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The Eatonville Care Centre is seen in Toronto, on April 13, 2020.

Fred Lum/The Globe and Mail

Ontario has ordered its local public health units to develop a plan to test everyone in long-term care homes for COVID-19, acknowledging the “prevalence” of the virus among staff who don’t show symptoms.

A new memo from the province’s top health officials comes as the death toll in Ontario’s nursing homes continues to rise, with 399 residents and a personal-support worker now having died from the disease. A total of 659 people in the province have died from COVID-19, according to the latest official data, although the number could be higher due to reporting delays.

Nearly a month after the first outbreak was reported at Pinecrest Nursing Home in Bobcaygeon, where 29 residents have died, Ontario health officials said the province will begin “pro-active surveillance testing” for COVID-19, including testing asymptomatic residents and staff.

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The province is also directing its 34 local public health units to immediately develop an implementation plan “to facilitate testing of every resident and staff at each long-term care home.”

“While testing of residents should be a priority, the implementation plan should also enable an understanding of the prevalence of COVID-19 amongst staff, particularly asymptomatically,” says the April 21 memo from chief medical officer of health David Williams, deputy minister of health Helen Angus, and Richard Steele, deputy minister for long-term care.

“It is expected that this plan be implemented as soon as possible.”

The memo says public health units should prioritize homes in an outbreak situation, which means they have at least one case of COVID-19, and residents or staff who show symptoms.

There are now 125 outbreaks officially reported at the province’s 626 long-term care homes, according to official numbers, but the number is much higher if suspected outbreaks are included.

David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, and four of his colleagues analyzed confirmed and suspected coronavirus outbreaks at 272 of Ontario’s long-term care homes as of April 7.

The province has temporarily banned employees in long-term care homes from working in more than one facility, but the order doesn’t apply to temporary or contract workers. In response to concerns raised about what is seen as a loophole, the government said that such workers are required to maintain staffing levels, and that the number is small.

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The Ontario Nurses Association is also in Ontario Superior Court on Wednesday, seeking a court order to compel three homes in the province to comply with health and safety standards, including proper protective equipment for staff.

Premier Doug Ford asked for the patience of Ontario residents as the province's orders to stay at home and practice physical distancing continue. Ford stressed that his government is preparing plans to gradually re-open the economy but that must be done carefully. The Canadian Press

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

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