Seniors advocate Isobel Mackenzie’s review of COVID-19 outbreaks in care homes included looking at thousands of survey responses and doing “52 in-depth personal interviews” with officials who handled the challenge.
But none of them included provincial health officer Dr. Bonnie Henry, or anyone in her office.
There was no face-to-face input from the public health leadership.
Mackenzie explained that conspicuous absence as follows: “Medical Health Officers and public health staff who were involved in the management of long-term care/assisted living outbreaks were invited to participate in interviews (June and July 2021), but were unable to participate due to urgent pandemic-related responsibilities.”
The pandemic was at relatively low ebb over most of that time, with as few as 48 cases a day. Much of the emphasis then was on the restart plan and relaxation of restrictions.
It’s unlikely any of those officials over a period of eight weeks could not find a couple of hours for an interview.
Word in the field is that Henry’s provincial public health office set a policy of declining to meet with Mackenzie. Maybe they were too busy, but it could also involve being leery of explaining themselves to an independent watchdog.
The seniors advocate had to make do with written responses to questions she submitted, a routine dodge that increasing numbers of governments and corporations use now.
Mackenzie said Henry’s office also provided lots of documents about guidance and measures taken on the outbreaks in each health authority. She thanked them for “their co-operation in these unprecedented times.” That’s a very polite way of thanking someone for mailing it in.
Since we’re going to be spending years dealing with reviews of the pandemic response, this dismissive attitude toward an independent authority is a poor way to start.
Still, Mackenzie managed to put together a detailed look at how care homes dealt with a sudden, brand-new, terrifying threat to tens of thousands of elderly people.
In one sentence: It was bad, but could have been a lot worse.
She gives health officials top marks for an early and aggressive response; curbing visitors, restricting staff to working at just one facility, lowering the threshold for reporting outbreaks and pouring millions into stabilizing the workforce and cleaning facilities.
B.C.’s care homes weathered the first wave far better than ones in Ontario and elsewhere, and those first steps became national standards.
However, the entire province weathered the first wave better than most, not just the care homes.
So whether it was the control measures or the generally lower community transmission of the virus is difficult to judge, she said.
The report also flagged a debate about different testing approaches.
She said there was a consistent theme of facility operators “favouring more frequent, widespread testing than was generally supported by the local medical health officer.”
Testing initially was based on symptoms and suspected exposure, so it didn’t identify asymptomatic carriers.
“It is reasonable to conclude that a more aggressive approach to testing early in the outbreak with frequent repeat testing would better contain outbreaks. … The risk from under-testing was arguably greater than the risk from over-testing.”
A section on the staff experience gives a glimpse into how difficult the past two years have been.
Two-thirds said their mental health has worsened, most cited negative family effects and three quarters reported that the workplace was always, usually or sometimes understaffed.
On the plus side, most felt that residents’ care needs were met during the declared outbreaks, and that they felt safe providing care.
Overall, Mackenzie said the biggest factor in determining outbreaks at care facilities was simply the level of community transmission. That’s reflected in the much higher number of outbreaks (at least one case of COVID-19) in the Metro Vancouver health authorities.
The report said the public health response was strong, but there were some inconsistencies and frustration about various directives in the facilities.
Still, three quarters of the outbreaks over the study period were handled with zero fatalities.
The 800 residents who died in the remaining outbreaks in the first year, mostly on the Lower Mainland, suggest how much worse it could have been.