New research finds thousands of long-stay home-care clients did not get flu shot in 2019

An estimated 61,000 long-stay home-care clients in Ontario and thousands more across Canada did not get a flu shot in 2019, researchers at the University of Waterloo have found.

John Hirdes, professor at the School of Public Health and Health Systems, said the number for Ontario is 18,000 more than the 2007 figure, when around 43,000 long-stay home-care clients did not get a flu shot.

He said the issue is critical now as the country grapples with "wave two" of the COVID-19 pandemic. 

"One reason for that is, if we can protect people against influenza, that may help them to be a bit stronger if they get infected with COVID," Hirdes told CBC News.

"The other is, by giving people the flu shot, we can keep them out of the emergency department, so that reduces pressure on the emergency department so they are not dealing with two viral outbreaks.

"Also, because there are so many similarities between the two conditions, if we get people the flu shot and can prevent the flu, then at least it may help in reducing some confusion of whether we're dealing with the flu or COVID in cases where people are infected," Hirdes added.

Study covered Alberta, BC, Ontario and Newfoundland 

The study, which covered Alberta, BC, Ontario and Newfoundland in Canada, also included Belgium, New Zealand and the United States. It included individuals living in their communities who need on-going supports from the government's home-care system.

According to the study, the rate of not being vaccinated for influenza in long-stay home-care clients is as follows:

• Ontario — 28.3 per cent.
• BC — 27.6 per cent.
• Alberta — 23.2 per cent.
• Newfoundland — 34.9 per cent.

"These are all frail, elderly people. They are very vulnerable to the effects of influenza so they definitely should be getting the flu shot," Hirdes said.

Noting that Ontario "used to do OK" where only about 20 per cent of long-stay home-care clients did not get a flu shot in 2007, Hirdes said it's "worrisome" that things have gotten worse over time.

Dr. Samir Sinha, director of geriatrics for Mount Sinai Hospital and the University Health Network in Toronto, said he's not surprised by the findings.

He noted that while the Public Health Agency of Canada has recommended at least 80 per cent of Canadians get the flu shot, that target is not being met.

"We're not even reaching that target amongst older Canadians and Canadians in general," Sinha told CBC News. 

"And that's concerning, because if we don't actually reach 80 per cent vaccination levels, we don't create a situation that we call herd immunity, meaning that if flu is circulating around, it's less likely to spread from one person to the other if 80 per cent of our population for example is immune, either by having recovered from the flu that year, or having received the flu vaccination that protects people from that strain of the flu."

Most governments have made the flu vaccine freely available and accessible, even in places like pharmacies across the country. The vaccine is available for anyone who is six months or older.

"The challenge is that for the type of person that John and his team is studying, these tend to be people who are functionally homebound," Sinha explained. 

"These are folks for example who can't really get out to see their doctor, can't easily get out to see their pharmacist.

"They are often people who are getting their medication delivered from the pharmacy to them at home. And because these folks have challenges getting out of the house, it just creates an additional challenge or barrier for them to actually get vaccinated," Sinha added. 

'Quite a bit of bureaucracy involved,' Hirdes says

Meanwhile, Hirdes said home-care based clinicians need to urgently have a conversation with their clients to make them aware why they should be getting a flu shot — especially now that we are in the midst of the COVID-19 pandemic.

"The role of the home-care nurse is to encourage them and make them aware of the options. One of the things that we need to think about is can we simplify things to make it easier for home-care service providers to also provide the flu shot," Hirdes said.

"Right now there is quite a bit of bureaucracy involved in this where home-care providers would have to ask to get flu doses from public health. 

"A home-care nurse doesn't carry it around in a small black bag so we need to think about ways to make it more convenient and easy to get flu shots to frail, elderly people in their homes," he added.

In August Canada's chief public health officer, Dr. Theresa Tam, stressed the months ahead will be a "period of challenge" given the combination of COVID-19 and influenza.

Last month, Tam said preparations for administering this year's flu vaccine is a "good rehearsal" for any COVID-19 vaccine.

The National Institute on Ageing has published a White Paper related to the issues of influenza in Canada. The findings include:

• Influenza (and pneumonia) is the seventh leading cause of death in Canada, and it is the leading cause of death among vaccine-preventable diseases.

• Influenza has been reported to cause an average of 12,200 hospitalizations and 3,500 related deaths each year in Canada.

• The influenza vaccination rate for older adults is only 62 per cent, well below the Health Canada target of 80 per cent needed for population immunity.

• In provinces where pharmacists are allowed to administer the influenza vaccine, more Canadians get vaccinated.

• Influenza leads to an estimated 1.5 million lost work days each year. Despite making some progress in promoting vaccination uptake, Canada still lags behind other countries like the United States and Britain.

It's not too late

Hirdes said it is not too late to get the vaccine to the thousands of long-stay home-care patients who did not get one last year.

"We're just starting to get vaccinations going with this and so this is the time for the system to work. If this was April or May in 2021 it would be too late, but now is the time," Hirdes told CBC News.

"The advantage that we've got is that the home-care agencies in the province have a complete list of all their clients who did not get a flu shot, so it's actually very easy for them with their electronic health records to identify which of their clients did not get a flu shot and to reach out to them to encourage them to get a flu shot.

"We serve about 200,000 home-care clients in the province a year so it's a manageable problem. These are people that are on the roster for home-care agencies — they can easily with their electronic health records identify who those folks are … it's not going to be that hard to reach them," Hirdes added.