Review of COVID-19 Outbreaks in Care Homes in British Columbia

In this report, Seniors Advocate Isobel Mackenzie released the results of a province-wide review of COVID-19 outbreaks in long-term care and assisted living sites during the first year of the pandemic. The review examined factors that can influence the probability that a site will experience a COVID-19 outbreak and factors that can minimize the number of staff and residents who become infected when an outbreak occurs.

Report Summary

The review examined 365 outbreaks at 210 sites for the period of March 1, 2020 to February 28, 2021 and found:

  • 84% of outbreaks occurred at sites in the lower mainland
  • 72% of outbreaks were contained to four or fewer cases
  • 75% of outbreaks had no COVID-19 fatalities with an overall case fatality rate of 30%
  • 87% of outbreaks were experienced in Wave 2 (September 2020 to February 2021)

In most outbreaks (76%), the first COVID-19 case was a staff member. In 22% of outbreaks, a resident was the first case and there was only one outbreak where the confirmed first case was a visitor. The report identifies that a site was more likely to have a large outbreak:

  • if the first case was a resident (four times more likely)
  • if the first case was a nightshift worker (five times more likely)
  • if the first case was a registered nurse or a licensed practical nurse (1.5 times more likely)

The review analyzed what factors were more common in larger outbreaks and found:

  • sites that provided fewer days of paid sick leave were more likely to experience a larger outbreaks (while almost all sites provide paid sick leave to staff, the number of days ranged from 2.5 to 18 days per year)
  • sites with lower levels of registered nurses as a proportion of the direct care hours were more likely to experience large outbreaks
  • sites that had shared rooms were more likely to experience a larger outbreak

The report includes seven recommendations:

  1. Increase paid sick leave for all staff
  2. Increase the pool of direct care staff
  3. Decrease contracting for direct care services
  4. Increase levels of registered nursing staff as a proportion of direct care staff
  5. Increase testing scope, timeliness and frequency
  6. Eliminate shared rooms
  7. Require staff of long-term care to be vaccinated and provide booster shots to residents