Crowded Long-Term Care Homes : Patients at High Risk for COVID 

"Too often, the building and the physical infrastructure gets forgotten in this conversation."
"[But] public health experts ... would know on face value that that's sort of infection-prevention 101: crowded rooms are bad."
Dr.Nathan Stall, geriatrician, Mt.Sinai Hospital, Toronto

"We saw the numbers -- then shared that information with government and said, 'We have a very large problem here'."
"We need to prepare today to look at alternate accommodations and solutions ... We have to move very quickly."
Donna Duncan, CEO, Ontario Long Term Care Association

Verla Pacey, 102, waves through a window at Stoneridge Manor Long Term Care Home in Carleton Place, Ont., where six residents died of COVID-19. Pacey survived the virus. (Supplied)

Some of the havoc caused by COVID-19 in nursing homes where the highest mortality rates in Canada were seen among the elderly, boosting Canada's death rate attributable to the effects of the novel coronavirus, had a quite simple explanation, according to a new study. Elderly and health-impaired residents kept in shared accommodation turned out to be a particularly lethal arrangement.

Close to 300 long-term care resident deaths in one province alone could have been prevented, had the residents been housed in two-bed, rather than the ward-like four-bed rooms, according to the research results. Ontario scientists from University of Toronto, McMaster University and Public Health Ontario highlighted a clear association in the degree of crowding in the homes -- the number of people sharing a room and lavatory -- and the spread of the hugely contagious COVID virus.

The elderly living in the most tightly packed of the facilities turned out to be twice as susceptible to being infected and to perish, in comparison to those living in the least-crowded homes, according to the paper. When the pandemic struck, one in every four long-term care residents was housed in four-bed rooms.

Ontario standards introduced in 1999 held that new facilities would plan for no more than two people for each room, while older homes, mostly for-profit enterprises, were encouraged to retrofit to the same standards. According to Dr.Stall however, few have committed to making those changes to meet the new standards of two people per room.

A new report by the Canadian Institute for Health Information underscores that nursing homes have seen about 80 percent of Canda's 8,500 deaths. The per-capita number of long-term-care deaths averages among like industrialized countries, according to the Institute report. Yet Canada's deaths exceed those of other Organization of Economic Co-opration and Development members.

OECD countries saw deaths in their long-term care homes averaging 42 percent, ranging from under ten percent in Slovenia and Hungary up to 55 percent in Spain. As a percentage of the nation's total COVID-19 death rate, deaths in Canada attributable to COVID, exceed the record of other OECD members.

The Ontario Long Term Care Association says that about ten percent of residents live in four-bed rooms and that converting them to two-bed accommodation at the present time would effectively remove 4,300 places from the system, at a time when waiting lists for nursing home places currently stands at 36,000.

In anticipating the arrival of a second pandmic, Ms.Duncan feels the province should consider the conversion of existing unused building space such as vacant hospitals, hotels or arenas, into long-term care housing. Facilities were ranked in the study on the density of housing ranging  from those with mostly single rooms to homes with only four-person rooms.

The infection spread was seen to be higher in crowded houses with 9.7 percent infected as opposed to 4.5 percent in the least crowded of the homes; deaths 2.7 percent and 1.3 percent respectively. Placing all residents who were in four-bed rooms into two-bed accommodations would have prevented 988 COVID-19 cases and 271 deaths.

Past surveys reveal that 80 percent of residents would select a private room over a shared one, according to the paper. Most four-bed rooms are located in older facilities, with high occupancy rooms having curtains to separate residents, but "curtains are no match for this" virus pointed out Ms.Duncan. Unsurprisingly, an earlier study found that outbreaks were significantly higher in for-profit homes.

People show support for staff and residents at Ottawa's Carlingview Manor long-term care home, a for-profit facility owned by Revera that has experienced 61 deaths due to COVID-19. (Francis Ferland/CBC)