How prepared are Windsor-Essex long-term care homes for the second COVID-19 wave?

As the second wave of COVID-19 hits Windsor-Essex long-term care homes, health officials say that what they learned from the start of the pandemic has left them better prepared. 

Of the 77 COVID-19 deaths in the region, 54 were living in long-term care or a retirement home. On Tuesday, the health unit reported that the most recent death was a long-term care resident and reported more cases in three care home outbreaks. 

Right now two long-term homes, Berkshire Care Center and Iller Lodge, are experiencing outbreaks along with retirement home Lifetimes on Riverside. In total, they've had 28 confirmed COVID-19 cases so far. 

Better prepared

Dr. Wajid Ahmed, medical officer of health at the Windsor-Essex County Health Unit, feels that the WECHU is better prepared to handle new long-term care home outbreaks. He says the most important thing the unit has learned is the importance of clarity on the roles that the WECHU, local hospitals and the home itself have.

The health unit, he said, now has better guidelines outlining responsibilities.

"It helps to know that, okay, what is public health responsible for and what we will do, and what are the expectations from each of our partners," he said. "What are we expecting from the facility to implement and enforce? What are the expectations that we have for our hospital partners? What are the expectations from the long-term care home inspector? And then bringing it all back together."

That's allowed the health unit to have more consistent protocols in place when a test comes back positive at a long-term care home. 

Right now, long-term care home staff in Windsor-Essex are getting tested every two weeks. Even a single case among a resident can result in WECHU declaring an outbreak.

If that happens, health inspectors from the WECHU get in touch with the home and relay control measures that must be immediately put in place, Ahmed said. Everyone at the home is then tested while the control measures are maintained for the duration of the outbreak. 

And while Ahmed said he's not concerned about the supply of personal protective equipment (PPE), inadequate staffing levels among healthcare workers is what worries him. 

"I think what we are struggling, and we have struggled even in the beginning, and now, is the health human resources," he said.

"So there are only a certain number of bodies that can do the work, in the region and even in public health. Even though if we say, yeah, well, you know, why don't you hire people?" he continued. "Well, we don't have qualified people that we can hire who can do the work. So it is just us."

It's a concern that Natalie Mehra, the executive director of the Ontario Health Coalition, agrees with.

"Really, I think Windsor has done some of the very best work in Ontario in terms of organizing for outbreaks in long-term care homes," she said. "On the other hand, though, there are systemic issues that affect Windsor and everywhere else. And one is just inadequate levels of staff in the homes."

"It really is a huge contributing factor because if there's not enough staff, really almost nothing else can happen properly," she continued.

Success with 'SWAT' teams

Though staffing at long-term care homes remains an issue, the head of nursing at Windsor Regional Hospital (WRH) says local hospitals had success with sending healthcare "SWAT" teams into long-term care homes with outbreaks.

"Hospitals put together teams of people that would go into the home with public health and say, 'how can we help?'" said Karen McCullough, chief operating officer and chief nursing executive at WRH. "Literally going top to bottom to see what we could all do together to really prevent the spread ... and to make certain that the staff had what they needed in order to keep the patients and the residents safe."

The teams usually consisted of a public health inspector, an infection control practitioner, and an environmental services team to help with cleaning and housekeeping.

Though the early outbreaks were not a walk in the park for anyone, by June COVID-19 transmission in long-term care had subsided. This gave WRH time to implement a sustainability plan to stay on top of potential LTCH outbreaks, which involves sending an observer into long-term care homes once a month in addition to a weekly phone call. 

McCullough says the SWAT teams approach teaches an important lesson about controlling the virus' spread.

"I think one of the biggest learnings with COVID in long-term care homes was early, early detection. Prevention, if possible. And if in fact an outbreak situation were to occur, to act rapidly," she said.

"As soon as you can get as many people on the ground as you can to help intervene. So speed is of the essence. And as many as you can get with as much expertise as you have, get them to the site and work together and shut it down the best that you can."