An internal report detailing the deadliest COVID-19 outbreak in British Columbia has painted a grim picture of the failures of the Langley Lodge long-term care home and the institutions meant to support it.
The 30-page report, dated Aug. 11 and written by Langley Care Society CEO Debra Hauptman, was anonymously leaked to Glacier Media by someone claiming to be a manager at one of the province’s health authorities.
Glacier Media reached out to Hauptman, who described the document as a factual record not meant to be shared in the public realm.
“The intent is not to lay blame or point fingers or push responsibility on to other parties,” she told Glacier Media. “[It was] to help us approach the second wave should it come.”
Still, as the report notes, mistakes were made at many levels in two outbreaks that would lead to the deaths of 26 residents with COVID-19, the most in any care home in the province.
THE VIRUS SPREADS
The 139-bed facility was first hit with a single case of COVID-19 on March 26 when an infected nurse on a nightshift avoided pre-shift screening protocols and transmitted the virus while providing care with active symptoms, notes to the report.
But that outbreak was contained to that single nurse and it wasn’t until the second introduction of the virus by another staff member, on April 27, when the gathering outbreak took a lethal turn.
“Staff worked past 2 shifts and was feeling unwell on both, but didn’t report and avoided the screening desk on last shift,” notes a timeline of the outbreaks included in the report. “Provided care to 16 residents on two separate units… possible breach of PPE.”
At the time, it was already clear that mass swabbing for asymptomatic patients was a vital tool in detecting stealth cases. But Hauptman told Glacier Media the home’s medical director had to push “really hard to have mass swabbing” and it wasn’t until May 4 when Fraser Health first carried out widespread testing.
As the virus spread from one floor to another, 15 staff members and 51 residents eventually fell ill with the virus, including 26 in a unit for people with dementia and other cognitive impairments.
“Staff were not able to socially isolate residents from each other … due to wandering and advanced dementia,” reads one of the contributing factors to the outbreak. “There was a lack of clinical guidance on COVID-19 precautions with this population.”
Or as Hauptman put it to Glacier Media, the behavioural stabilization unit was the worst place to have an outbreak: “They do not understand social distancing, social isolation, staying in their rooms, not touching one another. That’s where I really appealed to the health authorities.”
“We’re very fearful of that happening in that unit again — and so are my colleagues,” she added.
Like many long-term care homes, the average age of a Langley Lodge resident was 85, many falling into the most medically complex and highest-risk groups for COVID-19.
As the virus raged through the facility, the report describes an “unanticipated, dramatic drop in staffing levels, leading to ongoing, critical staffing shortages” as nurses walked away due to insufficient personal protective equipment and housekeeping services experienced a “huge drop-out rate” due to burnout.
HAZMAT SUITS, FEAR & FAILED AUDITS
Workers who stayed on the job did whatever they could to protect themselves.
“Due to fear of infection, many staff were double-gowning, and the gowns were extremely thin and not fluid resistant. Some staff purchased hazmat suits and donned/doffed gowns over the suits,” states the report, referring to the process of applying and removing personal protective equipment (PPE).
Donning and doffing PPE is a detail-oriented procedure to the point where hospitals usually have someone spotting staff to make sure they don’t make any errors. But even after training was ramped up with support from Fraser Health nurses, audits found “more education and coaching was required” to avoid contamination.
Of the 59 items assessed in a May 12 infection prevention and control audit, 18 were not up to standards. In one instance, Fraser Health is said to have provided four different PPE signs, with each deemed to be the “wrong poster.” In other cases, the audit found a risk of contamination after linen carts and garbage receptacles were found in the same utility room.
HEALTH AUTHORITY TAKES OVER
The single-site order handed down by provincial health officer Dr. Bonnie Henry at the end of March largely restricted staff to one facility and has been hailed by many experts across Canada as an important buffer that stemmed the transmission of the virus from one B.C. care home to another.
But according to the report, the order did not properly consider the needs of operators and resulted in the complete lack of relief staff as management scrambled for support. Described as provoking a “crippling” effect on staffing, the report warns there’s still a potential to repeat the staffing crisis if the care home were again hit by the virus.
Overall, said the report, long-term care homes “are not environmentally designed for the more stringent infection control processes that are necessary to eradicate this highly virulent COVID-19 virus.”
Fraser Health began sending extra staff to the facility by the second week of May. On May 14, a Fraser Health “clean team” had moved from backup roles into COVID-19 areas with positive cases.
That same day, the first Fraser Health worker tested positive for the virus. A day later, communal dining was shut down in favour of delivering food to residents’ rooms, a move the report describes as “extremely onerous” due to cost of disposable dishes and packaging, as well as difficulty in distributing food while observing residents who are “at risk of choking.”
Throughout the second outbreak, phone calls and emails from some loved ones are described in the report as “irate, accusatory and threatening” as they spoke to the media about their concerns.
At the same time, the report notes direction from some health officials complicated the response. Fraser Health, it claimed, gave conflicting information on mask use, at one point requiring one mask per worker per day, and at another point, requiring four per worker per day. Meanwhile, WorkSafe BC flip-flopped on “the right mask for COVID-19 care,” first recommending N95s and then changing to “surgical masks for COVID-19 care; N95s for aerosol generating procedures.”
Despite swapping over to Fraser Health’s supplier, the report states the care home still went out to find its own gowns, masks, face shields, hand sanitizer and touchless dispensers, often procured from local businesses like breweries and distilleries who had retooled to make hand sanitizer or face shields.
PREPARING FOR A SECOND WAVE
Just as Langley Lodge was hit with a rising toll from the coronavirus, its most fundamental operating procedures — based on palliative care where patients and their family are included in discussions about where they’ll get care — came into conflict with a new model to fight COVID-19, one which asserts “the needs of the community may outweigh the needs of individuals in such crisis” and that “personal rights and freedoms must sometimes be constrained.”
In an ideal world, Hauptman said that Fraser Health would remove all COVID-19 patients — or at the very least, those with dementia or related illnesses — and house them under one roof in a rehab unit of a hospital or a converted long-term care home during their incubation period.
“They are preparing for a second wave. I know that for sure,” she said. “[But] that is a point of contention that hasn’t been resolved yet.”
Other recommendations contained in the report include developing a testing strategy to capture asymptomatic carriers of the virus not detected by twice-daily screening, and creating one-way traffic flow and easy access to PPE throughout the care home.
The report claims it's meant to provide both a historical record for the Langley Care Society’s archives and to help other care homes identify the gaps in their pandemic preparedness plan and come up with a “backup plan.”
But in laying out a detailed timeline of the outbreak, the report also paints a portrait of a crisis, detailing the rising death toll from one day to the next, as well as how staff battled to keep the virus in check.
In retrospect and unlike hospitals, Hauptman said long-term care was too far away from epidemiological specialists who foresaw a virus like COVID-19 coming. And as cases continue to climb in B.C., there are still a lot of unanswered questions.
“We certainly didn’t anticipate that we’d go through an outbreak of this degree,” said Hauptman. “We still don’t have the answers and we don’t know what’s ahead.”
“We were not going to avoid this virus.”