: An outbreak is declared at Lions Gate Hospital in North Vancouver, where three administrative staff tested positive for the virus. They have no known link to Lynn Valley, and had no regular contact with patients. Another close contact of a Lynn Valley worker tests positive.

March 14: Five more cases linked to Lynn Valley are confirmed. By now, four residents and a dozen staff members have been infected. Due to a soaring number of cases in the province, the B.C. government has stopped providing details of individual cases.

March 16: Three more residents of Lynn Valley die. Lions Gate Hospital escalates its outbreak response and accepts only emergency patients.

March 17: Two more Lynn Valley residents die.

March 18: A resident of Haro Park Centre, an independent housing, assisted living and long-term care centre in downtown Vancouver, tests positive.

March 19: Another Lynn Valley resident dies.

March 20: Asked about cases at the care home, Dr. Henry said 36 residents had tested positive to date, and eight had died. As well, 18 health-care workers at Lynn Valley had tested positive but all of those cases were mild. A new outbreak was declared at the Dufferin Care Centre in Coquitlam, where a staff member tested positive.

If you have further information about this story, please email mhager@globeandmail.com and andreawoo@globeandmail.com.

With research from Stephanie Chambers and Rick Cash

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters.