SCIENCE IN ITS WORDS / Residents of long-term care facilities and retirement homes have been disproportionately affected by measures taken to stem the spread of COVID-19. In addition to social distancing and hand washing, measures adopted in Canada and other countries have included confinement in rooms with the prohibition or limited access to family members of residents, who are often also caregivers.
LHe Canadian Institute for Health Information (CIHI) is dedicated to the collection and dissemination of data on our health systems, which allows them to compare their performance. After the first three months of the pandemic, we took a look at how different countries have handled the spread of COVID-19 in long-term care facilities.
The restrictive measures were aimed at countering an urgent threat to public health. It is important to remember that at the beginning of the spring, the modeling of the COVID-19 epidemic in Canada presented the same trajectory as in Italy. All levels of government in Canada then took extraordinary measures to prevent the overcrowding of hospitals.
The majority of deaths in Canada
While Canada has been largely successful in managing the impact on hospitals, the same cannot be said for long-term care facilities; more than 80% of COVID-19-related deaths in Canada have occurred in these facilities.
On June 25, CIHI released an analysis that shows how Canada compares to 16 other Organization for Economic Co-operation and Development (OECD) countries in managing the spread of COVID-19 in healthcare long term. Our study compared the number of cases and deaths, as well as basic characteristics of the health system and the response of governments.
At the time the report was finalized, the number of Covid-19-related deaths among long-term care facilities varied widely from country to country. It was 28 in Australia, 30,000 in the United States, and over 10,000 in France, Italy, Spain and the United Kingdom.
The COVID-19 death rate in Canada is relatively low compared to other OECD countries (176 deaths per million in Canada compared to an average of 266 deaths per million in the OECD). However, Canada has the highest proportion of deaths from the coronavirus in long-term care facilities. More than 5,000 beneficiaries of these establishments have died. In other words, the majority of COVID-19 related deaths in Canada have occurred in long-term care facilities.
Although the conclusions of this report are painful to read, we can learn from them. Canada can learn from other countries. From the moment they imposed the confinement of residents and prohibited visits to long-term care residences, Australia, Austria, the Netherlands, Hungary and Slovenia have also introduced preventive measures. mandatory. Result: these countries recorded fewer infections and deaths linked to COVID-19 in this type of establishment.
Many other measures have had a significant impact. These include large-scale testing and contact tracing among residents and employees of these facilities, setting up hot zones to isolate infected people, hiring backup staff, presence of specialized teams and the purchase of personal protective equipment.
The report also showed that countries with centralized regulation and organization of long-term care facilities generally recorded fewer COVID-19 cases and deaths. However, more information is needed in Canada to determine how organizational structures, among other factors, influence results.
In Canada, we can also cite some measures that have proven to be effective.
For example, in Kingston, Ontario, a preventive inspection of infection control practices, the availability of health practitioners to answer questions about these practices, as well as a strong partnership between long-term care, health hospital and local hospital have helped prevent contamination to date in long-term care facilities in and around Kingston.
Curb the movement of personnel
Meanwhile, British Columbia has so far succeeded in controlling the spread of the epidemic in its long-term care facilities by changing the status of employees in private residences to public sector employees for six months. . By offering these workers a competitive salary, full-time work and better benefits, they were allowed to take time off work if exposed to the virus and to devote their time to a single establishment. This strategy also made it possible to standardize public health information.
In general, however, better knowledge of the inventory of personal protective equipment, the number of beds and their configuration in long-term care centers would have made it possible to draw up more effective plans to isolate infected residents. Data on the status of employees, including the number of people working in several centers, would also have identified gaps across the country. Performing early screening tests on all staff and residents of long-term care facilities would also have improved the assessment of infection rates. This data is essential to locate and contain outbreaks.
The importance of data
In Canada, we have rich clinical data on the health of residents of long-term care facilities. This makes it possible to plan care, assess the functioning of these establishments and monitor risks (such as the risk of pressure ulcers or falls).
These same data, especially on falls, worsening depression or pain support and support the public inspection reports. Getting this information from all provinces would give a better picture of the long-term care situation in Canada. Publishing reports based on common indicators across the country would help improve the quality of care for all residents of long-term care facilities.
We know you can’t improve what you don’t measure. With the data we have and the ability to collect more, it will be possible to make better decisions. Thousands of people across the country – from all walks of life – have made significant sacrifices to protect others. If we ask them to do it again, we have to give them the best possible explanation as to why.
The more we know, the better we can act.