'We are teetering': With new care-home outbreaks, Sask. should consider short lockdown, says epidemiologist

COVID-19 case numbers in Saskatchewan are higher than ever, and show no signs of slowing down.

Now, there are new outbreaks in two long-term care homes.

Over the past week, the Saskatchewan Health Authority reported that Golden Prairie Care Home in Indian Head and Rehoboth Elder Care in Saskatoon have had COVID-19 outbreaks. 

Saskatchewan has largely been able to avoid outbreaks in long-term care homes since the beginning of the pandemic, unlike other provinces, including Quebec, Ontario, Manitoba and B.C.

Dr. Nazeem Muhajarine, an expert in community health and epidemiology, says these two outbreaks are bad news for the province's fight against COVID-19.

"I was really hoping that we would be able to stave off any COVID outbreaks happening in long-term care homes. It comes as a huge concern, particularly at this time when our case numbers are generally are rising," said Muhajarine, who is a professor at the University of Saskatchewan.

"Outbreaks in senior-care homes really complicate matters because it's a very, very vulnerable and delicate situation."

Muhajarine says caregivers are quite mobile, often working at multiple care homes. That's problematic when community and home transmission rates are high. 

Saskatchewan's total number of active cases as of Wednesday was 1,363. 

The province now has a higher rate of active cases per 100,000 people than either Ontario or British Columbia, with 111 cases per 100,000 people as of Wednesday, compared to Ontario's 69 and B.C.'s 104. 

Strain on health care 

There were 11 COVID-19 patients in intensive care across the province as of Wednesday, six of whom are in Saskatoon. 

"These are very concerning indicators," Muhajarine said. "I think this is what we were hoping to avoid — outbreaks in senior care homes. And now there's real pressure on the acute care system, ICU beds and hospitalizations."

Many seniors have multiple pre-existing conditions and cognitive illnesses, like dementia. Adding these needs to COVID-19 care needs puts a lot of strain on front-line workers and resources, says Muhajarine.  

"I just really feel that we had eight months to prepare for a potential second wave. And here we are now again, sort of caught a little bit unprepared.

"These outbreaks can be actually quite fatal, as we have seen in other provinces. So this is a huge concern," Muhajarine said. 

"I think we are on the brink of a real serious situation. This virus is really getting the better of us. We are teetering."

Muhajarine says the province should consider a lockdown of two to four weeks to get ahead of the virus and regain control. 

"I think we shouldn't wait until things get any worse before we really consider a lockdown to bring down the hammer again."

Muhajarine says Saskatchewan needs to increase testing, contact tracing and its isolation and quarantining regime. 

"It would remind people that this is really serious. Those few people who are not adhering to the guidelines and the measures ... we need to get everyone into the mindset that we had back in March and April."

'Worst fear is realized'

Robin Hilton's mother is a resident at Golden Prairie Care Home in Indian Head, the site of one of the latest outbreaks.  

Hilton says her mother, who has late-stage dementia, is completely reliant on others to care for her.

Hilton and her family found out about the COVID-19 outbreak at the care home over the weekend.

"Your worst fear is realized," Hilton said.

"The home is a very vulnerable population. So obviously I initially felt fear and worry. But also, I have a lot of trust in the care workers at the facility. They're always great. They've been taking such precautions."

Hilton says she is unhappy with the province's approach to the COVID-19 case spike, which she says has been largely reactionary. She wants to see mandatory masks provincewide, not just in the bigger cities.

Hilton says she also supports a second lockdown. 

"It seems like we're just kind of letting it happen rather than taking proactive action. I think the biggest concern is that we don't overrun the health system," Hilton said. 

Her mother isn't the only vulnerable one in the family. Hilton's father is currently undergoing chemotherapy treatment.

"It was difficult before COVID and hard to watch. And now this … I couldn't imagine a more heartbreaking scenario when it comes to two elderly people. It's heartbreaking to think that this could be part of their final days," Hilton said. 

Action plan

Muhajarine says there are four actions that could be taken to contain and control outbreaks in long-term care homes. 

First, with the exception of essential workers, those entering the homes should be stopped, Muhajarine says. 

"All homes with the outbreaks should be considered active COVID zones and entry into, and exit from, should be closely controlled and monitored."

The Saskatchewan Health Authority has placed restrictions on long-term care homes and hospitals in Saskatoon after a spike in COVID-19 cases. 

Second, those who are working in the homes, or anyone who may have been there during or before the outbreak, should be tested. Their contacts should traced and either isolated or quarantined, Muhajarine said. 

"This test-trace-isolate should be done rapidly — within 48 hours. Those who are isolated or quarantined should be supported due to income loss for example or food, and should be enforced."

Third, anyone who is working at the long-term care homes needs to strictly adhere to their own family social bubble, he says. They should be advised not to interact with anyone outside their bubble.

Finally, all workers and residents who are not cognitively impaired should wear good-quality masks and practise proper hygiene. The premises should be cleaned and kept clean, and the premises should be ventilated, with air circulated with quality filters.

"The temperature in the homes should be kept high ... certainly above 25 degrees Celsius and humidity at 50 to 65 per cent if possible," Muhajarine said. 

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