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Out of date design of long-term care homes left residents more vulnerable to COVID-19: study – CBC.ca

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A study of long-term care homes across Ontario during the pandemic shows that aging facilities, whose designs date back to 1972 standards, were a significant factor in determining the likelihood of an outbreak. 

The authors found the odds were higher with older homes — many of which are for-profit — and were also linked to the infection rate in the local health unit and number of people inside the building. 

Dr. Andrew Costa, senior author and McMaster University professor, said he was surprised at how crucial the facilities’ design was when it came to managing an outbreak.  

“We were frankly disappointed… at how many facilities still maintained essentially 1972 designs,” he said. “That’s a long time ago. And the philosophy of care has changed so much.” 

The report, published in the Canadian Medical Association Journal, looked at all 623 long-term care (LTC) homes in Ontario — home to 75,676 residents — from March 29 to May 20, 2020.

Around 30 per cent of homes in the province experienced outbreaks during this peak period, with 110 occurring in for-profit homes, 55 in nonprofit homes and 25 in municipal homes.

There were 190 outbreaks of COVID-19 in LTC homes, which at this point killed 1,452 people. Their lives account for more than 80 per cent of Canada’s deaths. 

Deaths up 178 per cent at for-profit homes

At for-profit homes, the report said the rate of cases was almost double compared to those with non-profit status. These homes also had a 178 per cent increase in the number of resident deaths. 

For-profit homes, were “usually smaller, housed fewer residents, and had older design standards from before 1972 with multiple-occupancy rooms and chain ownership.” Costa said this was the case for around half of the for-profit places. 

Newer designs, the authors said, allow for larger and more private rooms, and less crowded and self-contained common space. This limits infection.

But older designs use ward-style accommodations and centralized common spaces where people can interact with each other, allowing the virus to spread. 

One in five of the nonprofits and very few municipal ones had old designs.

And it made a difference. If you factor in age and whether or not the home is a chain, Costa said, then “essentially there was no difference” between each type of residence.  

“It’s only now that we’ve seen the infection control issue as cleanly and plainly, where we can’t disregard it, that it’s gotten attention. But it’s always been bad for the people living there,” he said. 

The findings echo those in a CBC Marketplace investigation in June. 

Dr. Andrew Costa, senior author, says some buildings’ designs date back to 1972 and that “it’s time” for people to take this issue seriously. (McMaster University)

Of the 10 homes with the highest death rates, seven were for-profit homes with older design standards and chain ownership. Of the 15 homes with the highest rate of cases, 12 fell into this same category.

“From a Hamilton perspective, we have some old facilities in our midst…but it’s something that local public health units have to pay particular attention to,” he said and added that units and municipal government should identify these vulnerable facilities to create plans for evacuations and handling staff crises.  

About 23.8 per cent of residents in for-profit homes had the virus, which is higher than the average for nonprofit and municipal homes (17.1 per cent and 7.1 per cent respectively.) Around 6.5 per cent of all non-profit residents died of COVID-19. 

“It was clear that across the board, for all of our planning for covid, the long-term care sector was left neglected,” he said. “We were planning for a crisis in hospitals…that instead fell to long-term care. And we were on our back heels. And so now we have evidence, clear evidence [on] what the priorities are for prevention and we have to act.” 

The authors write that with government commitment to independent commissions and inquiries into the long-term care systems, “it is important that policy recommendations and changes consider all root causes of the present crisis, including supporting capital projects to retrofit or rebuild older LTC homes.” 

In May, the province announced an independent commission into long-term care. 

The authors did not look at retirement residences since they are privately funded and not administered by the Ministry of Long-term Care.

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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