Hundreds of COVID-19 deaths could have been prevented by eliminating four-person nursing-home rooms: study

National Post Friday, 26 June 2020 ()
A new study points to a disturbingly simple explanation for some of the havoc wrought by COVID-19 in Canada’s nursing homes: keeping residents in ward-like shared accommodation can be lethal.

The deaths of close to 300 long-term care residents in just one province could have been prevented if those individuals were housed in two-bed instead of four-bed rooms, suggests the research.

The study by University of Toronto, McMaster University and Public Health Ontario scientists, found a clear association between the degree of crowding in homes — how many people share a room and lavatory — and the virus’s spread.

Residents of the most tightly packed facilities were twice as likely to get infected and to die as those in the least-crowded homes, concluded their paper.

And yet, one in four long-term-care residents were in four-bed rooms when the pandemic hit, they say.

“Too often, the building and the physical infrastructure gets forgotten in this conversation,” said Dr. Nathan Stall, a geriatrician at Toronto’s Mt. Sinai hospital and one of the authors. “(But) public health experts … would know on face value that that’s sort of infection-prevention 101: crowded rooms are bad.”

He noted that Ontario standards introduced in 1999 said new facilities could have no more than two people per room. Older homes, most of them for-profit , were encouraged to retrofit to those standards but few have done so, said Stall.

COVID-19’s disastrous toll on nursing homes has been the central story of the pandemic in Canada, accounting for about 80 per cent of the country’s 8,500 deaths.

A new report by the Canadian Institute for Health Information underscores that fact. Canada’s per-capita number of long-term-care deaths has been about average among similar industrialized countries, the institute found. But as a percentage of a nation’s total COVID-19 mortality, Canada’s deaths far exceed those of other Organization of Economic Co-operation and Development members, the institute found. Deaths in long-term-care in OECD countries averaged 42 per cent, and ranged from less than 10 per cent in Slovenia and Hungary, to 66 per cent in Spain.

After getting an early preview of the Ontario researchers’ findings, the province has already acted, mandating that newly admitted residents have no more than one roommate.

The industry agrees such set-ups are one of the root causes of the devastating outbreaks, said Donna Duncan, CEO of the Ontario Long Term Care Association. But moving away from four-bed accommodation will have a major impact, she said.

· Companies managing troubled Ontario long-term care homes run dozens more, make millions in profits
· Four out of five COVID-19 deaths have been linked to seniors homes. That says a lot about how Canada regards its elders

Though the association says only about 10 per cent of residents, not 25, live in those rooms, converting them to two beds now would take 4,300 places out of the system, adding to a waiting list for nursing home places that already stands at 36,000, said Duncan.

“We saw the numbers … then shared that information with government and said, ‘We have a very large problem here,’ ” she said. “We need to prepare today to look at alternate accommodations and solutions … We have to move very quickly.”

With a second pandemic wave expected, Duncan said the province should consider converting existing, unused buildings, like vacant hospitals, hotels or arenas, into long term care housing.

The study, by Stall and colleagues, published on an academic “preprint” site without having undergone peer review, ranked facilities based on the density of housing, ranging from those with mostly single rooms to homes with only four-person rooms.

That data was then correlated with COVID-19 infections and deaths.

The type of accommodation didn’t affect whether a facility had an outbreak. But the spread of the virus was higher in crowded homes — 9.7 per cent infected versus 4.5 per cent in the least crowded — while deaths were 2.7 per cent and 1.3 per cent respectively.

The researchers used their findings to create a simulation, which indicated that putting all the residents who were in four-bed rooms into two-bed rooms would have prevented 988 COVID-19 cases, and 271 deaths.

It’s what residents prefer, as well. Past surveys indicate that 80 per cent of residents would choose to have a private room over a shared one, noted the paper.

Most of the four-bed rooms that the study highlights are in older facilities, said Duncan. The higher occupancy rooms have curtains to separate the residents but “curtains are no match for this,” she said.

A previous paper by Stall and colleagues, also not yet peer-reviewed, found that outbreaks were significantly bigger in for-profit homes, mainly because they operated under the older standards that allowed more residents per room.

• Email: [email protected] | Twitter: tomblackwellNP

You Might Like

Related videos from verified sources

New study reveals number of deaths at long-term care facilities [Video]

New study reveals number of deaths at long-term care facilities

Local doctors from the Boston University School of Medicine have been examining data from across the country.

Credit: WCVB     Duration: 02:13Published

Tweets about this