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People wait to be screened before entering Little Mountain Place in Vancouver on Jan. 3, 2021.DARRYL DYCK/The Canadian Press

An internal investigation into Vancouver’s Little Mountain Place, which had the deadliest outbreak of COVID-19 of any care home in B.C., has found that the facility where 41 seniors died had inadequate staffing, hygiene and communicable disease controls. Six weeks after it was completed, the report detailing those findings has not been released.

At the same time that the Feb. 2 report was quietly filed in B.C., the Manitoba government released the results of an independent investigation into a COVID-19 outbreak that led to 56 deaths at the Maples Personal Care Home.

Manitoba Health Minister Heather Stefanson committed to implement all 17 recommendations in the report, which found shortages in staff caring for Maples residents and in housekeeping, inconsistent cleaning and not enough infection control expertise on-site. The tragedy will lead to better care at all personal care homes in the province, Ms. Stefanson vowed.

Residents in long-term care homes across the country have borne the brunt of the pandemic. In Manitoba, Ontario and Quebec, public inquiries or inquests have been commissioned to find out what went wrong, and what needs to change. But in B.C., the government has sought no comprehensive review.

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Adrian Dix, B.C.’s Health Minister, said every outbreak of COVID-19 in B.C. care homes is investigated thoroughly. “We’ve learned a lot from every single one,” he said in an interview. But for the families of the almost 800 seniors who have died in care because of the virus over the past year, the answers remain difficult to find.

British Columbia emerged from the first wave of the pandemic as a model for the country because of its early intervention to protect seniors in long-term care. In that first wave, COVID-19 took the lives of 7,311 seniors in long-term care across the country, and B.C. accounted for 120 of those deaths.

B.C. was held up as a model for its “decisive, co-ordinated and consistent” response to protecting vulnerable residents in long-term care homes, a peer-reviewed article in the Canadian Medical Association Journal concluded after the first wave. In March, 2020, the province moved quickly to increase public-health support, improve staffing and boost infection prevention and control measures.

The second wave of the pandemic, however, was very different.

A report by the National Institute on Ageing shows that between Sept. 1, 2020, and Feb. 15, there were 7,181 COVID-19 deaths in long-term care in Canada – a small decrease compared with the first wave. The decline was largely because of Quebec’s response to its devastating outcomes in the first wave, with a massive hiring blitz to improve staffing in care homes and the creation of infection prevention and control teams. In B.C., the second-wave death toll in care homes was almost five times higher than in the first wave: 567 residents.

Samir Sinha, a co-author of the report and the director of geriatrics at the University Health Network and Sinai Health System in Toronto, said British Columbia did remarkable work, initially. A key innovation was a single-site order that provided workers in care homes job security without juggling shifts at different facilities, and full sick pay benefits so they could afford to stay home when feeling ill. The provincial government funded that at a cost of $165-million.

But the province hasn’t adjusted and learned from the changes demanded by the more significant second wave of the pandemic, Dr. Sinha said. ”There are things to be learned in the second wave in B.C.,” he said.

He said that B.C., like the other Western provinces, balked at testing people who showed no symptoms of COVID-19 during outbreaks. “Pandemic Management 101 didn’t seem to be the core focus in B.C. care homes – and most care homes in Western Canada. That’s why you saw these massive outbreaks, because they missed people who were infected early on,” he said. “That was highly problematic, it was a higher death toll than it needed to be.”

Mr. Dix maintains that B.C. has done better relative to other Canadian jurisdictions because it imposed sweeping changes early on. It has recruited 2,000 new workers to the sector, and when there are outbreaks, health authorities have stepped in to support and sometimes manage the care homes. At Little Mountain Place, for example, 87 staff were brought in to help, including an interim administrator.

The second wave had worse outcomes because the virus was spreading rapidly in communities, he said. Asked if the death toll was preventable, he said: “It’s not inevitable, but community spread had a lot to do with it,” he said. “Our response wasn’t perfect because the system that we dealt with clearly isn’t perfect and has to be made better. And so I feel a powerful sense of responsibility.”

Isobel Mackenzie, B.C.’s independent Seniors Advocate, is conducting an investigation into why some long-term care homes such as Little Mountain Place were unable to contain outbreaks. Her findings are expected to be published in the summer.

Mr. Dix said he is not prepared to call for his own inquiry into the deaths in long-term care right now, but that may yet happen. “There will be a broad reflection when this is over.”

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