Lack of asymptomatic testing in Manitoba care homes questioned Retired epidemiologist calls it best way to protect residents, staff By: Danielle Da Silva Posted: 7:15 PM CST Wednesday, Nov. 18, 2020 Last Modified: 6:52 PM CST Thursday, Nov. 19, 2020 Updates

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This article was published 18/11/2020 (1759 days ago), so information in it may no longer be current.

Shortly after an employee at Riverview Health Centre’s personal care home tested positive for COVID-19 in early November, retired epidemiologist Larry Mackie called the managers who oversee the care of his 98-year-old mother.

He wanted to know whether staff and residents at the home would be tested for the disease, even if they weren’t obviously sick with the virus, in an attempt to catch any possible infections and stop the spread.

After watching personal care home tragedies unfold in his home province of Ontario, and here in Winnipeg, where the coronavirus has spread to nearly all residents of Maples Personal Care Home, he needed to know everything was being done to protect his mom, Ruth Seel.

However, the response he received from the home sparked anger and concern. At the direction of public health, testing would only be offered to those who have symptoms at Riverview, Mackie was told.

“I know the staff are doing a wonderful job there… but I think they’re working under a handicap of not feeling secure themselves, that they’re not an asymptomatic carrier,” Mackie said. “You don’t know unless you’re tested.”

Mackie said his mother is doing well and is being well cared for while in isolation, but has yet to be tested for the virus.

“I think that she should be tested, as every resident in the personal care home should be, as with the staff members,” Mackie said.

“What you stand to lose is the protection of individuals, both the residents and staff, and what you stand to gain is the protection, the safety of lives of these individuals.”

Since the outbreak was declared on Nov. 9, four staff members have tested positive for COVID-19 and no cases have been reported in residents. It’s unclear how many residents of the home have been tested.

According to the province, testing for COVID-19 is prioritized for those at the highest risk of transmitting the virus — namely close contacts of confirmed COVID-19 cases, and only once they start to show symptoms.

When an outbreak is declared at a personal care home, close contacts, whether they be staff or residents of a confirmed case, are tested when symptoms appear, with the exception of some circumstances, public health officials say.

Dr. Samir Sinha, director of geriatrics at Sinai Health in Toronto, and the University Health Network, said that in an outbreak scenario, the best practise is to test all asymptomatic residents and staff who could have potentially been exposed to the virus, to better understand the scope of the outbreak.

Part of the reason the virus can spread quickly in care homes is because people can be contagious before they show symptoms, he said.

“It’s kind of a COVID 101 outbreak playbook strategy,” Sinha said. “We’ve seen countless outbreaks that have happened in western provinces where this is not a standard practice, where certainly outbreaks were allowed to get a lot larger than they needed to be, which honestly, ended up costing lives.”

Sinha said asymptomatic testing, while an important component of outbreak management, does not necessarily need to be widespread.

If public health determines that possible exposures are contained to a floor, or a unit, asymptomatic testing can be limited to those settings.

In the case of Maples Personal Care Home, where 153 residents of the 200-bed home and 67 staff tested positive, operator Revera Inc. hired outside help to test everyone in its effort to control the outbreak, which Sinha described as the gold standard.

“Certainly right now, my advice to the Manitoba government is you should likely be doing asymptomatic testing of residents and staff during an outbreak. You should be generous with this because you can’t afford to take chances like this,” Sinha said.

Asked Wednesday about public health’s approach to asymptomatic testing in personal care homes that have declared an outbreak, chief provincial public health officer Dr. Brent Roussin said such tests are offered on occasion.

“Just like any intervention we need to be able to, it has to change what we do,” Roussin said. “So when we declare an outbreak, all residents will be isolated in their room. And even before then, we have universal (personal protective equipment) use.

“So if a resident is isolated in their room, if they test positive or negative, it doesn’t change what we do. They’ll still be isolated in their room,” he said.

If residents need to be cohorted in a personal care home, some asymptomatic testing will be conducted, Roussin noted. Testing capacity is also a limiting factor, he said.

“But just to do widespread asymptomatic testing, just every time on everyone, doesn’t necessarily change what we do,” he said.

A spokesperson for the provincial government said in some circumstances, asymptomatic testing might be recommended for staff and residents not identified as close contacts but who may have been exposed.

The government did not provide any examples of where this approach has been deployed.

While other jurisdictions, including Ontario, conduct asymptomatic surveillance testing of long-term care home staff, Manitoba has no such policy.

On Wednesday, the Ontario government changed its guidelines to require all long-term care home staff who work in areas considered orange or red zones to be tested for COVID-19 on a weekly basis. Previously, testing was required twice a month.

Roussin said introducing a similar measure in Manitoba has not been ruled out.

“We have a lot of things in place that we really want to decrease the importation of the virus into these settings. First and foremost is the screening for symptoms and the universal PPE and so that should provide a great deal of protection to residents,” Roussin said.

However, for Mackie, and families like his, simply knowing all options to prevent the introduction of COVID-19 are being exhausted would restore confidence in the long-term care system.

“People just want to feel secure. And if (four) members of staff are positive for COVID at least something more positively, and actively is being done to help control it rather than wait for symptoms to appear,” he said.

danielle.dasilva@freepress.mb.ca