By the time Revera Inc. secured a supply of face masks for its nursing homes in mid-April, 97 per cent of the residents who tested positive for COVID-19 during the first wave of the coronavirus were already sick.
The delay is just one example of how public-health officials and governments neglected the needs of seniors’ homes as they rallied to support hospitals, according to an independent panel that examined how the virus swept through a chain of privately owned homes in the spring.
A series of systemic breakdowns in Canada allowed the virus to flourish in long-term care homes, says the report prepared for Revera by a 10-member panel of leaders in medicine, health policy and geriatrics.
The failure of officials to enact safeguards for these homes at the outset of the crisis – including mandatory use of personal protective equipment to shield staff and residents from getting infected, and broad testing to identify those with COVID-19 – proved to be disastrous for the sector, where 80 per cent of first-wave deaths occurred.
As the virus continues to ravage many seniors’ homes, Bob Bell, chair of the Revera panel and a former hospital chief executive officer and deputy health minister in Ontario, said the first people health officials should be testing are those coming into the facilities who could be unwittingly spreading the virus to the frail elderly.
“The fact that we are not doing that across Canada is just astonishing,” Dr. Bell said in an interview. “This to me is the great Canadian tragedy.”
The starkest example of how seniors’ homes were ignored was the decision to reserve Canada’s scarce supply of PPE for hospital staff, says the report, which Revera will release on Monday.
On April 6 – nearly four weeks after the disease was declared a global pandemic – Canada’s top doctor, Theresa Tam, said everyone should wear face masks in public. Masks became mandatory in long-term care homes in Ontario on April 8. But they were not delivered to the homes until five days later, on April 13.
By then, the report says, COVID-19 had gained a strong and stubborn foothold in dozens of long-term care homes across Canada. Among the 873 residents in Revera’s nursing homes sickened with the virus during the first wave, the company’s data show, 844 cases can be traced back to outbreaks prior to April 13.
The magnitude of the crisis was amplified by a combination of the health system’s tendency to prioritize acute care over chronic care, and historical challenges in the long-term care sector, including staffing shortages and outdated homes with multibed wards, says the 91-page report.
“The unfortunate chain of events led to outbreaks where dozens of infections seemed to suddenly appear out of nowhere.”
The virus killed nearly 6,000 residents in nursing and retirement facilities during the first wave, accounting for more than 80 per cent of Canada’s COVID-19 deaths.
With much of the country in the grip of a second wave, the report serves as a grim reminder that many of the barriers seniors’ homes initially faced in trying to corral the virus remain in place.
Routine surveillance testing that could have identified infected staff members and residents was introduced only toward the end of the first wave of the virus in Ontario. Prior to June, screening of staff and residents became the “imperfect substitute,” the report says.
In British Columbia, Alberta and Manitoba – all provinces where COVID-19 cases are climbing at an alarming rate – health officials do not require surveillance testing of staff in long-term care homes, missing opportunities to detect the coronavirus before an outbreak is declared.
Revera, one of the country’s major, for-profit operators of long-term care and retirement homes, assembled the independent panel to investigate the circumstances that led to the COVID-19 crisis in its homes.
The Mississauga-based company, a wholly-owned subsidiary of the federal Public Sector Pension Investment Board, owns 170 facilities in six provinces.
The report examined the policy environment in which seniors’ homes operate rather than Revera itself. The company said its experience in the first wave suggests that home operators should become as self-sufficient as possible in securing PPE and collaborate with public health to track community spread of the virus.
Among Revera’s 55 long-term care homes that had an outbreak of COVID-19 during the spring, 45 were in Ontario. Nine of the homes in Ontario were hit particularly hard, accounting for 241 of the 266 seniors in Revera facilities who lost their lives to the virus. All but two of the nine homes are older, where many of the residents sleep in the same room and share a bathroom with two or three other people.
The report says Revera often received contradictory advice from various levels of government in Ontario and the province’s 34 municipal public-health units on keeping the crisis in check, triggering rounds of confusion. One local health unit, for example, said staff should isolate for 14 days following potential exposure to the virus. Another unit said the isolation period should be 28 days.
There was also little consensus on how to separate residents sick with the virus from the healthy, a particular challenge in homes with ward rooms.
“The clashing instructions from various public-health authorities resulted in multiple moves that increased the risk of spreading the virus and also contributed to residents’ decline,” the report says.
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