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Post investigation exposes undisclosed Vancouver outbreaks, as medical chief says relatives blame her for deaths
Ian Young in Vancouver
10 min read
Two previously undisclosed Covid-19 outbreaks in Vancouver, including one at a retirement facility in which 12 people were infected and two residents died, have been exposed as a result of an investigation by the South China Morning Post.
Provincial Health Officer Dr Bonnie Henry revealed the existence of the outbreaks during a press conference on Thursday, hours after an interview with the Post about a document that described the one of the incidents.
During the interview she also said the Post's previous reporting had caused people to blame her for some care home deaths.
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Henry did not explain to the daily press conference the circumstances of how she became aware the outbreaks were never made public.
But the Post had informed the Vancouver Coastal Health (VCH) authority on Tuesday that it had obtained a VCH document showing 10 residents and two employees of the Terraces on Seventh assisted-living facility in the South Granville neighbourhood had been infected about five months ago, information never publicly disclosed.
Despite the multiple infections, the January 7 document lists the Terraces as being under "enhanced surveillance", a status whose precautionary protocols are much less stringent than an outbreak lockdown.
Henry said in the interview the Terraces had actually been on full outbreak status.
But a spokeswoman for West Coast Seniors Housing Management, which manages the Terraces denied this: "There was nothing to disclose as it was not considered an outbreak."
Henry said in her press conference: "It has come to my attention in the past week that there are several outbreaks in assisted living that were responded to over the past number of months and were managed aggressively as we do for all outbreaks, but have not been reported or posted in our outbreak reports."
She identified the Terraces, and a second outbreak at nearby Chalmers Lodge, another assisted-living facility in South Granville. She did not explain what she meant by "several".
The November 7-20 Chalmers Lodge outbreak, in which six residents and three staff were infected but no one died, was uncovered in a review conducted this week after the Post shared its documentation of the Terraces outbreak, Henry said in the interview.
The Terraces outbreak lasted from December 22 to January 6, the health ministry later said, and two residents died. Both outbreaks were added to public records late Thursday.
A care industry source provided the VCH document last week. It is an agenda for a January 7 Zoom meeting with care home operators that was hosted by VCH, one of Vancouver's two health authorities along with Fraser Health.
In addition to revealing that some BC outbreaks were kept from public knowledge for months, the document - whose authenticity Henry said she had no reason to doubt - also sheds light on situations where outbreaks were not declared at all.
It shows that multiple staff infections and even the infection of a resident did not always trigger outbreak status at facilities for elderly British Columbians, depending what type of housing was involved. Henry confirmed this could be the case.
In addition to the Terraces, the document lists six other facilities as being under enhanced surveillance status, whose protocols allow many facilities to continue visits, group activities and other social interactions.
VCH guidelines state that outbreaks are declared if more than one worker, or any resident, tests positive to Covid-19 in a long-term care home. But the document suggests outbreaks were not declared at certain facilities, and they instead remained under enhanced surveillance, even if multiple staff or a resident had tested positive to Covid-19.
For instance, Haro Park Centre, a combined long-term care and assisted-living facility in downtown Vancouver, is listed on the document as having been under enhanced surveillance despite having one infected resident and two infected staff.
Central City Lodge, a long-term care facility which also has addiction recovery rooms in the Downtown Eastside neighbourhood, is meanwhile listed as having two infected workers.
Although she denied the Terraces had avoided outbreak status, Henry confirmed that enhanced surveillance could remain in place with no outbreak declared at facilities with multiple staff infected.
"It could be," she said. "And it could be because the staff have not been in the facility at any point they were infectious."
She said it was also possible for a resident to test positive, and outbreak status still not be declared. One resident case would trigger an outbreak on long-term care, but not necessarily in an assisted-living or independent-living facility, she said.
"It could be. Yeah, certainly, if [we] knew exactly where they became ill, and they have not been around anyone else in their infectious period."
Every single case was assessed, she said, and "there are some, albeit rare occasions, where it might be a resident in an assisted living place, who has their own apartment, who doesn't go down for communal dinners, who just stayed in when they were sick and went to hospital when they were noted".
Regarding the outbreak at the Terraces - a high-end multistorey facility in which residents own their flats but have communal facilities including dining, recreation and media rooms - Henry blamed its omission from public records on VCH.
"My expectations about assisted living facilities were that all outbreaks were reported publicly," she said. "I wasn't aware it had not been reported. I was aware it had been managed."
She told the press conference that the undisclosed outbreaks "were managed aggressively as we do for all outbreaks ... Full action was taken by local public health and by my public health colleagues to manage with those facilities".
Nevertheless, the January 7 VCH document clearly lists the Terraces with the six other facilities under a red-banner heading that says "Enhanced Surveillance - Single Staff Case".
The other six also appear on a list of facilities that employed enhanced surveillance and not outbreak status, that was provided by VCH this month after a freedom of information request by the Post. The Terraces does not.
A spokeswoman for the health ministry later suggested that incorrect formatting of the December 7 VCH document may have mistakenly made it appear to be listed as an enhanced surveillance case.
But in addition to that document, the Post has also obtained notes describing the previous week's VCH Zoom meeting, that were written by a different person involved in the care industry as they listened in.
Those rough notes, dated December 31, say the Terraces was among "7 sites on enhanced surveillance".
And on Friday, Mireille Harris, regional sales and marketing manager at West Coast Seniors Housing Management told the Post that enhanced monitoring, and not outbreak status, was employed. "[Once] the first case was discovered, enhanced monitoring measures were implemented to help find additional cases more quickly," she said.
"Communication to residents and families happened on a daily basis, frequent calls and assessments with VCH, and daily calls with our company [Covid-19] emergency response team ensured consistent care."
VCH's freedom of information office did not respond when asked why the Terraces was not named on its list of enhanced surveillance situations.
Last week, a Post investigation revealed that 192 care home residents had died at 42 VCH and Fraser Health facilities where outbreak status was not immediately declared, when one staff member had tested positive to Covid-19 in circumstances deemed low risk.
Instead, the facilities were placed under enhanced surveillance/monitoring - until it was discovered that the virus had spread and outbreak lockdowns were imposed.
On average, it took almost five days after the detection of the staff infection for outbreak lockdowns to occur. More than 1,000 people became infected in those outbreaks.
British Columbia's Provincial Health Officer Dr Bonnie Henry answers questions from the media in Vancouver last year. Photo: Reuters alt=British Columbia's Provincial Health Officer Dr Bonnie Henry answers questions from the media in Vancouver last year. Photo: Reuters
The investigation was repeatedly raised in British Columbia's Legislative Assembly this week, with the opposition pressing Health Minister Adrian Dix for more answers about enhanced surveillance/monitoring and how the outbreaks occurred.
In her interview, Henry said the investigation had resulted in her being blamed for the deaths in homes that employed enhanced surveillance/monitoring protocols.
"We feel very deeply, for every single one of the families that has been affected. And that is incredibly important," said Henry.
"And I know some people have as a result of your article blamed me for those deaths. And it is something that from the very beginning we have paid attention to doing everything we can to prevent our seniors and elders in care from getting ill."
Part of that, she said, was the enhanced surveillance mechanism, which she strongly defended as a way to "catch things as early as we can".
Henry said enhanced surveillance was introduced on November 9 not as an alternative to outbreak status, but as a way to monitor facilities which did not pass the outbreak threshold.
VCH has previously said enhanced surveillance allowed staff resources to be conserved, as well as allowing residents to continue to enjoy social situations that would otherwise be curtailed under outbreak status. "Managing these scenarios under ESP [enhanced surveillance and precautions] has allowed us to apply a full outbreak response to declared outbreaks, which would not be possible if all of our many one-staff scenarios were declared to be outbreaks," a spokeswoman said.
That suggests the policy's ultimate goal was fewer outbreak declarations, by weeding out those which were deemed unnecessary.
But Henry said this was not necessarily the case, pointing out that more than three-quarters of VCH enhanced surveillance cases had not been followed by an outbreak. "It was a way of doing an assessment of what was going on," she said.
Enhanced surveillance was "absolutely not" an alternative to outbreak status, she said. "It was an advance step, being extra careful, so that we could prevent outbreaks and in most of the cases we did prevent those outbreaks."
"Conserving staff resources is not the goal of this," said Henry.
She said the situations of enhanced surveillance that eventually required an outbreak declaration might not have been declared any earlier, if the enhanced surveillance policy did not exist.
In many cases, the worker whose positive test resulted in enhanced surveillance was not the person who triggered the eventual outbreak, Henry said, and in any case, facilities under enhanced surveillance were "very aggressively managed".
Regarding BC's worst outbreak, at the Little Mountain Place care home where 41 residents died, Henry said it was "not likely" that it would have been mitigated had outbreak status been declared immediately when the first infected worker was detected on November 20, instead of two days later when a resident was also found to be infected while the facility was under ESP status.
"That was not the index case. But it was the case than made public health go in and look," said Henry of the infected worker. Immediate outbreak status "would have made no difference".
"A single staff case means that we go in and look more carefully," she said, adding "outbreaks themselves are complex. There's many reasons for transmission".
An email to Chalmers Lodge was not immediately answered.
Facilities do not decide whether to impose outbreak status. That is up to medical health officers from health authorities that include VCH, who in turn answer to Henry.
