Ontario is holding out the hope of light at the end of the COVID-19 tunnel as its daily case counts hover around 400 and a post-Thanksgiving Weekend surge has not materialized. As a result, the provincial government is beginning a lifting of capacity limits for Ontario bars, gyms and restaurants starting Monday the 25th and has outlined a long-term plan that could see all restriction lifted by March of 2022 – including mask mandates and vaccine-certificate rules.
However, the government maintains that it will pursue a cautious approach that will monitor assorted indicators that could prompt a tightening of restrictions if necessary. That may indeed be the result given that countries such as Denmark and Finland which eased restrictions – including masking – have seen a rebound in COVID cases despite high vaccination rates. Reasonably good vaccination rate compliance and masking in public places are probably the key reason why Ontario has not seen a rebound this fall. However, the announcement that vaccine certificate requirements may be lifted in the spring will not do anything to incentive the remaining 25 percent of Ontarians who have yet to get fully vaccinated.
And, while light at the end of the tunnel may be coming for many Ontarians, the contrary seems to be underway in the province’s long-term care homes. The rather large proportion of staff in long-term care homes that have still not been fully vaccinated means that the risk of the virus being carried into homes is still high. Even fully vaccinated residents of LTC homes are still vulnerable given their waning immunity and frailty. As a result, the Ontario government is creating new requirements.
As provided in an October 1st news release:
“Vaccination rates of staff in many homes are not high enough in the face of the risk posed by the Delta variant, and this is putting vulnerable residents at risk. To ensure the health and safety of staff and residents, mandating vaccination for in- home staff has now become essential, and homes are now required to meet the following requirements:
· Staff, support workers, students, and volunteers will have until November 15, 2021 to show proof that they have received all required doses of a COVID-19 vaccine, or to show proof of a valid medical exemption.
· Staff who do not have all required doses or a valid medical exemption by the deadline will not be able to enter a long- term care home to work.
· Newly hired staff will be required to be fully vaccinated before they begin working in a home unless they have a valid medical exemption.
· Homes will begin randomly testing fully vaccinated individuals, including staff, caregivers and visitors, to help detect possible breakthrough cases of COVID-19 as early as possible.
In addition to adding randomized testing of vaccinated individuals, homes will continue to regularly test individuals who are not fully vaccinated. The ministry will leverage provincial testing resources to inspect and audit these results by sending testing teams into homes to validate the results that homes have been reporting to the province. The ministry will also step up rigorous inspections of homes’ infection, prevention and control measures.”
The provincial government is understandably nervous about the long-term care sector given that 41 percent of the province’s COVID-19 deaths to date have been long-term care residents given such residents number about 115,000 – just barely over half of one percent of the province’s population. There have continued to be outbreaks with 5 LTC homes in Ontario currently experiencing an outbreak – all in southern Ontario. The government recognizes that the vaccination rates are not high enough and has mandated them by November 15th and yet it obviously does not believe it is going to happen because it is mandating additional testing requirements. Yet, what is more interesting is the response of the long-term care sector to the announcements.
Take for example the Southbridge Group which has interpreted the provincial requirements as follows and applied them to all their homes across the province:
1. Fully vaccinated essential caregivers and visitors shall be required to do a COVID-19 rapid test once a week. Daily swab clinics will be held Monday to Sunday from 10am- 6pm.
2. Essential caregivers and visitors who have received only a single dose of the COVID-19 vaccine (i.e. partially vaccinated) shall be required to do a COVID-19 rapid test every day they attend the home up to 14 days after the day they receive their second shots. After this time, they will follow the testing frequency listed in #1 above.
3. Essential caregivers and visitors who are unvaccinated will be required to do a rapid test every day they attend the home.
We also ask that unvaccinated essential caregivers and visitors should limit their movement only to the room of the resident they are visiting and should refrain from going to common areas such as dinning or lounge rooms where other residents are congregated.
This is a particularly interesting interpretation of “randomized
testing.” A quick search reveals that the definition of “random” as usually
applied in statistics or polling is: “made,
done., happening, or chosen without method or conscious decision”. So, one might expect that 1 in every 20 visitors
might be selected for testing or perhaps 1 in 10. A test at least once a week for everyone is not random no matter what the business school graduate brainiacs at corporate head office might think. Applying testing to both the fully vaccinated
as well as the unvaccinated equally seems a bit unreasonable but acceptable if
it truly is random. Mandatory testing
for the unvaccinated and random testing for the fully vaccinated seems more
reasonable. However, this application of
the requirements treats everyone the same – vaccinated or unvaccinated - a one
size fits all policy – that in the end is being done because so many long-term-care
staff and workers and even visitors are apparently still unvaccinated. And why 10am to 6pm only for testing? What if a family member wants to visit in the
late evening after a long day at work or early in the morning before work?
And what is more interesting is that the anecdotal evidence - gleaned from others who like myself who have a loved one in long-term care - suggests the application of the new provincial requirements differs across homes in Ontario and often even the same community. Some homes are indeed testing randomly all staff and visitors, some say fully vaccinated visitors and caregivers will not be tested at all, some are testing everyone irregardless of vaccine status, some say you can now only visit in the resident’s room, while others say you can help feed the residents in the dining room. Moreover, unlike the provincial approach to the relaxation of restrictions which ostensibly is going to be attuned to case counts and local conditions, there is no evidence that the LTC sector is using local case counts in their approach in terms of a measured approach to the new restriction requirements. For some LTC homes, It is essentially a fortress mentality that is turning LTC homes into prisons.
Overall, the Southbridge rules – and likely those of other homes and providers across the province –represent a return to a much more restrictive set of rules. This is after a gradual easing of restrictions during the summer and early fall that saw a somewhat more normal pattern of visitation. The new requirements for many will in the end discourage visitation to the homes further accelerating the decline in the condition of residents that became apparent during the pandemic when personal visitation ceased completely. One understands the skittishness particularly in the case of for-profit LTC homes given that their deaths rates from COVID were higher. And yet, there must be a better way. The long-term care sector needs to think more creatively and employ fewer one size fits all solutions and more outside the box solutions to balance resident safety with resident needs for frequent care and visitation.
