British Columbia’s handling of Covid-19 in long-term care homes has come under fire in the Canadian province’s legislative assembly, in the wake of a South China Morning Post investigation that revealed at least 192 residents had died in homes where outbreaks were deliberately not declared when an employee was first found to have contracted the virus.
In questions about the protocols that stretched over Monday and Tuesday, opposition leader Shirley Bond of the BC Liberals told Health Minister Adrian Dix that the report was “devastating”, and had “appalled” British Columbians.
But Dix said on Tuesday that “to make a causal link [between the protocols and outbreaks] is not supported by the evidence”, although “all of these decisions … will be the subject of questions in the future”.
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The Post report published last Thursday described how BC health authorities implemented protocols on November 9 that outbreaks should not be declared if just one staff member of a care home tested positive for Covid-19 in circumstances deemed to present low risk of transmission.
The protocols, known as “enhanced surveillance” or “enhanced monitoring”, were intended to preserve staffing resources and allow residents to continue to enjoy visits and other social interactions, health authorities have said.
But documents obtained by the Post via freedom of information requests showed that on at least 42 occasions, outbreaks had to be declared anyway at homes that were already under enhanced surveillance/monitoring.
Today, 192 families are asking questions about whether more could have been done to prevent their family members from dying of Covid-19
Shirley Bond, BC opposition leader
On average, it took about five days before the facilities overseen by Vancouver’s two health authorities, Vancouver Coastal Health (VCH) and Fraser Health, realised the disease was spreading .
More than 1,000 people became infected in such circumstances, and some of the outbreaks were disastrous. They included BC’s deadliest outbreak, at Little Mountain Place care home in East Vancouver, where 41 residents died.
“Today, 192 families are asking questions about whether more could have been done to prevent their family members from dying of Covid-19,” Bond said on Monday. “These families deserve answers. Will the premier tell these 192 families why this policy change was implemented and families were left in the dark?”
Dix, of the ruling New Democratic Party (NDP), said the protocols were “to ensure immediate action took place when there was even a suggestion of exposure. This did not change the fact that public health leaders and medical officers would declare an outbreak where appropriate, but it ensured that action was taken immediately”.
Dix said he was “very proud of our medical health teams and all the work that they do”.
However, Bond said “heartbroken” families deserved “a full public accounting about what happened”.
Opposition health critic Renee Merrifield said outbreaks had been “hidden” under the policies, and “the only reason we know about this today is because the government was forced to turn over documents through FOI [freedom of information]”. She said risks were concealed under the enhanced surveillance/monitoring policies.
Dix called this an “extraordinary” attack on the province’s public health professionals.
I support the provincial health officer, and I support medical health officers. And I will continue to do so
Adrian Dix, BC health minister
“In difficult circumstances, when the declarations of outbreaks have profound effects on people, as well, and their health, they’ve done a very, very good job,” he said.
BC Green Party leader Sonia Furstenau also picked up the line of questioning and continued to assail Dix over the policies.
“Why were the rules relaxed for long-term care homes in a growing second wave? Who made the choice, and was it approved by the minister?” she asked.
Dix said decisions about whether an outbreak was declared “are statutorily the responsibility of medical health officers under the direction of the provincial health officer [Dr Bonnie Henry]”.
“I support the provincial health officer, and I support medical health officers. And I will continue to do so,” he said.
The Post investigation, published last Thursday, showed that VCH had a written policy that the initial staff infections that triggered the status of enhanced surveillance could be kept secret from residents, families and even fellow workers, with visits and group activities allowed to continue.
Dr Michael Schwandt, a medical health officer with VCH, said on Twitter on Tuesday that the enhanced surveillance protocols “standardised the approach taken in episodes that did not meet outbreak criteria”, allowing for a consistent response without full outbreak restrictions.
He denied that the November 9 protocols “degraded” the definition of an outbreak.
“It has been clear in provincial policy since long before [November] 9 that a single staff case in LTC [long-term care] is subject to risk assessment before outbreak declaration,” he said.
In a statement last Friday, Dix said he took the Post report “extremely seriously”. He said the ministry would “look into this important matter, and we will have more to say once we have completed this vital work”.
Bond returned to the issue on Tuesday, asking Dix for terms of reference for that review of the policy, which Merrifield later labelled “disastrous”.
“After safety measures were relaxed, we saw 42 outbreaks and 192 deaths of seniors. Cause. Effect,” said Merrifield.
Dix said that whether correct decisions had been made about when to declare outbreaks “will be the subject of discussion. But we are in the middle of a pandemic and our goal right now is to keep people safe”.