When COVID-19 vaccines finally arrive on Canadian soil, the first shots will almost certainly go into the arms of people living and working in the country’s virus-ravaged nursing homes.
That’s the recommendation of an expert committee that advises the Public Health Agency of Canada on immunization, and it is the preference of the handful of provincial governments that have released preliminary plans for vaccination blitzes that could begin as early as the first week of January.
Yet nursing-home operators, workers’ unions and groups representing the long-term care industry say they’ve received little or no advice from provincial governments about how to prepare.
The silence has been especially deafening in Ontario, where the government didn’t unveil a vaccine task force until Friday – the same day an independent commission published an interim report highlighting the province’s failure to protect long-term care during the second wave.
“We still need to get more information on how [the vaccine] is going to roll out,” said Lisa Levin, chief executive officer of AdvantAge Ontario, which speaks for municipal and not-for-profit nursing homes in the province.
Sharleen Stewart, president of SEIU Healthcare, a union that represents personal support workers in long-term care, said, “We’ve heard nothing yet. Just what we hear in the media.”
It’s hard to overstate the importance of a swift and smooth vaccine rollout in seniors’ facilities. It is a matter of life and death for vulnerable residents, and a test of how Canada will fare with the more logistically complex task of vaccinating the wider public.
In November alone, at least 1,142 residents of nursing, retirement and assisted-living facilities died of COVID-19, according to a Globe and Mail tally of data from all provinces except British Columbia, which declined to provide a figure. That’s 61 per cent of virus deaths outside of B.C. last month.
“Time saves lives,” said Samir Sinha, director of geriatrics at the University Health Network and Mount Sinai hospital in Toronto. If Health Canada authorizes the first COVID-19 vaccine this month, as the regulator has signalled it will, and doses languish in freezers for even a short time, “there’ll be more cases of COVID and more deaths,” Dr. Sinha said. “And that will just be an absolute shame.”
Retired general Rick Hillier, recently appointed to lead Ontario’s vaccine task force, told The Globe the province’s goal is to give the first available doses to residents and staff of long-term care homes, but that depends on shipping and storage constraints.
Pfizer Inc.’s vaccine – which proved 95-per-cent efficacious in a large phase 3 trial, and which Health Canada expects to authorize first – has to be stored at -70 C, an ultracold temperature usually reserved for freezers at research laboratories and some hospitals. ”We want to get to those folks [in long-term care] as soon as we possibly can,” Mr. Hillier said, “but the practicality of it may just make it a few batches down before we get to them.”
Such logistics aside, seniors’ facilities could be among the simpler places to give the first COVID-19 vaccines, all of which require two doses. Finding residents to jab them a second time should be easy.
As well, nursing and retirement homes are experienced at vaccinating against influenza. Most of their workers, mindful of the flu’s ability to kill the elderly, roll up their sleeves every year. According to a bulletin published by Public Health Ontario on influenza immunization rates, 76.4 per cent of staff in long-term care homes got the flu shot in 2019-20, well above the 54.1 per cent of staff in hospitals.
Flu shot clinics will serve as a model for Chartwell Retirement Residences when COVID-19 vaccines are administered at its just under 200 retirement and long-term care homes across Canada. But spokeswoman Sharon Ranalli said the private chain needs direction from government to get started.
“We are actively awaiting more information from the government to support this critically important vaccine for the protection of our residents and staff, including their direction on timing, storage and consent processes required,” she said.
Consent is one of the first hurdles homes will face. Dr. Sinha said 70 per cent of long-term care residents have dementia; many won’t be capable of saying “yes” to a COVID-19 vaccine on their own. Administrators will have to ask relatives for permission, a process that can’t begin in earnest until Health Canada authorizes the first vaccine.
“Across the country, you’re going to have to have thousands of conversations with substitute decision makers,” said Nathan Stall, a Mount Sinai hospital geriatrician.
Another question is whether long-term care workers could be forced to take a COVID-19 shot.
Most Canadian political and public-health leaders say vaccination will be strongly encouraged rather than legally required. “If people are thinking of going into those [long-term care] settings and don’t believe in immunization,” B.C. Provincial Health Officer Bonnie Henry said this week, “they should look for other things to do.”
Mandatory vaccination is less of a concern for workers than swift access to a safe and effective COVID-19 vaccine, union leaders say. “They want to be relieved of the ongoing anxiety that they could either contract this or bring it into their workplace and give it to people who are vulnerable and frail,” said Michael Hurley, first vice-president of CUPE Ontario.
Mr. Hurley’s fear is that staff who don’t provide direct care to patients, including cleaners and kitchen workers, could be left out of the first round of immunizations.
The same fate could befall essential family caregivers. Their vital role in feeding, bathing and entertaining residents became clear in the first wave of COVID-19, when they were locked out of seniors’ facilities as a precaution. Since then, several provinces have permitted residents to designate one or two essential caregivers who can come in wearing personal protective equipment.
Scott Ovenden, the executive vice-president of clinical programs at Baycrest, a geriatric hospital and long-term care centre in Toronto, said he wants essential caregivers to be at the front of the vaccine queue with staff and residents. “From an epidemiological risk perspective,” he said, “we don’t see a significant difference between staff and caregivers.”
Baycrest has 262 posthospital beds, 472 long-term care beds and 120 retirement suites. All told, residents have designated more than 700 essential caregivers, Mr. Ovenden said.
The National Advisory Committee on Immunization (NACI), which published updated guidance on Friday about who should be vaccinated first, did not mention family caregivers in its call for residents and workers at seniors’ facilities to receive the first shots. NACI recommended they be followed by adults of advanced age, beginning with people older than 80, frontline health care workers and adults in Indigenous communities.
Donna Duncan, CEO of the Ontario Long Term Care Association, said she would welcome a definitive statement from the government telling staff and residents in nursing homes they will be first to receive the vaccine.
Many residents are frailer after the virus tore through nursing homes in the spring, and would benefit psychologically just knowing they are a priority, she said.
“The fear and isolation is real, and in many cases, homes have experienced organizational trauma,” she said.
With a report from Laura Stone
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