B.C. care-home providers want better guidance on when to declare a COVID-19 outbreak

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Care-home providers in British Columbia are calling on the province for better guidance about when to declare a COVID-19 outbreak, saying Omicron’s different impact has prompted confusion.

Early in the pandemic, an outbreak was declared in care homes when there was one case. But B.C.’s Public Health Officer has said the definition of an outbreak has been shifting as each wave of COVID-19 brings different circumstances. Bonnie Henry said at a briefing Friday that her office has been working on new guidance. The Health Ministry said the advice is expected as early as this week.

Terry Lake, chief executive officer of the BC Care Providers Association, said care homes have been operating for weeks without clear guidance from the ministry.

“That’s a big, big oversight,” he said.

Mr. Lake said the definition of an outbreak on the BC Center for Disease Control’s website remains the same, which is one or more clients and/or staff with a laboratory-confirmed COVID-19 diagnosis. But the practical definition that’s being used by regional health authorities has changed.

“We have homes that have up to a dozen positive cases, but they’re not declared an outbreak,” he said.

“We need clear understanding of how we’re supposed to manage in long-term care, because between one health authority and another health authority, it may be managed differently. And operators aren’t getting clear messages about how to manage the situation. So we need clarity about that.”

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According to a BCCDC report, published last Thursday, Vancouver Coastal Health declared two outbreaks in total, both with more than 60 cases. However, a newly declared outbreak in the Island Health region reported only one case.

Vancouver Coastal Health’s website notes that when an outbreak is declared, it triggers measures such as enhanced cleaning, more isolation, and a reduction in group and social activities.

Dr. Henry said local medical health officers assess the situation in every long-term care, or LTC, home.

“We are still managing every single facility and it’s not based on a specific number. It is based on the clinical situation in each facility,” she said, adding the new guidelines will provide clarity on consistency in declaring outbreaks across the province.

Dr. Henry previously has said health officers are modifying and adapting their approach in seniors’ residences because there’s a very high rate of vaccination coverage among residents and staff, and the severity of illness is declining.

“We’re finding that the measures that we put in place that have been very, very strict around COVID outbreaks in LTC homes are causing more harm than Omicron is at the moment. And we need to balance that with a health care worker being off with relatively mild illness again, too,” Dr. Henry said at a briefing on Jan. 18.

B.C. Seniors Advocate Isobel Mackenzie said the changing definition is among her biggest concerns about the sector.

“We need to go back to what was the standard definition of an outbreak, which is two resident cases constitutes an outbreak and go from there,” she said.

“We need to understand what’s happening and we can’t be going and changing a definition of an outbreak that’s existed for dozens of years.”

She said the case fatality rate in care homes is much lower than in previous waves. However, she said she cannot judge how transmissible Omicron is in these facilities because the way of collecting and reporting data is no longer the same.

We need “to make sure in long-term care that we are accurate in reporting outbreaks. … And then we need to tailor how we respond to these outbreaks to reflect what we now know about the virus and how we can control it,” she said.

Dan Levitt, CEO at KinVillage in Tsawwassen, B.C., which is in the Fraser Health region, said in the latest wave, an outbreak is declared when there’s sustained transmission involving many resident and staff cases. Declaring an outbreak requires balancing the health risks of spread with the consequences of stricter measures for residents, he noted.

“If you had 100 people that live in one care home together, and you see the spread is in the single digits, that’s going to be just enhanced monitoring,” he explained.

“If you start seeing 20 per cent, 30 per cent of the residents and those similar kind of numbers of staff, where you have your staffing compliment that’s usually available to being decimated by not being available, those are the outbreaks.”

Mr. Levitt said home operators should safeguard freedoms and rights of seniors living in care.

“It’s obviously very important we look through the medical lens and infection control lens that we have to do, but we should be tempering that with the impact it has on people who are isolated, who already have lost a lot of independence because of where they are in their aging journey,” he said.

Mr. Levitt said what’s been done differently, compared with before, is that asymptomatic residents on the infected unit don’t have to be isolated.

Editor’s note: An earlier version of this article incorrectly described which health region includes KinVillage in Tsawwassen, B.C.. This version has been corrected.

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