A team of restaurant inspectors in Southeastern Ontario fanned out to every seniors’ residence in the region last month, armed with a four-page checklist.
The six inspectors normally spend their workday making sure restaurants prepare food safely. But on March 18 – one day after the Ontario government declared a state of emergency and temporarily closed all but essential businesses across the province – Kingston public health reassigned them to help long-term care and retirement homes prepare for the pandemic.
The inspectors worked through the checklist with staff at all 27 homes in Kingston and surrounding communities to ensure they were taking every precaution to limit the spread of COVID-19, the respiratory disease caused by the coronavirus.
“If a home didn’t adhere, we went back again and again,” said Kieran Moore, medical officer of health for the region.
The coronavirus has cut a frightening swath through seniors homes in Canada. The virus has killed 1,309 residents of these homes in Quebec, accounting for four of every five deaths in the province. In Ontario, 671 have died in these facilities – two-thirds of the province’s COVID-19 fatalities.
Kingston, by contrast, has kept the virus at bay, thanks to a raft of protective measures adopted by local health officials. Those include protecting vulnerable populations by redeploying the restaurant inspectors – an initiative recently expanded to the region’s nine prisons – and encouraging primary care physicians to test patients.
So far, no one in the community has died from the virus, no one is hospitalized and no seniors’ home or correctional facility has an outbreak of COVID-19.
In the early days of the pandemic, health experts say, government leaders across Canada worried about averting a catastrophe in this country’s hospitals, similar to what had happened in Italy and New York. They focused most of their attention on expanding the number of available hospital beds in anticipation of an influx of patients with COVID-19.
Kingston stands out because its pandemic planning addressed the frail elderly as well as hospitals by including measures to protect the health of residents in the broader community from the highly contagious virus, including the 2,600 residents in seniors’ homes.
Cathy Szabo, chief executive officer of Providence Care, a sprawling organization in Kingston that operates a long-term care home, a hospital and several community-based rehab and mental-health programs, has worked closely with public health on infection control and prevention measures throughout the pandemic – initiatives she says were not front and centre enough in many other regions.
"I don’t want to criticize decision makers in health care, but the tendency is to focus everything on acute care and the community is a bit of a second thought,“ Ms. Szabo said.
The public health inspectors in Kingston have used the checklist to educate homes on best practices during the pandemic. The checklist asked whether the homes are screening residents twice a day for symptoms of the coronavirus. Did staff know how to properly don and remove personal protective equipment, including surgical masks? What would staff do if they developed symptoms of the virus?
The inspectors continue to work with a handful of homes with minor outstanding issues. As part of the health unit’s progressive enforcement regime, Dr. Moore said, the inspectors have the power to enforce non-compliance with fines of up to $5,000 a day.
The inspectors have taken action against one unidentified home, ordering it to comply with provincial directives including screening staff and residents for symptoms of the virus.
The region also ramped up testing for the virus. Dr. Moore invited 100 family doctors to a meeting on March 4 at Public Health in Kingston, where he talked about the importance of monitoring high-risk individuals, including front-line health care workers. “We went over what swabs to use, when to use them and how to report to us,” he said.
The meeting, which took place just days before Canada recorded its first COVID-19 death at a long-term care home in Vancouver, helped physicians identify the first clusters of coronavirus infections in rural communities.
Amanda Antoine, manager of a medical clinic in Verona, a town north of Kingston, was a member of one of those clusters. On the morning of March 25, she got a telephone call from Dr. Moore, telling her she had tested positive.
“The first thing that came to mind was, ‘I'm probably going to die,’” Ms. Antoine said.
Public health officials “picked through my history and contact information with a fine-tooth comb,” and closed the clinic for 14 days, she said. At the time, the clinic was only treating patients over the phone.
In order to help spread awareness that it can happen to anyone, Ms. Antoine revealed on Facebook that she had tested positive. She has since fully recovered.
“I knew that at some point I would probably contract COVID-19, but never dreamt I would be the 13th case in [Kingston Public Health],” she said in the interview.
Last week, Dr. Moore’s staff closely monitored Providence Care’s long-term care home, the region’s largest with 243 beds. The health unit declared an outbreak at Providence Manor on Monday, after a resident appeared to have become ill with the virus.
“It was heartbreaking,” said Ms. Szabo, the Providence Care CEO. “We were screening diligently at the door. We keep testing our residents. We keep looking for all the signs and symptoms."
At the end of March, a staff member at the home had tested positive. But every resident who came in contact with the individual was tested and isolated in separate rooms, and the virus did not spread to anyone else, Ms. Szabo said.
This time around, the resident who appeared to be sick with the virus was tested two more times after the initial results were a “weak positive.” Both results came back negative, so the health unit continued investigating her case.
At 4:45 on Friday afternoon, Kingston Public Health declared that the outbreak at Providence Manor was over. The resident who originally appeared to have COVID-19 turned out to be a "false positive.”
In all, the region, which has a population of 213,000, has had 59 positive cases.
“We can’t let our guard down,” Dr. Moore said. “The rest of us still don’t have immunity.”
Our Morning Update and Evening Update newsletters are written by Globe editors, giving you a concise summary of the day’s most important headlines. Sign up today.