At least 860 people have died of COVID-19 after contracting the virus in an outbreak at an Ontario hospital, according to a new public health report that reveals a far higher death toll than previously known.
The total, contained in an epidemiological summary from Public Health Ontario (PHO) updated earlier this month, means Ontario hospitals have been the province’s second deadliest scenario for COVID-19 outbreaks in the pandemic, behind long-term care homes and ahead of nursing homes, but with little of the public estimates observed in those sectors.
“There is no other way to represent this than a total tragedy,” said Dr. Abdu Sharkawy, infectious disease consultant for the University Health Network and assistant professor of medicine at the University of Toronto. The death toll highlights the changes hospitals must make to better control the spread of respiratory diseases now and in the future, he added.
Another serious respiratory illness is “invariably, inevitably, it will come our way at some point in the future,” he said.
In recent months, Ontario public health officials have defended the province’s hospital safety protocols against criticism that they have not been modified to reflect growing evidence of the risk of airborne transmission of COVID; The province’s health officials remain firm, this was the right decision.
The province’s key guidance to protect hospitals from the virus relies instead on familiar “drop and touch” protections, exemplified by surgical masks, face shields, and physical distancing, and calls for stricter airborne protocols such as wearing Exclusive to N95 and negative pressure respirators. isolation rooms – for specific medical procedures only.
Marlene Chorley, whose father Rob Chorley died after contracting COVID at Oakville Trafalgar Memorial Hospital last February, said Wednesday it was “shocking” to learn that so many others have suffered the same fate.
The Chorley family say they were told little about how Rob, a 67-year-old retired Air Canada worker, may have contracted the virus at the hospital. What they do know is that he was exposed on February 22 while in the hospital to have a small tumor removed from his spine, and within days of testing positive, he began to have trouble breathing. He died on March 22.
“These are statistics, but they are real people who are dying,” he said.
The province guidelines are formulated in a document known as “Directive 5”, which is supported by the vast majority of infection prevention and control experts managing the outbreak response within Ontario hospitals. Critics, however, say the rules are at odds with the latest research.
Last month, an important review in the journal Science He noted several lines of evidence, each offering “strong and unequivocal evidence of airborne transmission.”
In a new peer-reviewed study published in Clinical Infectious Diseases this week, an independent team of US researchers was able to collect and grow COVID-19 aerosols from the breath of people wearing cloth or surgical masks, a finding that suggests that “the virus is evolving toward more effective spread over through aerosols and shows that infections the virus can escape loose masks. ”
The authors conclude: “Therefore, until vaccination rates are very high, continuous monitoring in capes and tight-fitting masks and respirators will be necessary.”
In a written response to Star’s questions, Bill Campbell, a spokesman for the Ministry of Health, emphasized that hospitals must “adhere to all components of Directive 5 on precautions and procedures required for health and safety and the use of health and safety equipment. personal protection. “
Campbell noted that the province’s medical director of health has issued a directive that requires hospitals to have a COVID-19 vaccination policy for employees. Ontario is “doing better than other jurisdictions because we have maintained public health measures, including maintaining capacity limits and indoor masking, as we continue to implement the first and second doses as part of our last-mile strategy,” he said.
The failure of infection control experts at Ontario hospitals to act on the evidence of airborne spread shows that they are “absolutely in denial,” said Colin Furness, an infection control epidemiologist at the University of Toronto. The infection control field “will be in a multi-year reckoning when COVID is over,” he said.
“Now there is a flood of evidence from everywhere,” Sharkawy added.
Unlike long-term care, Ontario does not publish a detailed list of hospital outbreaks by facility, making it impossible for Star to do the kind of in-depth analysis it has done on COVID outcomes in nursing homes. .
The province first released front-line data on COVID deaths in hospital outbreaks earlier this year, revealing that there were 297 deaths among patients who contracted the virus in a hospital outbreak from the start of the pandemic to December 26. 2020.
Following this, Star was able to use data from the local health unit to confirm a total of at least 500 outbreak deaths in Ontario hospitals through the end of June 2021, a finding that revealed hundreds more patients had died after the contracting COVID in a hospital outbreak on Waves 2. and 3.
That analysis lacked data from several of the largest health units in the province, and the new PHO report reveals a substantially higher death toll during a similar period: 6,292 infections and 860 deaths from the start of the pandemic to July 5, 2021, near the end of the third wave.
The difference from the previous PHO report (563 patient deaths) again highlights that hundreds more have died after contracting COVID inside an Ontario hospital since Directive 5 it was last substantially modified last fall, and after the arrival of the more transmissible Alpha and Delta variants. (The latest issue has probably not yet been counted, as it does not include anything new in the last two months.)
The new PHO report also finds that outbreaks in Ontario hospitals have tended to be larger and longer lasting than outbreaks reported in nursing homes and long-term care, the other settings the province classifies as “group care. “.
Campbell, the ministry spokesman, noted that the two PHO reports reflect two very different moments during the pandemic. “The original PHO report reflects a time period prior to the Delta variant, when COVID-19 was less communicable,” he said. “The most recent report reflects the high transmissibility of the Alpha and Delta variants in the community.”
In May, the province rejected a judicial appeal that asked the medical director of health to update Directive 5 in response to the risk of the virus in the air. Among other things, the Ontario Nurses Association asked a judge to enforce a mandate to wear N95 respirators, which are rated to filter out smaller particles that surgical masks can bypass.
“This high death toll in hospitals tells us that COVID-19 is indeed airborne, as the Ontario Nurses Association (ONA) warned since the beginning of the pandemic,” the ONA president said Wednesday. , Vicki McKenna. “It didn’t have to be this way and the government was warned many times.”
Although studies have shown that surgical masks reduce transmission, they are not otherwise designed to prevent spread through the air; Standard guidelines for controlling known airborne diseases, such as measles and tuberculosis, call for N95 or better, strict isolation protocols, and a focus on ventilation.
Supporting the province against the nurse court challenge, 29 infection prevention and control professionals representing 24 Ontario hospital networks signed their names endorsing Directive 5 and expressing their view that COVID is primarily transmitted via of “drops and contact”, rather than airborne transmission.
Directive 5 saw its last major update in October, however the basic reliance on “drop and contact” protocols, with situational exceptions, has remained unchanged since spring 2020.
For Sharkawy, the death toll shows that Ontario has “betrayed” the trust patients placed in hospital care amid the pandemic. He remembered, in particular, a patient of his who had been at Toronto Western Hospital waiting to be transferred to a different facility. The woman contracted COVID-19 in an outbreak at the hospital before she could be transferred and died after a “precipitous” illness, she said.
“It was such a bitter pill for me to swallow, knowing that we let that happen, that she probably would have been fine if we had the right setup, the right design, the right level of tightness and sealing around our patients,” he said. .
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