April 23, 2020 – See below for messaging from Dr Vera Etches to provide additional information on how Ottawa Public Health (OPH), and regional healthcare partners, are supporting long term care facilities during the COVID-19 pandemic.
April 15, 2020 – OPH continues to work closely with the healthcare sector including Long-Term Care Homes. Locally, LTC ‘strike teams’ have been assembled to implement the Action Plan released by Ontario Health (more details follow). In concert, OPH Public Health Nurses and Public Health Inspectors have been aligned to the facilities to provide additional support in outbreak management.
On April 15, 2020, the Government of Ontario announced the COVID-19 Action Plan for Protecting Long-Term Care Homes to keep residents in long-term care homes safe.
This plan is focused on a three-pronged approach:
- Aggressive testing, screening, and surveillance enhancing testing for symptomatic residents and staff and those who have been in contact with persons confirmed to have COVID-19; expanding screening to include more asymptomatic contacts of confirmed cases; and leveraging surveillance tools to enable care providers to move proactively against the disease.
- Managing outbreaks and spread of the disease supporting long-term care homes with public health and infection control expertise to contain and prevent outbreaks; providing additional training and support for current staff working in outbreak conditions.
- Growing Ontario’s long-term care workforce redeploying staff from hospitals and home and community care to support the long-term care home workforce and respond to outbreaks, alongside intensive on-going recruitment initiatives.
Beyond the activities announced in this Action Plan, the Ontario government is also moving forward with the following additional measures:
- Public health units will be working with each individual long-term care home to assess immediate needs for support – for testing, outbreak management, or staffing.
- Asking hospitals to temporarily stop transferring hospital patients to long-term care and retirement homes, leveraging current capacity in the hospital sector.
The Ontario government is also working in the very near term to deliver:
- enhanced testing and surveillance for symptomatic residents and staff and those in contact with persons confirmed to have COVID-19;
- testing of asymptomatic residents and staff in select homes across the province to better understand how COVID-19 is spreading;
- risk and capacity assessments for all homes;
- working with Ontario Health, the Ontario Hospital Association, and public health units to assemble infection control and preventions teams and additional supports;
- enhanced guidance on personal protective equipment and continued priority distribution to homes;
- enhanced training and education to support staff working in outbreak situations; and
- redeploying hospital and home care resources into homes.
The Government of Ontario also passed emergency orders restricting long-term care staff from working in more than one long-term care home, retirement home or health care setting, and guidance on masks and conservation of PPE supplies.
Further guidance and Ministry of Health directives are available in French and English on the Ministry’s website.
For daily updates on all currently active outbreaks in institutional settings (including hospitals, long-term care homes and retirement homes) please visit OPH’s Outbreak Reports in Ottawa Healthcare Institutions webpage.
Message from Dr Vera Etches
COVID-19 OPH Long-term Care and Retirement Home Update
As a follow-up to previous messaging shared with Council last week with respect to the Provincial announcement on Long-Term Care (LTC) and Retirement Home (RH) action plans, I would like to provide additional information on how Ottawa Public Health (OPH), and regional healthcare partners, are supporting these facilities during the COVID-19 pandemic.
OPH encourages residents to follow the special statements by officials, and to visit OttawaPublicHealth.ca/Coronavirus for evolving information.
OPH has been collaborating with the Champlain Health Region Incident Command to develop and launch new teams that can provide greater supports to LTC/RHs in our region. These teams are comprised of hospital leads who can provide concrete assistance with staffing, clinical supports, and access to Personal Protective Equipment (PPE), as well as community paramedics who can provide support with testing and non-urgent medical care, and OPH staff who can provide overall outbreak and Infection Prevention and Control (IPAC) guidance. These collaborative teams are already in place and have been in contact with the highest need LTC/RH facilities currently experiencing COVID-19 outbreaks and will continue to expand to other LTC/RHs over the coming days and weeks. Ottawa hospitals are mounting a significant effort to staff LTC homes and hospital staff are supporting these facilities, many of which are in outbreak.
In addition to Ministry of Health guidance, OPH has, for some time, been instructing all LTC/RH with a positive or presumptive case to:
- Implement facility-wide outbreak management control measures and whole facility droplet precautions;
- Isolate all residents, including the closure of dining rooms and cancellation of all activities (meals to be provided in residents’ rooms);
- Ensure all staff wear PPE and take droplet / contact precautions in all residents’ rooms; and
- Ensure staff work at only one (1) facility and wear PPE to avoid carrying the virus from one facility to another.
Update on Testing
Pursuant to provincial guidelines with respect to COVID-19 testing protocols, OPH has communicated provincial testing recommendations to all LTC/RHs relating to COVID-19. Please note that, as per Ministry of Health guidance, one single confirmed case of COVID-19 in an institution results in the declaration of an institutional outbreak. OPH’s COVID-19 Testing Criteria webpage provides the details with respect to who should be tested for COVID-19, based on those who are most in need and this will be updated shortly with the new guidelines.
On April 21, 2020, the province announced proactive surveillance testing to understand the current status of COVID-19 in LTC and RHs, including targeted testing of asymptomatic residents and staff. While testing of residents and staff in COVID-19 outbreak that are symptomatic and asymptomatic close contacts should be a priority, additional testing will enable an understanding of the prevalence of COVID-19 amongst residents/staff, particularly asymptomatic. OPH is in continual communication with the province and our health care partners to determine the best way to effectively and efficiently carry out the new provincial surveillance initiative. Given the large numbers of residents and staff in the region to be tested, this will take several weeks to coordinate and complete.
It is especially important to mention that a negative test does not rule out that an individual is infected, since they could be incubating an infection and therefore the result could be falsely reassuring. Tests conducted early in an infection may also be falsely negative if a person’s viral load is low. A reliance on testing results with ongoing testing of people initially negative is a challenge, raising concerns of sustainability and potential distraction from the primary importance of infection prevention and control efforts. PPE such as masks, gloves, goggles and gowns, and sound infection prevention and control practices are what make a difference in reducing transmission.
Families Considering Moving their Loved-Ones from LTC/RHs
We understand some families may contemplate removing their loved ones from LTC/RHs to protect them from COVID-19. While we are unable to provide individual advice, our recommendation to anyone thinking of removing their loved one from a long-term care facility / seniors’ residence is to assess the situation, including the different risks in bringing the person home. Is someone able to manage their care at home? Is there movement in and out of the home that could introduce risks? Is there anyone else in the home at risk for more serious outcomes with COVID-19 infection?
It is also important to recognize that once someone is removed from a LTC/RH that has an outbreak, they cannot go back until after an outbreak is declared over. The person will need to be kept in self-isolation within the family home as well, given the potential exposure to COVID-19 and risk to others. There are guidelines for self-isolation on the OPH website.
Information on Home Care and Personal Support Workers
At this time the guidance with respect to restricting the work of personal support workers so that they do not work in multiple facilities only applies to Long-Term Care and retirement homes, where those workers are employed directly by the facility to provide care to its residents. It does not apply to apartment buildings where some tenants may require assistance from home care or personal support workers.
With respect to home care and personal support workers, OPH has received confirmation that our local home and community care sector has received guidance and has been working closely with their staff to educate and build awareness about preventing COVID-19 transmission. Given that home care workers cannot rely on physical distancing in the home because of the nature of their work, all home care staff now require PPE.
With respect to apartment buildings, OPH has provided guidance and resources to landlords and building managers to assist them in ensuring a safe environment for their tenants. Specifically, our recommendation is that landlords / building managers disinfect commonly touched surfaces (elevator buttons, door handles, handrails, etc.) twice daily. Further, it is recommended that all residents, including tenants living in apartment buildings, thoroughly wash their hands whenever they return home (or to their own units) after spending time outside their personal dwelling and that they avoid touching their face except with freshly washed hands.
Thank you for your ongoing support during this challenging time. As noted in this information it is important to recognize that the COVID-19 situation is evolving very quickly. Please refer to OttawaPublicHealth.ca/Coronavirus to stay up-to-date on the latest. Content is being updated continuously and new content is always being developed and added to provide additional and more targeted information.
Dr. Vera Etches, MD, MHScm CCFP, FRCPC
Medical Officer of Health
Ottawa Public Health