More than 100 long-term care residents have died of COVID-19 since late August
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Less than three months into a surge of COVID-19 that has left more than 100 long-term care residents dead, the Ontario government has tightened masking rules in long-term care homes.
There have been 7,157 confirmed COVID-19 cases among residents and staff of long-term care homes since Aug. 27, the start of the respiratory virus surveillance season, according to Public Health Ontario. Of those, 181 residents were hospitalized and 106 died.
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Meanwhile, there are 105 ongoing outbreaks in long-term care homes across the province.
“Should we be seeing this number of outbreaks? No, we shouldn’t,” said immunologist Dawn Bowdish, a Canada Research Chair in aging and immunity at McMaster University.
“It is just so very depressing.”
The changes brought in by the province on Nov. 7 require staff, students, support workers and volunteers to wear masks when they are in resident areas in long-term care homes.
But visitors and caregivers are not required to wear masks. The ministry is “strongly recommending” they do when in resident areas indoors, except when with a resident in their room or when eating and drinking in a shared communal space. When two residents share a room, and one roommate is uncomfortable with visitors removing their masks, homes are “encouraged” to provide a space where the roommate can have visitors without masking.
The outbreaks come at a time when many pandemic control measures are no longer in place in the community and many people have moved on.
It’s also happening at a time when LTC staffing remains a challenge, noted Ottawa’s medical officer of health, Dr. Vera Etches.
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“This is going to be a strain throughout the respiratory season.”
To advocates and academic experts, the masking changes are overdue. But they don’t go far enough.
“A caregiver should be masking. You can’t isolate in one room — germs travel. I got tired of wearing a mask, but when I looked at my mother I thought: ‘This is keeping her safe,’ ” said Betty Yakimenko, who was caregiver for her late mother during deadly outbreaks at Madonna Care Community in Ottawa in the early months of the pandemic.
Yakimenko, who continues to advocate for improvements to long-term care, was shocked to hear the latest guidance does not require visitors and caregivers to wear masks in resident areas.
“It’s the difference between somebody dying and somebody living. When you are dealing with a vulnerable population, I think you have to go the extra mile.”
The wording of the memo from Kelly McAslan, assistant deputy minister of the long-term care operations division in the Ministry of Long-Term Care, describes the masking changes as optimizing health and safety “while balancing the impact on resident and staff well-being.”
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The requirements reflect a reticence to be overly restrictive in long-term care homes, said Andrew Costa, Schlegel Research Chair in clinical epidemiology and aging at McMaster University
“There doesn’t seem to be a lot of energy for those kinds of approaches that restrict lifestyle,” he said. “Many residents are happier to live with more risk than we presume is the case.”
Some see it as part of an ongoing failure by the province to protect LTC residents, who accounted for more than 60 per cent of Ontario COVID-19 deaths early in the pandemic, despite making up a small percentage of the province’s older population.
Death rates have dropped dramatically since then, largely because of high rates of COVID-19 vaccination among long-term care residents and changes in the virus. The mortality rate among long-term care residents infected with COVID-19 is now about three per cent, compared to over 30 per cent during the beginning of the pandemic, according to Public Health Ontario.
Despite promises of change, issues such as room crowding, poor air circulation and ventilation, lack of infection protection and control training and staff working in multiple locations continue to be unresolved. Crucially, there is still no rigorous inspection system, said Bowdish.
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Ageism plays a role, she said.
“I don’t think it’s inevitable. I think we need to do better. It’s a shame we have been brainwashed into thinking dying of an infectious disease is inevitable. These are not good deaths. I feel strongly we have to do better and provide people with a better quality of life in their final years.”
The province is monitoring trends and determining whether further action is required to protect the health of those living in, working at and attending long-term care homes, said Ministry of Long-Term Care spokesperson Mark Nesbitt in a statement.
“All decisions of the Ministry of Long-Term Care continue to be informed by Ontario’s Chief Medical Officer of Health.”
The ministry’s COVID-19 guidance document for LTC homes includes ensuring access to COVID-19, influenza and RSV vaccines for all eligible residents and regular infection prevention and control audits, which homes must follow.
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Province tightens masking rules in long-term care, critics say more needs to be done - Ottawa Citizen
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