BC’s new COVID outbreak protocols now in effect in long-term care facilities

New COVID outbreak protocol procedures have officially come into effect in BC’s long-term care homes, along with a change in the definition of what constitutes an outbreak to begin with.

Provincial health officer Dr Bonnie Henry briefly discussed the changes in a press conference on Feb 1, saying that a “one-size-fits-all approach” to declaring outbreaks in care homes is no longer applicable.

Previously, an outbreak would be declared in a care home if there was evidence of COVID transmission from one person to another. As of Feb 1, however, that’s no longer the case.

“An outbreak may be declared at the direction of the medical health officer (MHO) or their official designate. A COVID-19 outbreak will not be declared solely on the basis of cases diagnosed among residents or staff,” reads the BCCDC’s newly updated outbreak management protocol.

The decision to declare an outbreak in a particular wing, unit, or facility will now be based on several factors, including vaccination coverage, the severity of illness among cases, and the rate of increase in cases.

If transmission is found but an outbreak is not declared, a facility may be placed on enhanced monitoring or enhanced infection prevention and control (IPC) protocols; a decision that also rests with the MHO.

Less transparency around COVID cases

All staff, residents, families and visitors do not need to be informed of the virus’ presence in a facility unless an outbreak has been declared. Signage also does not need to be posted at the entrances of the facility under enhanced monitoring or enhanced IPC.

And the BC Care Providers Association says while it supports the changes for the most part, that’s a point of concern. CEO Terry Lake told the Beacon that while the new protocols are a better way of responding to the presence of Omicron in care homes while balancing the virus with residents’ quality of life, it’s not as transparent as the old system.

While families will be notified if their own relative has tested positive (while taking the resident’s right for privacy into account), Lake said he’d like to see more open communication around cases in a facility.

“I put this question to Dr Henry. I said it would be nice for people to know that there’s COVID in the home, even if it’s not an outbreak,” Lake said.

“And she said, ‘Well, people that are visiting, first of all, have to be fully vaccinated, they’re only going to the visitor’s room, they’re not circulating around the home, they’re wearing a mask. So really, there’s no danger to visitors going into a home if there’s not an uncontrolled circulation of the virus.’”

Asymptomatic testing

Another concern among long term care staff is the lack of rapid testing. The current protocols reserve tests, even in outbreak situations, only for staff or residents experiencing symptoms.

Lake said he raised that question with Henry as well, who told him that the prevalence of Omicron is no higher in residential care homes than it is in the general community—and that the greatest risk to the health of residents right now is a staffing shortage.

And Lake said Henry also told him the possibility of false positives on rapid tests could make that staffing shortage more acute.

A study from the University of Toronto published in the Journal of the American Medical Association found that the rate of false-positive rapid tests was “very low.” A large chunk of the false positives examined in the study were likely the result of manufacturing issues.

Other false positives were possibly related to the timing of the test (too early or too late in the infectious period), or issues with how the self-test was completed, researchers said.

Lake said he understands there is a supply shortage on rapid tests.

“But if I’m a staff member and there’s COVID in the home, I’d really like to know whether or not I have the virus because that’s going to affect what I do when I get home, or how I conduct myself at work as well. We’ve said we would prefer to have all staff tested all the time, at least on a regular basis,” he said.

“But one problem is we just don’t have enough rapid tests to be able to do that. This has been an issue we’ve raised for over a year, is the lack of use of rapid tests in long term care homes. And now, of course, everyone wants rapid testing. We don’t have enough. … So I think that speaks to the lack of preparation, in terms of having adequate numbers of rapid tests, which a lot of people would like to have available.”

While the province has alluded to supply shortages in the past when asked why BC doesn’t have enough rapid tests to hand out to the public, like other provinces, the Public Health Agency of Canada clarified in an emailed statement to the Beacon last December that provinces are responsible for informing the federal government of their rapid test requirements.

However, health minister Adrian Dix said Wednesday that the province expects to receive 25 million rapid tests by the end of the month—and said those would be used for “higher risk” patients.

Aerosol transmission

The new outbreak protocols place a heavy emphasis on droplet and contact precautions if an outbreak is declared in a facility.

Residents with confirmed or suspected cases of COVID-19, along with their roommates, must be placed on droplet and contact precautions. According to a March 2020 informational document from the Provincial Health Services Authority, that entails wearing PPE like masks, gowns, gloves and eye protection. There is also a focus on cleaning hands with soap or hand sanitizer.

Aerosol transmission—accepted as an important mode of transmission by general scientific consensus in many jurisdictions outside BC—is not mentioned at all. Henry and Dix have downplayed its role in COVID transmission to focus mostly on droplets—although they have in many cases referenced the importance of good ventilation in indoor spaces.

The BC approach to aerosol transmission has resulted in calls for easier access to N95 respirators, both in the workplace and the community. Newly released guidance from the American CDC says that well-fitting respirators offer the highest protection against COVID transmission.

But in healthcare settings, in particular, health authorities and the province have been reluctant to change their policies on N95s—even, in Fraser Health, going so far as to tell patients there is “no evidence” N95s are safer because they may not be fit-tested.

“I think BC has been slow to acknowledge the importance of aerosol transmission… there’s many staff members and many operators who would like to see N95s just become mandatory equipment, working in care homes where there’s any COVID or potential for COVID,” Lake said.

“And the government has been very—you know—they have not wanted to adopt that kind of philosophy.”

BC’s Occupational Health and Safety Regulations mandate that N95 respirators worn in the workplace must be fit-tested. Lake said, however, that that could easily be accommodated for long-term care staff.

“We would like to see those who would like to wear N95s be fit-tested to make sure they’re using the proper one and using it properly, but have the option of wearing these superior masks.”