Nearly 1,000 infections and hundreds of deaths from the novel coronavirus could have been prevented at Ontario nursing homes if residents were placed in two-bed rooms instead of four-bed rooms, according to a new study.
The study from researchers at University of Toronto, McMaster University and Public Health Ontario found residents in more crowded facilities were twice as likely to get infected and die from the virus.
“There have been a lot of issues in the [long-term care] for a long time,” said Andrew Costa, a professor at McMaster University’s school of medicine and co-author of the study.
“We are confronting it now because of the scale of the deaths.”
While more crowded rooms didn’t affect whether a long-term care home had an outbreak, the study found the spread of the virus was higher in four-bed rooms, with a 9.7 per cent infection rate versus 4.5 per cent in the least crowded.
Deaths were 2.7 per cent and 1.3 per cent respectively, according to the study, which has not been peer-reviewed.
Researchers gathered data from 618 homes in the province, which house roughly 78,000 residents, and ranked the facility on how crowded it was on a scale of one to four, with four being a fully occupied home of entirely four-bed rooms.
They then ran a simulation to evaluate what would happen if residents from four-bed rooms were placed in two-bed rooms from the outset of the pandemic.
The study found the shift would have prevented 988 COVID-19 cases, and 271 deaths.
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Costa said their research found that homes with four-bed rooms also correlated to more crowding in general.
“Homes, where there are two people to a room, have better designs where residents are housed within independent units of 32-40 residents,” he said. “That means if you have an outbreak … even if it gets out of control you can usually limit it to one of your units so it doesn’t spread like wildfire.”
“These facilities are generally more home-like and have more space.”
Long-term care homes across Canada have been pummeled by COVID-19 accounting for roughly 80 per cent of the country’s over 8,500 deaths.
Costa said the high death toll in homes has forced governments to address the problems at nursing homes, like overcrowding and understaffing, which have stretched back years.
“We are confronting it now because of the scale of the deaths,” he said. “The situation was always untenable but this is the straw that broke the camel’s back.”
Ontario long-term care homes have been hit particularly hard with more than 1,800 resident deaths and over 1,900 staff sickened by the virus.
Tamara Daly, professor of health policy and director of the York University Centre for Aging Research & Education, said the paper reveals some “interesting correlations” that need to be furthered explored. Daly was not involved in the study.
“Given that nearly half of the older homes didn’t have an outbreak and just over 30 per cent of the homes that did have an outbreak, that are older, controlled it raises really important questions,” she said.
Tamara said other factors like management styles, staffing and ability to produce medical supplies need to examined as part of the inquiry into why some homes were devastated by COVID-19 and others weren’t.
“This isn’t the whole story, it’s just a piece of the story,” she said. “It may well turn out it’s an important piece but we need more data on whether it played a more important role compared to other factors.”
Long-term care rooms with more than two beds were prohibited by the province when it updated its standards in 1999. However, roughly 25 per cent of long-term care homes in Ontario still have four-bed rooms, according to the study.
Some of the province’s worst-hit homes are made of entirely or mostly “C” beds, a classification meaning they are built to 1972 design standards that permit four beds in a room, according to structural data from Ontario’s Ministry of Health and Long-Term Care.
Costa said although the study has not yet been peer-reviewed it has been shared with the province.
Ontario’s Chief Medical Officer of Health announced a ban on residents from being admitted into rooms with more than one resident on June 10. The new directive did not apply to those already in those types of accommodations.
However, Costa said long-term solutions to nursing homes crisis will require significant government spending to build more beds in the province to meet demand and reduce the growing wait-list for nursing home places that already stands at 36,000.
“You need to build more facilities so it becomes a larger capital project,” he said.
Ontario Long-Term Care Minister Merrilee Fullerton said in a statement that crowded ward rooms are “badly exacerbating” the COVID-19 crisis.
“These are long-standing structural and capacity issues that, coupled with a severe staffing shortage that predates the virus, have led to the tragedy we have seen in our homes. We have known for decades, as our population has aged, that these issues were mounting, but they went unaddressed by the previous government,” Fullerton said in a statement.
“We are learning more every day from the challenges posed by this virus, and have much to consider to shore up the cracks in the system. We need to build a system that works in the best interest of residents and the people that work so hard to keep them safe.”
Meanwhile, Prime Minister Justin Trudeau said Thursday that provincial governments have “failed to support seniors” in their handling of the novel coronavirus pandemic, while floating the idea of bringing in national standards at long-term care facilities.
Trudeau came after a new report from the Canadian Institute for Health Information that found long-term care residents made up 81 per cent of all reported COVID-19 deaths in Canada compared to an average of 42 per cent among all countries studied.
“I think one of the things that is very clear is our current system of supporting seniors across this country has not worked,” Trudeau told reporters.
“It is a provincial responsibility. So it is them that have failed to support our seniors,” he said.
Trudeau said that although the facilities fall under provincial jurisdictions, he hinted the federal government may propose legislation to regulate long-term care facilities.
“We want to respect provincial jurisdictions, but I think we know that things need to change. Do we need national standards, or do the provinces just need to increase their standards significantly? These are conversations we can have with the premiers.”
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