At least 860 people have died of COVID-19 in Ontario hospital outbreaks. What we now know about the ‘unmitigated tragedy’

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At least 860 people have died from COVID-19 after catching the virus in an Ontario hospital outbreak, according to a new public health report, revealing a far larger death toll than previously thought .

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The total is contained in a Public Health Ontario (PHO) epidemiological summary Updated earlier this month, which means Ontario hospitals have been the province’s second deadliest setting for COVID-19 outbreaks in the pandemic, behind long-term care homes and ahead of retirement homes – but areas that saw little public count Has been.

“There’s no way it could be a completely unplanned tragedy,” said Dr. Abdu Sharqawi, an infectious disease consultant at the University Health Network and an assistant professor of medicine at the University of Toronto. He said the death toll highlights the changes that hospitals need to make to better control the spread of respiratory diseases now and in the future.

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Another serious respiratory illness is “always, inevitably going to come our way at some point in the future,” he said.

In recent months, Ontario public health officials have defended the province’s hospital safety protocols against criticism they have not been changed to reflect growing evidence of airborne exposure to COVID; State health officials stand firm, it was the right call.

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The province’s key guidance to protect hospitals from the virus relies on familiar “droplet and contact” protection – exemplified by surgical masks, face shields and physical distancing – and mandates strict airborne protocols – such as N95 respirators and Special use of negative-pressure isolation rooms – for specific medical procedures only.

Marlene Chorley, whose father Rob Chorley died last February at Oakville Trafalgar Memorial Hospital after catching COVID, said on Wednesday it was “shocking” that so many people faced the same fate. had to do.

The Chorley family say they were told little about how Rob, a 67-year-old retired Air Canada employee, could have contracted the virus at the hospital. What they do know is that on February 22, a small tumor was removed from his spine at the hospital and within days of testing positive, he started having trouble breathing. He died on 22 March.

“These are figures, but these are real people who are dying,” she said.

are prepared in the guidelines of the province A document known as “Instruction 5” Which is supported by the majority of infection prevention and control experts managing the outbreak response inside Ontario hospitals. However, critics say the rules contradict the latest research.

last month, A major review in the journal Science pointed to several lines of evidence that each provided “strong and clear evidence for air transmission”.

In a new peer-reviewed study Published in Clinical Infectious Diseases This week, a different team of US researchers was able to collect and culture COVID-19 aerosols from the breath of people wearing surgical or cloth masks, a finding that suggests “the virus may allow more effective spread via aerosols.” further development and shows that infectious loose-fitting masks can protect against the virus.”

The authors conclude: “Therefore, unless vaccination rates are very high, continuous layered controls and tight-fitting masks and respirators will be necessary.”

In a written response to the Star’s questions, Bill Campbell, a spokesman for the Ministry of Health, stressed that hospitals are required to follow “the precautions and procedures necessary for health and safety and all components of Directive 5 on the use of personal protective equipment.” “

Campbell said the province’s chief medical officer of health has issued a directive to hospitals to create a COVID-19 vaccination policy for staff. Ontario is “doing better than other jurisdictions as we have put in place public health measures, including maintaining indoor masking and capacity limits, while continuing the first and second doses as part of our last-mile strategy,” They said.

The fact that Ontario’s hospital infection control experts haven’t acted on evidence of airborne spread shows they are “absolutely in denial,” said Colin Furness, an infection control epidemiologist at the University of Toronto. The infection containment zone is “going to be on a multi-year count when COVID is over and done,” he said.

“There’s an avalanche of evidence now from everywhere,” Sharkawi said.

Unlike long-term care, Ontario does not publish a comprehensive list of hospital outbreaks on a facility-by-facility basis, making it impossible for Starr to conduct in-depth analyzes conducted on COVID outcomes in nursing homes. .

The province first published topline data on COVID deaths in hospital outbreaks earlier this year, revealing that patients caught the virus in hospital outbreaks from the start of the pandemic to December 26, 2020. There were 297 deaths in

Subsequently, STAR was able to use local health unit data to confirm a total of at least 500 deaths in Ontario hospital outbreaks by the end of June 2021 – a finding that showed Waves 2 had one Hundreds more patients had died after catching COVID in the hospital outbreak. and 3.

That analysis was missing data from many of the province’s major health units, and the new PHO report reveals a much larger toll over the same period – 6,292 infections and 860 deaths from the start of the pandemic to the end of July 5, 2021. third wave.

The difference since the first PHO report – 563 patients died – again highlighted that hundreds more have died after catching COVID inside an Ontario hospital since Instruction 5. The last was substantially replaced, with the arrival of the more transmissible Alpha and Delta variants. (The latest numbers are still likely to be lower, as it does not include any developments in the last two months).

The new PHO report also finds that Ontario’s hospital outbreaks tend to be larger and longer-lasting than outbreaks reported in long-term care and retirement homes, with other settings deeming the province “isolated.” -different care”.

Ministry spokesman Campbell said the two PHO reports reflect two different times during the pandemic. “The original PHO report reflects a period before the delta version, when COVID-19 was less transmissible,” he said. “More recent reports show higher transmission potential of alpha and delta variants in the community.”

In May, the province defeated a court challenge calling for the chief medical officer of health to update Directive 5 in response to airborne exposure to the virus. Among other things, the Ontario Nurses Association asked a judge to enforce a mandate to use N95 respirators, which are rated to filter out tiny particles that can bypass surgical masks.

“This high number of hospital deaths tells us that COVID-19 is exactly what the Ontario Nurses Association (ONA) warned about from the beginning of the pandemic,” ONA President Vicki McKenna said on Wednesday. “This should not have happened and the government was advised several times.”

Although studies have shown that surgical masks reduce transmission, they are not otherwise designed to prevent airborne spread; Standard guidelines for controlling known airborne diseases, such as measles and tuberculosis, call for attention to N95s or better, strict isolation protocols and ventilation.

Backing the province against the nurses’ court challenge, 29 infection prevention and control professionals representing 24 Ontario hospital networks signed their names backing Directive 5 and stating their opinion that COVID is primarily in Hawaii. It is spread by “droplet and contact” route rather than transmission.

Directive 5 saw its last major update in October, however, the basic reliance on the “droplet and contact” protocol, with situational exceptions, has remained unchanged since spring 2020.

For Sharkawi, the death toll shows that Ontario has “betrayed” the trust patients placed in hospital care amid the pandemic. He recalled, in particular, one of his female patients who was awaiting transfer to a different facility at Toronto Western Hospital. The woman caught COVID-19 in the hospital outbreak before being transferred, and died after a “precipitated” illness, he said.

“It was such a bitter pill for me to swallow, knowing that we let this happen, that she probably would have been fine, if we had the right set up, the right design, the right level of tightness and seal around our patients. , ” he said.

With files from Megan Ogilvy
Ed Toub is an assignment editor and a contributor to the Star for Crime and Justice focus. He is based in Toronto. Follow him on Twitter: @edtubb
Kenyon Wallace is a Toronto-based investigative reporter for Star. Follow him on Twitter: @KenyonWallace or reach him via email: [email protected]
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