Nurses allege lack of cleaning and isolation contributed to deadly COVID-19 outbreak at Calgary care home

Two nurses say they believe staffing shortages, a failure to properly clean and ineffective isolation practices contributed to the COVID-19 outbreak at a Calgary nursing home — the site of Alberta's largest long-term care outbreak — that has killed more than a dozen people and infected at least 90 others.

Revera, the company that runs the McKenzie Towne continuing care centre, says it has been working closely with Alberta Health Services to resolve the staffing shortages, denies any cleaning issues and says it's practising proper isolation protocols.

COVID-19 is particularly dangerous for the elderly and those with chronic health problems. Since it began quietly snaking its way through the long-term care facility in the Calgary's southeast, it has killed 13 people. Another 45 residents and 45 workers have tested positive, as of Wednesday.

"It's heartbreaking," said one of two licensed practical nurses who spoke to CBC Calgary on the condition of confidentiality because they fear for their jobs.

"Almost every day, patients are dying. It's unbelievable."

The nurse, whom CBC has chosen to call "Lynette," believes mistakes early on contributed to the rapid spread.

As residents started getting sick, some workers panicked and stopped going into work, Lynette said. Then, as the outbreak swelled, many workers started falling ill themselves and were forced to stay home and self-isolate.

Staff worked double shifts

As the outbreak began to unfurl, nurses scrambled to balance the routine medical needs of residents and the ever-growing demands of deteriorating patients with fewer and fewer employees to help, she said.

"Staff were working double shifts, back to back," said Lynette. 

Another licensed practical nurse — whom CBC has also agreed not to identify for fear of job repercussions and will call "Debbie" — tells a similar story.

"It was hectic, stressful for the nurses," Debbie said.

"The residents were very concerned — not exactly understanding how it would impact them. It was difficult to get everything done on time."

For most of one shift as patients were falling ill, Debbie says she had to care for 21 patients alone, without the help of any health-care aides. Other days, she had help but was in charge of 42 residents.

"It's very difficult. It is stressful as well because we see that there's deterioration of the health status of a lot of the residents because we're not able to give the attention and assistance that they need," she said. "It's concerning."

Nurse says she was emptying garbage cans

In the early days, Debbie worried about infection control. With so many staff members away, housekeeping suffered, she says. 

"I myself had to empty garbage from the residents' rooms…. There was no extra cleaning or disinfecting. And the cleaning that we had from before was insufficient," she said.

"I think that's a huge factor that has caused this spread of this virus."

Debbie also questioned the isolation protocols at the McKenzie Towne continuing care centre.

Some patients who have suspected or confirmed cases have been sharing rooms with people who are showing no signs of illness, including sharing a bathroom.

"I don't think it is appropriate. I think the residents should have been separated — whoever is positive and whoever is not," Debbie said.

"As we've seen, it has spread so quickly between residents who are not even sharing a room. So it's a higher risk having them stay in the same place."

She also questioned communication within the nursing home.

Debbie says she was not aware of any formal meetings by management to discuss infection prevention prior to Alberta Health officials declaring an outbreak at the facility on March 23. 

Most of the information Debbie gleaned was informal, through word of mouth, she said.

"They didn't really meet with us and tell us that we should be watching for these symptoms [or] what steps to take," she said.

"They just weren't taking appropriate measures to prevent the spread. It wasn't handled in a timely manner." 

'Gravely concerning'

CUPE, the union representing approximately 160 workers at the McKenzie Towne facility, including health-care aides, LPNs and housekeeping staff, says it has received reports as recently as five days ago that housekeeping had to stop because there wasn't enough staff and equipment. 

The union is still investigating.

"This was gravely concerning. We're still trying to track this down… We've had concerns about housekeeping not taking place the way it should," said Rory Gill, president of CUPE Alberta.

The union has been actively calling for stronger oversight by the Alberta government, including asking the province to follow the lead of some other provinces and impose a single-site mandate to prevent potential spread between nursing homes and even take over management of long-term care homes.

"We need the province to step in and say we're in an emergency situation. These are the most vulnerable people in our society. They need to be cared for properly," Gill said.

Revera says it met isolation, cleaning standards

Revera — the company that runs McKenzie Towne Care home — has spoken with CBC News before, it  but did not agree to an interview for this story.

In an emailed statement, Dr. Rhonda Collins, chief medical officer with Revera  said: "We know this is a very frightening time for anyone who has a family member living at McKenzie Towne.  We are singularly focused on doing everything we can to contain this outbreak and are working closely with Alberta Health Service's public health experts to implement and comply with their directives."

Collins said housekeeping has not suffered.

"McKenzie Towne has had cleaning staff throughout the outbreak and they have consistently maintained standards for cleaning throughout the outbreak. Residents with confirmed cases or symptoms were immediately placed in isolation and all residents are getting basic care as always," the statement said.

According to Revera, "isolation" does not involve moving the sick patients into a different part of the facility.

Collins says COVID-19 positive patients can stay in the same room with non-symptomatic residents as long as they are kept two metres apart.

And the company says it is actively working to address critical staffing shortages. 

"Since the outbreak began, 37 new staff have been hired, along with 10 agency staff. Alberta Health Services continues to support McKenzie Towne with important nursing resources and clinical expertise."

Collins says staff who are working directly with residents who have confirmed cases of COVID-19 wear full personal protective equipment, including a mask, face shield, gloves and gown. And, in a new step, all other staff are now wearing masks when they're inside the care home.

AHS involved

Alberta's chief medical officer of health has previously expressed concern with how the McKenzie Towne care centre handled the outbreak, saying Revera should have reacted more quickly.

Alberta Health Services is now working closely with the facility in an effort to control the outbreak.

In a statement to CBC News, an AHS spokesperson said that includes "implementing strict infection prevention and control measures, isolating any residents who have tested positive or are suspected to have COVID-19, and restricting any visitors to the site."

AHS said other measures include having:

• An AHS medical officer of health make daily contact with the site to oversee the outbreak and address any new needs or concerns.
• Someone ensure appropriate care is being provided to all residents.
• AHS physician leadership provide guidance as needed.
• AnAHS clinical nurse specialist at the care centre to provide care, oversight and guidance as required.
• Infection prevention and control practitioners and continuing care auditing staff visit the site to ensure care and support meets required infection prevention and control measures.
• Environmental Public Health provide guidance and direction to the site with regard to cleaning and infection prevention and control measures.
• AHS continuing care leadership connect with the site multiple times each day to assist with any supply needs such as swabs or personal protective equipment or any other immediate needs.

Traditional approach to flu outbreaks not working

Research by the Centers for Disease Control — looking at outbreaks in Washington state nursing homes — is revealing nursing homes need to take a more aggressive approach to battling COVID-19, according to Dr. Samir Sinha, director of geriatrics at Sinai Health System and the University Health Network in Toronto.

"The traditional ways in which we've been actually approaching COVID in nursing homes based on flu outbreak protocols are not actually the right protocols to be following. In fact, we have to actually be much stricter in the way that we manage it," he said.

Sinha says data shows the rates of asymptomatic spread are more significant that previously understood — which means restricting non-essential visitors is key.  While provinces like B.C. and Ontario locked down long-term care homes fairly quickly, Alberta didn't put that measure in place until Tuesday, when it banned most visits.

Sinha also underlines the need for all workers to wear masks, as Revera recently mandated, since staff could unwittingly bring the virus into care homes.

When it comes to isolation practices, Sinha says long-term care residents who are sick with COVID-19 should be physically separated from those who have no signs — a step Revera isn't taking.

But, according to Sinha, long-term care facilities need to go even further and test residents living close to those who are infected even if they aren't showing symptoms.

"If we don't isolate that person and we don't test that person for example, we may be unwittingly allowing them to wander around and spread the infection to other people. Or staff themselves might be working with that individual — might not be wearing PPE for example … and therefore may contract the virus from that individual and pass it on to someone else," said Sinha.

Under Alberta's current protocols, testing is only done on continuing care residents who are symptomatic. However, the province says the definition of "symptomatic" is broad and can include diarrhea, for example.

"That's why we've been seeing this virus spread like wildfire in certain homes — some of the first homes that have been reporting outbreaks," said Sinha.

He points out that because some of these measures weren't taken, the number of care homes with outbreaks around the country has ballooned from a handful a few weeks ago to over 700.

Meanwhile, Debbie ended up becoming sick and testing positive after caring for residents with COVID-19. As a nurse, she says, it's been difficult to see so many patients succumb to the virus.

"It makes me sad. We all really care about our residents and it's sad that this has spread and it's sad to see the families suffering for their loved ones."