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July 17, 2020 13h39
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How countries have controlled the COVID-19 in their centres long-term care
David O’toole
Canadian institute for health information, Queen’s University
SCIENCE IN ITS WORDS / residents of institutions for long-term care and homes for the elderly have been disproportionately affected by the measures taken to contain the spread of the COVID-19. In addition to the social distancing and hand washing, the measures adopted in Canada and in other countries have included the confinement in rooms with the ban or limited access to family members of residents, who are often also caregivers.
The canadian Institute for health information (CIHI) is dedicated to the collection and dissemination of data on our health systems, which allows to compare their performance. After the first three months of the pandemic, we examined how different countries have managed the spread of the COVID-19 in the institutions of long-term care.
The restrictive measures were designed to counter an urgent threat to public health. It is important to remember that at the beginning of the spring, modeling the epidemic of COVID-19 in Canada had the same trajectory as in Italy. All levels of government in Canada have taken extraordinary measures to avoid the overloading of hospitals.
The majority of deaths in Canada
If Canada was largely successful in managing the impact on hospitals, we can not say as much in the institutions of long-term care ; more than 80 % of the deaths related to the COVID-19 in Canada have taken place in these institutions.
On June 25, CIHI released an analysis that shows how Canada compares to 16 other countries in the Organization for economic cooperation and development (OECD) in terms of management of the spread of the COVID-19 in long-term care. Our study compared the number of cases and deaths, the same as the basic characteristics of the health system and the response of governments.
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At the time the report was finalized, the number of deaths related to the Covid-19 among the institutions of long-term care varied considerably from one country to another. It was 28 in Australia, 30,000 in the United States, and more than 10 000 of them in France, Italy, Spain and the United Kingdom.
The mortality rate of the COVID-19 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, it is the Canada that we see the greatest proportion of deaths caused by the coronavirus in institutions of long-term care. More than 5 000 beneficiaries of these institutions are deceased. In other words, the majority of deaths related to the COVID-19 in Canada have taken place in the centres long-term care.
Effective measures
Although the conclusions of this report are painful to read, we can learn from it. Canada can learn from other countries. From the moment they were imposed by the confinement of residents and prohibits the visits to the residences of long-term care, Australia, Austria, the netherlands, Hungary and Slovenia have also implemented prevention measures mandatory. As a result, these countries have experienced fewer infections and deaths related to the COVID-19 in this type of establishments.
Deaths related to the COVID-19 to 25 may 2020 to 21 hours : number per million inhabitants (total and long-term care)
O’toole 2020
Many other measures have had a significant impact. Among these, we mention the testing and tracing of contacts on a large scale among the residents and employees of these institutions, the establishment of hot zone to isolate infected persons, hiring of helpers, the presence of specialist teams and the purchase of personal protective equipment.
The report also showed that countries where the regulatory and institutional long-term care are centralized have generally recorded fewer cases of COVID-19 and death. However, it will take more information in Canada, to determine how the organizational structures, among other factors, influence the results.
In Canada, we can also mention some measures that have proven effective.
For example, in Kingston, Ontario, inspection, preventive infection control practices, availability of health practitioners to respond to questions relating to these practices, as well as a strong partnership between the long-term care, public health and the local hospital have avoided, to date, the contamination in the centers of long-term care in the Kingston area and surrounding areas.
Slow down the movement of staff
Meanwhile, British Columbia has been able so far to control the spread of the epidemic in its institutions of long-term care in changing the status of the employees of the private homes for employees in the public sector for six months. Providing these workers with a competitive salary, a full-time job and better benefits , it allowed them to be absent from work if they were exposed to the virus and to devote their time to a single institution. This strategy also made it possible to standardize the information of public health.
Gold general, a better knowledge of the inventory of personal protective equipment, the number of beds and their configuration in the centres long-term care would have enabled them to develop plans that are more effective for isolating the residents infected. Data on the status of the employees, including the number of people working in several centers, would also have helped identify gaps in the country. The fact of perform early testing on the entire staff and residents of facilities for long-term care would have also allowed a better assessment of the infection rate. These data are essential to localize and contain outbreaks.
The importance of the data
In Canada, we have rich clinical data on the health of residents of facilities for long-term care. This allows you to plan care, evaluate and assess the functioning of these institutions and monitor risks (as the risk of pressure ulcers or falls).
These same data, including falls, worsening of depression or pain to support and underpin the public reporting of inspection. Obtain this information from all the provinces would give a better overview of the situation of long-term care in Canada. The publication of reports based on common indicators across countries would help to improve the quality of care for all residents of facilities for long-term care.
We know that you cannot improve what you do not measure. Thanks to the data we have and the possibility to gather more, it will be possible to make better decisions. Thousands of people across the country – from all walks of life – have made important sacrifices to protect others. If you ask them to do it again, we need to give them the best explanations possible about the reasons for doing so.
The more we know, the better we can act.
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This text first appeared on the website of the franco-canadian of The Conversation. Reproduced with permission.
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