Some Toronto-area assessment centres are reporting an increase in the number of health-care workers from long-term-care facilities asking to be tested for COVID-19.

It’s yet another sign the virus continues to surge in long-term-care homes, retirement homes and other congregate living facilities, even as health officials say the first wave of the outbreak has peaked in the wider community.

“In the past week we are seeing more hot spot workers, people who work in retirement facilities or long-term-care facilities,” said Daria Gefrerer, a nurse practitioner who helps oversee the COVID-19 assessment centre at Sunnybrook Health Sciences Centre. “They know they maybe took care of a (COVID-19) positive patient with maybe not wearing as much Personal Protective Equipment (as they require) and they themselves are now worried they are positive.

“They are a big proportion of the people we are seeing. Many are symptomatic; they do have symptoms (of COVID-19).”

Staff at Women’s College Hospital’s COVID-19 assessment centre have seen an uptick in the number of long-term-care workers wanting to be tested for the virus, said Darryl Yates, the hospital’s vice-president of Patient Care & Ambulatory Innovation.

Between April 6 and April 19, the hospital’s assessment centre saw an eight per cent increase in the number of people coming to the centre who work in long-term-care, when compared to the previous two weeks, Yates said.

A similar trend has also been observed “over the last several weeks” at Michael Garron Hospital, where staff have seen an increase in the “number of cases of COVID-19 diagnosed in health care workers from long-term-care and assisted-living homes,” said Dr. Janine McCready, an infectious disease physician at the hospital.

“This served as part of the catalyst for the work we have been doing to pre-emptively engage and work with long-term-care in our community,” she said in an email to the Star.

As of Tuesday, 128 of the province’s 626 long-term-care facilities had recorded a COVID-19 outbreak. The Ministry of long-term-care on Tuesday reported at least 399 Ontario nursing home residents have died of COVID-19.

John Hirdes, a professor in the University of Waterloo’s School of Public Health and Health Systems, said it’s difficult to slow the spread of COVID-19 once it breaches the doors of a long-term-care home or assisted living facility and moves among vulnerable residents.

“I don’t expect that we are going to see these (case) curves go down quickly,” he said.

On Monday, Ontario health officials released data showing how much COVID-19 case numbers have increased in long-term-care homes. On April 12, for example, about 600 long-term-care residents had a confirmed COVID-19 diagnosis. Less than a week later, on April 18, there were 1,533 cases among long-term-care residents.

David Fisman, an epidemiologist with the University of Toronto’s Dalla Lana School of Public Health, said the sharp rise in cases is likely “driven by more active testing and case-finding” in long-term homes, which he said is “exactly the right thing to do.”

Fisman is among a group of Ontario infectious disease and medical experts who recently released new and as-yet unpublished research showing the rapid rise in deaths of seniors in Ontario’s long-term-care homes can be linked, in part, to staff infected with COVID-19 inadvertently spreading the deadly virus to residents.

The study, which sought to better understand how COVID-19 has had such a fatal impact in the province’s long-term-care homes, underscores the urgent importance of measures to curb the spread among vulnerable elderly populations — including masks being worn by employees, broader testing within facilities, and limits on staff working in multiple homes. The study is a “preprint” and has not been published in a peer-reviewed journal.

The province has acknowledged that some outbreaks in long-term-care facilities may have been caused by staff who work in two or three homes bringing in the virus. On April 15, Ontario issued an emergency order preventing long-term-care staff from working in more than one home, although the move has been criticized for only coming into effect for a short time starting April 22.

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The research drew on data over a 10-day period between March 29 and April 7 from 627 Ontario long-term-care facilities. Of those, 272 — or 43 per cent — were identified as having either confirmed or suspected COVID-19 infection in residents or staff, according to the study.

Researchers linked infection of COVID-19 in staff with deaths by examining Ontario Ministry of Health data then analyzing infections and deaths by date and long term care facility. What emerged, said Fisman, was that it was the staff infections that would, days later, predict deaths in residents.

“Which is just a line of evidence supporting what we might have supposed anyway, which is, given the nature of these facilities, given how immobile residents are, it makes sense to regard the staff basically as vectors,” said Fisman. “Whereas residents aren’t really creating risks for other residents.”

Many long-term-care homes are staffed primarily by personal support workers who often work long hours for poor pay, while also needing to work multiple jobs at different residences. While there has long been calls to offer more protections to personal support workers, who often work with few job and safety protections, experts say even more needs to be done to help these vulnerable workers during the pandemic.

Fisman said the new research also highlights that COVID-19 does not discriminate: the coronavirus has hit all types of long-term-care facilities in the province, regardless of whether it was privately or municipally run, big or small.

“Long term care in Ontario has a problem, and it cuts across sectors, and it cuts across the province,” he said.

Dr. Nathan Stall, a physician who specializes in internal medicine and geriatrics at Mt. Sinai Hospital in Toronto, said the link between infection in staff and deaths was a big takeaway — especially because, during the time period the data reflects, universal masking policies “were not widespread across the province.”

“I suspect that a lot of asymptomatic transmission happened between staff who are working there,” said Stall.

Dr. Samir Sinha, director of geriatrics at Sinai Health System and the University Health Network, said the research highlights the importance of measures such as the recent ban on working in multiple homes. He noted similar steps need be taken to reduce the spread of the virus in Ontario’s retirement homes, where the impact of COVID-19 has not yet been effectively measured.

“This is what we need to be doing because these homes are so vulnerable, and they’re like tinder boxes,” Sinha said. “If we’re not doing all the things we need to do to try and prevent and manage COVID-19 well, you can imagine that this can spread like wildfire.”

Dr. Isaac Bogoch, an infectious disease faculty member at U of T and one of the study’s co-authors, said a central aim of the work was to “put some numbers behind some of the trends that we’re seeing” in long-term-care facilities. The “multi-prong approach” of increased testing and limits on staff working in multiple facilities will likely produce positive results, though he notes there’s no “silver bullet.”

“We now have policies in Ontario, that will hopefully limit the devastation that COVID-19 can have in long-term-care facilities,” he said.

With files from Rob Ferguson