VANCOUVER -- Internal documents and a freedom of information battle reveal details of the provincial government’s quiet changes to outbreak response in B.C. care homes, which are being criticized as slow, confusing and inadequate.
Implemented last fall, new criteria redefining outbreaks did not alter the province’s testing strategy in care homes. Under the new guidelines, in many cases a positive COVID-19 test for a single staff member was met with little more than meetings and a secrecy clause.
CTV News Vancouver has obtained documents from Vancouver Coastal Health and Fraser Health discussing “enhanced monitoring” and “enhanced surveillance” procedures, which avoided a formal outbreak declaration in the event of a single staff member being diagnosed with the coronavirus.
The South China Morning Post spent nearly four months trying to find out how many care homes had implemented the enhanced monitoring/surveillance designation through Freedom of Information requests, with mixed results.
During the first wave of the virus and through the summer, health officials declared an outbreak whenever a staff member or resident at a care home tested positive. When the definition changed, at least two staff members or a resident had to have a lab-confirmed positive test to prompt an outbreak declaration.
In British Columbia, COVID-19 testing typically only takes place when someone has symptoms.
Under “enhanced surveillance and precaution” protocols, a document dated Nov. 9, 2020, from Vancouver Coastal Health essentially instructs care home operators to closely watch for symptoms among staff and residents and hold meetings.
“Notification of all residents, families, staff and other service providers is not required (i.e. through letters and signage),” the document notes.
Fraser Health has a similar document labeled “No Outbreak Declared Monitoring Only Final” and dated Dec. 17. The document instructs affected units end social visits, group activities and new admissions.
“The provincial approach to COVID-19 exposures in long-term care and assisted living has been updated and Fraser Health will be aligning with this approach to COVID-19 exposures and outbreaks, as outlined by the B.C. Centre for Disease Control and the Ministry of Health,” the document reads.
Ian Young, the Vancouver bureau chief for the South China Morning Post, spent four months trying to find out how many times staff members tested positive for COVID-19 and prompted the enhanced surveillance or monitoring protocols.
“I was struck by how difficult it was to extract this data from Vancouver Coastal Health and Fraser Health and neither of them would give it up without Freedom of Information requests, but I found Vancouver Coastal particularly problematic because I've been seeking this information since mid-January," said Young.
"They weren't talking about it. They weren't revealing this information about how these outbreaks occurred, and I think that should be on the public record. It's crazy that it wasn't."
Neither health authority answered questions about enhanced monitoring from CTV News.
When contacted for comment, the Office of the Seniors Advocate, which is in the process of reviewing care home outbreaks during the first year of the pandemic, says its including the enhanced surveillance/monitoring cases in its report for consistency since they meet B.C.‘s original criteria of an outbreak.
Little Mountain: A case study
The documents Young was ultimately able to obtain don’t paint the full picture, but show at least 75 care homes in the Lower Mainland came under enhanced surveillance protocols, with several later declaring outbreaks in the wake of more infections. Some of the outbreaks led to dozens of deaths.
Among them was Little Mountain Place, the East Vancouver care home that saw the highest death toll of the pandemic: 41 residents died in less than two months, with 99 of 114 residents and 72 staff infected.
“I'm very disappointed that they had warnings, they knew that there was an outbreak, but they sent an email saying there’s enhanced surveillance,” said Rose Chang, whose mother was living in Little Mountain Place at the time. “They knew there was COVID going on and they failed to take strict measures to control this.”
Vancouver Coastal Health investigated the outbreak and found as staff fell ill, cleaning and upkeep suffered. Leaked recordings also revealed staff would “tough it out” and go to work sick, thinking they were fatigued after working so many days in a row to keep the facility running.
Chang said she often saw staff without masks leading up to the outbreak, and when her mom started losing her appetite and getting increasingly fatigued during the outbreak, she had to pressure staff to agree to test her mom
“I said to the nurse, ‘Can you get my mom tested for me?’ And she said, 'Oh, maybe she's just under the weather,'" Chang recalled. “If I hadn't asked for it, I don't think my mom would've gotten tested until later on when she got very sick and I get a phone call that my mom is dying."
Her mom’s second COVID-19 test was positive and she was hospitalized for weeks; she ultimately died from the virus, but Chang and her sister had time to say goodbye.
Provincial health officer defends policy
As Young’s story went public, Dr. Bonnie Henry defended the pre-outbreak designation as reasonable and in the best interests of residents.
“It was a way of making sure we weren't overly cautious and putting in place those very severe measures an outbreak entailed, and we know how hard that was on seniors and elders in long-term care,” she said, pointing out the majority of the staff cases did not result in subsequent infections.
"Where we had some clinical judgement was if there was a single staff person who had not been in the facility during the period of time of their infectiousness or had been fully adherent with the infection control precautions like wearing of PPE, then there was a judgement made about the risk and that was an enhanced surveillance,” said Henry.
Did the testing policy lead to preventable deaths?
B.C.’s resistance to asymptomatic testing throughout the pandemic has prompted frustration, confusion and dire warnings. BC Care Providers Association president Terry Lake was blunt about the consequences of this strategy in care homes.
"This decision cost people their lives,” said Lake. “Without having widespread testing and the stubborn refusal to not implement rapid testing, to not have widespread swabbing with PCR test when you had evidence of a positive case, sort of refusing to acknowledge that asymptomatic transmission was a key driver of outbreaks, it's baffling to me."
The enhanced surveillance and monitoring documents from both health authorities suggest asymptomatic testing only when ordered by the medical health officer investigating the site.
That position was entrenched in public health in B.C., despite researchers estimating up to half of care home deaths in the province could’ve been avoided with the deployment of two million rapid tests provided by the federal government and approaching expiry dates in provincial warehouses.
Henry had dismissed the tests as not accurate enough, despite the local research and their successful use in Atlantic Canada, where provinces have largely avoided second and third waves, in part due to their testing. On Thursday, B.C. performed 9,109 tests while Nova Scotia – which has one-fifth the population – did 7,320.
Deputy provincial health officer Dr. Reka Gustafson has rejected asymptomatic testing in all but a handful of cases, and B.C.’s testing levels have remained relatively static, despite a third wave that saw record-breaking infections and hospitalizations.
"I know everyone has been doing their very best and it's been very challenging, but I think the decisions on policy around testing were wrong and are responsible for outbreaks that could've been prevented," said Lake.
When CTV News asked whether the possibility of vaccine-beating variants could put care homes back at square one, Lake said the need for widespread asymptomatic testing and a better outbreak response from public health remains a pressing issue, with outbreaks still continuing, albeit dramatically reduced due to the vaccine campaign.
"We only have to look at a long-term care home in Kelowna that currently has three deaths despite a high level of vaccination among residents, but only 67 per cent of staff are vaccinated,” he said. “We can't let down our defenses despite the fact the vaccine has made such a difference. It's shameful and sad that outbreaks that went on from enhanced surveillance to full outbreaks could've been prevented with more widespread testing."
