As COVID-19 spreads, few 'outbreaks' declared in B.C. care homes

After a change in how outbreaks are defined and declared in British Columbia, no care homes in Vancouver Coastal Health have met the new threshold for nearly two months despite dozens of cases at a single facility, CTV News has learned. 

Late last year, the province told care home operators that medical health officers would decide whether infections in long-term care or assisted living facilities would be considered outbreaks or not, which prompted confusion and questions about why incidents involving multiple cases aren’t declared outbreaks.

CTV News has since obtained a memo to families of seniors living in Haro Park, where an administrator said 45 staff and residents had tested positive in what he called “an active and growing COVID-19 cluster” – yet the facility is not on the B.C. Centre for Disease Control or Vancouver Coastal Health’s listings of outbreaks.

“As of writing this letter, Haro Park has 39 active infections,” wrote CEO Rob Gillis on March 20. “Therefore effective Monday, March 21, all group activities will be suspended until further notice with the exception of Amber Lane.”

A request to Vancouver Coastal Health asking for an explanation as to why there has been no outbreak declaration has gone unanswered. CTV News asked VCH and Fraser Health how many care homes are experiencing “clusters” or are under “enhanced monitoring or surveillance” due to viral transmission, but neither has provided the information.

The most recent guidance document from the BCCDC is dated last week and says when it comes to care homes, “an outbreak is described as an unexpected or unusual increase in COVID-19 cases or case severity amongst residents, characterized by transmission within the facility and necessitating additional public health action beyond usual surveillance, case management and baseline infection prevention and control measures.”

CARE HOMES A MAJOR RISK CENTRE FOR COVID-19

In January alone, 40 per cent of the deaths attributed to COVID-19 were among care home residents, with age being the biggest factor in experiencing serious illness from the virus, though vaccination helps reduce the risk.

"Even though we've got some care homes that in some cases are dealing with a significant number of positive residents, it's not the same situation at all,” said BC Care Providers Association CEO Terry Lake, who pointed out all staff have to be vaccinated, and most residents have had booster doses. “And we're dealing with a virus that's less virulent than the other forms we've seen.”

Lake also pointed out operators are doing everything they can to keep visitation open, which has only been the case for the past month or so, because it’s so crucial to residents’ mental and emotional well-being.

But he did say that in his weekly meetings with health officials, he’s been emphasizing the importance of having a plan in place if NACI approves a second booster, which may be necessary now that there are signs vaccines only provide strong immunity for about six months.

"I think the ministry and the public health officer are getting tired of hearing from me about needing to have a plan on the shelf ready to go just as soon as we see that inflection point change, so that we get right on top of it,” said Lake. “In older people, their immunity will fall off sooner than perhaps in a younger person…and if this virus changes at all, we need to be ready to get that second booster in the arms of people in residential care just as soon as possible."

EARLY WARNINGS SIGNS IN CARE HOMES?

The provincial health office has changed the definition of outbreaks before: when the pandemic started, a single positive test result by a resident or staff member counted as an outbreak, but months later most care homes made the controversial decision to have “enhanced surveillance” instead, as they waited to see if more people got sick. 

At this point, health authorities and the BCCDC only provide statistics of COVID-19 transmission in care homes if there are outbreaks, so it’s not clear how much of the virus may be circulating – or increasingly infecting residents.

B.C.’s COVID-19 hospitalizations increased slightly on Wednesday, for the first time in nearly two months, as the test-positivity rate crept up in some health authorities. Most information about COVID-19 is delayed by two weeks and published only weekly on the BCCDC’s website. 

After testing centres were overwhelmed at the start of the Omicron wave, the province changed the criteria so that seniors and those seriously ill were the only ones with easy access to lab-confirmed testing for the virus.