B.C. hospital sees fast spread of COVID-19, but no outbreak declared due to 'negative connotations'
Health authority instead using 'enhanced measures' for infection control such as masking and extra cleaning
Health-care workers at a hospital on Vancouver Island are sounding the alarm about the fast spread of COVID-19 at the facility in the last few weeks, after public health officials said they would not declare it an outbreak because of "negative connotations."
Dr. Jeff Unger, an ER physician at Saanich Peninsula Hospital, said 18 patients tested positive for COVID-19 as of Aug. 31, occupying nearly 30 per cent of beds at the hospital. Most patients at this hospital, Unger said, are over the age of 75, making them particularly vulnerable to COVID-19.
"The vast majority of them were hospitalized for other reasons and then developed symptoms, and hence were tested in hospital," Unger said. CBC News also spoke with two other health-care workers at the hospital who independently confirmed his account.
Unger detailed his concerns — that neither staff, nor patients are fully aware of the escalating spread of the virus under current protocols — in an email to officials at Island Health, the regional health authority.
The response, seen by CBC News, from a medical director says they know about COVID-19 transmission in the hospital and have implemented measures to reduce it, but are choosing not to declare an outbreak.
"It is very clear that the word 'outbreak' has very negative connotations to the public and would have media attention, possible patient shunting to [other local hospital] beds, and closing of all admissions to the affected units," reads the response from Island Health.
"There is now a more informed approach that does not alarm the public and staff that should have the same outcomes as when outbreaks were previously called."
That approach involves setting "enhanced measures" — the same protocols put in place in the event of an outbreak, without using the word "outbreak" and reporting it publicly.
As COVID-19 hospitalizations rise again across Canada, there is just one publicly reported COVID-19 outbreak in B.C. at a hospital in Chilliwack.
The B.C. Centre for Disease Control defines an outbreak in acute care as the "occurrence or suspicion" of linked cases acquired in the health-care facility within a 10 day period, with more cases or more severe illness than expected based on the circulating virus. Whether or not to declare an outbreak falls under the discretion of the local medical health officer or their designate.
In comparison, neighbouring Alberta has reported nine COVID-19 outbreaks as of Sept. 5, while Ontario reports 101 ongoing outbreaks as of Aug. 26. Some schools and hospitals have also reinstated mask mandates in the U.S., and the Ottawa Hospital will follow suit this fall.
Enhanced measures
According to health-care workers at Saanich Peninsula Hospital, the 18 cases were all detected within a week and a half. Hospital and public health communication about the situation, however, does not include the word "outbreak".
During past COVID-19 outbreaks, Unger said, this high number of COVID-19 patients would have triggered signage throughout the hospital letting them know about the situation.
Now, a photo sent to CBC News of handwritten signage on the door of an inpatient unit at the hospital reads "enhanced measures are in place for increased respiratory illness on unit," and recommends masks with eye protection. The sign does not mention COVID-19.
"When front-line staff get emails and notices and you only see signage around the hospital that says 'We're under enhanced measures,' I think unfortunately many people don't understand that. It doesn't prick up their ears to think about that; they're likely to just skim over that email or not read it in detail," Unger said.
"The measures to control the spread of [the virus] that should happen as a result of enhanced measures don't get instituted as fully as they would if the term 'outbreak' was used."
According to an Aug. 23 email to staff seen by CBC News, which emphasizes there is "not an outbreak," the enhanced measures for a unit of the hospital include:
- Universal mask and eye protection for staff on the unit.
- Increased cleaning requested.
- Closing doors to the unit, with signage directing visitors to the desk.
- Visitors should wear a surgical mask on the unit.
Neither the BCCDC nor the provincial health ministry has answered CBC questions including how many acute care facilities in B.C. currently have these steps in place, in time for publication.
The impact of COVID in hospital
In general, COVID-19 cases are much less severe than earlier in the pandemic because of immunization rates and previous infection. But when a patient at Saanich Peninsula Hospital is infected with COVID-19, it almost always leads to a longer hospital visit, said Unger.
"They develop other complications from COVID or they're just weaker," Unger said. "It unfortunately adds complexity to their care and will almost certainly prolong their hospital stay which impacts overall burden on the health-care system and our hospital capacity rates."
Lower capacity means more patients seen in crowded hallways, less space for infection prevention measures, and a vicious cycle of virus spread that leaves more people at risk of severe illness and death.
Dr. Anthony Fong, an ER physician and general practitioner who has worked in every B.C. health authority over the past few months, foresees a difficult fall ahead with a spike in COVID-19 and other respiratory illnesses coinciding with relaxed public health measures.
"Over the past several months, I've noticed that health-care workers are masking less than before," Fong said. "Some health authorities have been pretty much making masking optional during patient care."
"[Masking is] 100 per cent mandatory as far as I'm concerned," Fong said.
"Especially [because] you have no idea which patient is going to end up being vulnerable to the disease, who has a compromised immune system or who has high risk past medical history that makes them really at risk."
Managing risks including long COVID
Information about the virus and its spread needs to be more readily available to the public particularly as public health measures are relaxed, said Caroline Colijn, an epidemiologist at Simon Fraser University in Burnaby, B.C.
"We're being asked to manage our own risk but it's hard to do that …without good information," said Colijn, a Canada 150 Research Chair in Mathematics for Evolution, Infection and Public Health.
"I think the public does need to be informed of what's going on with COVID, about the risk of COVID infection and also the risk from COVID infection."
Colijn said more information and conversations are needed about the risk of longer term outcomes like long COVID, cardiovascular complications, and diabetes after contracting COVID-19.
A report from Canada's chief science advisor in May stated that long COVID "has the potential to become a mass-disabling event." As of August 2022 more than 1.4 million people in Canada — about 15 per cent of those who contracted COVID-19 — said they experienced symptoms three months or longer after being infected.
This number may be an underestimation, according to the report, because of the lack of a clear definition for the disease and low availability of COVID-19 diagnostic tests.
"We don't really have community testing and we don't have reported cases at the community level, so we don't really have a good lens on how much COVID is circulating in the general population," Colijn said.
According to Unger, before this recent spike in cases, patients were not tested regularly for COVID-19. Things are starting to change.
"Part of that was [because] cases were decreasing, illnesses weren't as severe, everyone kind of got feeling like the pandemic is over," Unger said.
"But … with the virtual outbreak in the hospital, all the physicians in the emergency group are aware and are having lower thresholds for testing now. People that we are admitting [who] may have just a cough or diarrhea or something that perhaps a month ago wasn't on the radar to test for, we're testing for again now."
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