By Sue Tiffin
As of last Wednesday, the public health unit was responding to nine outbreaks at long-term care homes, including one at Hyland Crest in Minden where two essential caregivers tested positive.
Gemmill said of the more than 140 cases that had been reported in the health unit’s region over the past two weeks – at the time of last Wednesday’s press conference – more than half of the cases were associated with outbreaks, and over half of those outbreak cases were associated with a testing campaign conducted at one of the long-term care homes.
“We call them outbreaks because that is what the province of Ontario has defined them as, and that is one person or more … whether they have symptoms or not, testing positive for coronavirus,” said Gemmill. “And in fact of those nine, I’ll call them situations, two of them are truly outbreaks that have affected a number of the residents and staff for which we are doing regular re-testing, we are ensuring that all of the infection control procedures are in place to try to bring these to a halt.”
Two long-term care facilities in the region were dealing with “more significant situations,” those being Caressant Care long-term care home on McLaughlin Road in Lindsay, and Hope Street Terrace in Port Hope.
“I will be honest with you, and tell you that my experience working in other parts of Ontario, is that one of the characteristics of these outbreaks with coronavirus, despite best efforts of all involved – and I mean, really, this is hugely stressful work for the staff who work in [a facility in] outbreak – that they tend to drag on. It just seems to be something we’re observing all over the place.”
At Hyland Crest, as of press time, all residents and staff had tested negative for COVID-19 after two essential caregivers – visitors, limited to two, designated by residents or family to help provide care during the pandemic – tested positive on Jan. 31. The outbreak is the first to occur in Haliburton County since the pandemic began last March.
“The Hyland Crest situation is one of the situations which I would describe as a situation, as opposed to an outbreak,” said Gemmill. “We’re instructed to call them outbreaks and treat them like outbreaks, and to get all the infection control in place, but what we have there … is two, what we call essential care visitors, those are people nominated by the family to come in and assist with the care. We’ve got two of those people who have tested positive but neither of them has any symptoms.”
The essential caregivers were tested as part of routine testing for anyone entering a long-term care facility.
“We know that in some places, people with no symptoms have been responsible for spreading the virus and so we cannot take any chances. Even if they’re false positive tests, we can’t take any chances. So that’s why we’re treating it like an outbreak, even though we only have two people, neither of whom is ill, in that setting. ”
The caregivers who tested positive are in isolation, but the long-term care centre is still open to other essential caregivers who are providing care to residents.
“I personally think that’s quite a reasonable thing to allow an exemption [from stay-at-home orders] for,” said Gemmill. “I think staying at home … I’m a big fan of it, but here’s a situation where they’re being tested. The idea of stay-at-home is that you go from home, to where you need to go, and then you go home, and that’s what I understand essential caregivers will be doing as well. They’re not going out to the pub afterwards, they’re going from home, to provide the care at the long-term care home and then back home to reduce the risk not only to themselves but also the people they’re looking after.”
Stay-at-home orders reducing both influenza and COVID-19 cases
Gemmill said cases in Ontario had gone from close to 4,000 per day a couple of weeks ago to fewer than 2,000 last week, while cases locally had dropped to 10 or fewer per day.
Additionally, he said influenza cases are at an all-time low – by Jan. 22, he said, just 55 cases were being reported Canada-wide, while normally there would be thousands.
While some people have suggested, Gemmill said, that the reduction in influenza is due to the COVID-19 and influenza viruses competing – an interesting hypothesis, he noted – less international travel and the personal measures people are taking in wearing masks and not gathering also play a factor.
“But also, I’m going to suggest, in addition to that, some of the restrictive measures such as the lockdown and particularly the stay at home order – because it’s been since the stay-at-home order we’ve seen some of these reductions,” he said. “So what’s actually happening then? My belief is that the restrictions are working and it’s especially these stay-at-home orders – and I’m a very strong supporter of them – I’ll go on the record as saying that because I think what it does is send the message out there that we’re not to gather. We are seeing the flow being stopped up as the virus cannot circulate without that human-to-human contact.”
Gemmill uses an analogy of a flowing garden hose, with stay-at-home orders and other restrictions acting as a sort of thumb over the hose to stop the spread of illness.
“We all know that even though they’re making a difference, once we relax the restrictions the case counts will rebound,” he said. “Thumb off the hose, it will all start all over again, and that’s because there’s so many susceptible people out there. I think it’s a message we can get out to the population that we have these restrictions in place because we want to keep the numbers down so that people can get a vaccine when we’ve got it available, and I hope that’s not in too many weeks from now.”
Gemmill hopes that when it is available, as many residents as possible choose to get a vaccine, hoping that a more normal life can be in place by this fall. While it has been delayed, he said a committee has been struck to ensure that when the vaccine is more readily available, it will be ready for the health unit region’s residents.
“These restrictions, can they go on forever? I think they’re helpful at the moment, I think they might be unsustainable a year from now. Do we want to be doing this same thing? I don’t think so. There’s a need to get back to normal.”
Playdates and sleepovers not essential
Brick and mortar schools reopened locally to staff and students on Jan. 25, with additional health and safety measures including mask-wearing during recess and breaks, and an ask from the school board that people not congregate before and after school. When asked for clarification on that ask, specifically in regards to playdates and sleepovers, Gemmill said they’re best avoided.
“The way I would characterize it is, at schools there is some element of control over the type of interaction between students,” said Gemmill. “Yes, they’re in the same classroom, but there is a semblance of order I think, in how kids interact and so it’s not zero, [but] I think it’s lower than it might be say for example, [for kids getting together for a sleepover.]”
Gemmill has said that confirmed COVID-19 cases in schools have remained low, but it is not clear if that is because students are less likely to contract the virus, or if they are asymptomatic. Confirmed cases of COVID-19 in kids who physically attend school were not associated with continued transmission within the school, he has said, and spread has been controlled there.
“To me, the stay-at-home order is stay at home unless there’s an essential reason to leave, and that is essential work that some people do, whether it’s public transportation or healthcare or groceries or [essential caregivers] or whatever it is, but I consider education of children to be amongst those essential reasons … if you’re not leaving home for those reasons, you shouldn’t be leaving home. And so yes, I think going to school is an essential reason, but going for a sleepover is not. That’s still part of stay-at-home.”
Variants not yet identified in Haliburton County or health unit region
In response to a question from media about coronavirus variants and whether or not Gemmill is concerned about their spread, he noted: “the answer is, we have to be.”
Currently, the variants have not been identified in the Haliburton, Kawartha, Pine Ridge district.
“We’ve seen what happened in Italy in March and April, we saw what happened in the UK, in New York, and now as I understand it, California,” he said. “There seem to be some strains of this virus that seem to be able to race through institutions and congregate living homes causing a huge number of cases and sometimes mortality as well.”
A recent report showed more than 5 per cent of positive COVID-19 cases collected in a study last month tested positive for B.1.1.7 or B.1.353 variants, which are considered to be more highly infectious, with the majority of those positive tests being reported in the Simcoe-Muskoka public health unit, 85 of them linked to the Roberta Place long-term care home outbreak in Barrie.
“I certainly don’t envy anybody who is dealing with the outbreak in Barrie,” said Gemmill. “It’s heartbreaking. It’s heartbreaking, I know, for the families of course but it’s also certainly heartbreaking for the people who are responsible for their care, staff and the public health people working there. We don’t want that to happen.”
In any outbreak that occurs, at least one of the proved positive specimens will be run for screening for the variants, including in the HKPRD health unit region. Gemmill noted that some experts are predicting a variant will replace the less transmissible stream and will become the predominant stream, so he said our own local health unit has to be watching for it.
“Is it only a matter of time?,” asked Gemmill. “Well, possibly, if we can keep the restrictions in place, maybe we’ll be lucky. I’m a realist as well as sometimes an optimist. I think that it could be only a matter of time, depending on how quickly we can get people protected [through vaccine].”