British Columbia’s Provincial Health Officer has loosened restrictions on long-term care homes, making it easier for residents to see visitors and ensuring that lockdowns are not as harsh as they were earlier in the pandemic.
The death rate from COVID-19 is on the decline and the illnesses caused by the Omicron variant are milder, so Dr. Bonnie Henry says it is time for residents to be allowed two visitors, up from one.
Her office has also changed the definition of an outbreak to ensure care homes have more flexibility about how to respond when residents are infected but not seriously ill. “This one-size-fits-all approach is no longer applicable,” she said.
“We have been trying to find that balance of minimizing risk to residents in long-term care, minimizing the risk of the virus, as well as finding that balance of having that all-important contact with our loved ones and making sure we can handle social interactions that are so important.”
Aside from an essential visitor, now all residents are allowed to have one other designated visitor, and in exceptional circumstances, that visitor can be filled by a substitute. Residents can have one visitor at all times, regardless of whether there is an outbreak or COVID-19 cases in that facility.
Both the head of the BC Care Providers Association and B.C. Seniors Advocate Isobel Mackenzie welcomed the move.
“I think this guarantees that everyone has the right to a visitor and that will go a long way to ensuring not just the mental health but the physical health of residents in care,” the association’s Terry Lake said. “These are folks that are in their last home and to separate them from their family and friends causes them to have a much reduced quality of life and we see real clinical impacts in terms of their mental health and physical health as well.”
Ms. Mackenzie said when some of the restrictions are removed in the general public, she expects rules around long-term care visitation can be further relaxed.
Meanwhile, in British Columbia, the declaration of an outbreak will not be solely based on cases diagnosed among residents or staff, like early in the pandemic. Instead, it will be left to medical health officers to decide.
According to guidelines posted by the BC Centre for Disease Control on Wednesday, an outbreak means the occurrence or suspicion of an increase in cases of health care-associated COVID-19 that are epidemiologically linked to a care unit or health care facility over a defined time period.
An outbreak is usually defined when there are two or more active cases in a facility, but in the first wave of the pandemic, the threshold was lowered to one case among either staff or residents in B.C.
“We are now seeing it is qualitatively very different in long-term care homes with Omicron. ... So it has always been at the judgment of the [medical health officer] doing the investigation of each of the outbreaks, but declaring an outbreak is a little more nuanced now based on what we’re seeing in a highly vaccinated population, both workers, visitors and residents in particular,” Dr. Henry said at a briefing.
She said in some care homes, there might be cases, but those don’t necessarily constitute circulation within the facility that puts people at risk.
“So it is finding that balance and that judgment and we don’t need to tell a 300-bed facility that one person has COVID,” she said.
But Ms. Mackenzie insisted the definition should not be changed. She said the balance should be found in ways to respond to an outbreak.
“I think that the greater clarity and transparency is to continue to declare an outbreak when there is virus transmitting in the care home. And the usual standard has been two cases because that tells you it’s transmitting,” Ms. Mackenzie said in an interview Wednesday afternoon.
“Declare the outbreak so that everybody understands there’s virus transmitting, whether it’s COVID, or influenza or norovirus, or whatever it is. And then what you’re doing in response to that is where you find the balance.”
She said residents and their family are entitled to know whether there’s a virus circulating in that care home, and the only way for them to know is through a declaration of an outbreak.
Ms. Mackenzie said the case fatality rate in B.C.’s long-term care was at 30 per cent before vaccination was available but now it’s at about 4.5 per cent.
Dr. Henry said seniors are still the most vulnerable to the virus. She said 40 per cent of people who’ve died in January have been related to outbreaks in long-term care.
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