The agency responsible for protecting the health of Ontarians is vastly under-reporting the number of deaths caused by COVID-19 at long-term-care homes in the province, a Star analysis has found.

As of Wednesday morning, Public Health Ontario was reporting 144 residents of Ontario long-term-care homes had died during a confirmed COVID-19 outbreak. But a Star analysis of deaths reported by the province’s regional public health units and local media reveals there have been at least 219 deaths at Ontario long-term-care homes — a difference of more than 50 per cent.

Having an accurate and timely picture of the virus’s impact in long-term care settings is crucial not only for provincial officials, medical workers, and home administrators and staff planning responses to outbreaks, but also residents and their families, experts say.

“How can you plan or get the right equipment or get the right staffing if you don’t have the right information,” asked Jane Meadus, a staff lawyer at the Advocacy Centre for the Elderly in Toronto.

“If you don’t know there’s a problem you can’t fix it. If you don’t know there’s an issue, you can’t provide resources. You can’t do anything.”

Every morning, Public Health Ontario releases a detailed summary of information on COVID-19 cases taken from a provincial database called the “integrated Public Health Information System.” The summary notes that the system relies on all 34 public health units across the province to enter numbers by 4 p.m. the previous day, so the data “may be under-reported.”

The provincial data does not provide a case-by-case breakdown of long-term-care home deaths, so it is impossible to know which cases being counted by the Star are not being reported by the province — but in some cases the differences are obvious.

Notably, the provincial data has for several days listed just 18 COVID-19 deaths in the cottage-country health district of Haliburton, Kawartha, Pine Ridge. That region is home to the Pinecrest Nursing Home, where 29 residents of the long-term-care facility have died; the health unit’s website has listed a total of 33 deaths for nearly a week.

The problem isn’t so much that the province’s data is wrong, said University of Toronto epidemiologist David Fisman, it’s that the delays built into the reporting system make it more difficult to know where you are so you can plan ahead.

“One of the issues that I’ve had for a while is there doesn’t seem to be a capacity to look at today’s numbers and know what the implications are,” he said, “The information is coming, but it’s maddening that it’s late, because it’s a public health crisis.”

Such a system in a post-SARS world where information can be shared quickly is simply “not acceptable” said Laura Tamblyn Watts, CEO of the national seniors advocacy group CanAge.

“This is not acceptable because people are not numbers. People are not cases. These aren’t things that just happen,” she said, noting that relevant and timely data would make it easier to ensure proper care, infection control and planning for future outbreaks.

Tamblyn Watts is calling for the creation of an integrated data portal where information from across the province is stored and easily accessible to all stakeholders in seniors care.

“We can then, as a province, make sure that we know how to order what we need and how to make sure that we put in protective measures at the time that we need them,” she said. “If we don’t have the data, it’s going to happen again.”

Hayley Chazan, a spokesperson for Health Minister Christine Elliott, said Ontario’s public health system is “incredibly decentralized with 34 public health units” and that these health units are responsible for reporting deaths from COVID-19, “as this information is provided to them by hospitals, long-term-care homes and other relevant health facilities.”

She added that the provincial government’s action plan for responding to the virus includes $100 million in additional investments for health units to support COVID-19 monitoring and testing, including funding to support enhanced contact tracing.

“This funding would enable public health units to hire more personnel to assist with more timely data entry,” she said.

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Not all of Ontario’s 34 public health units report deaths in long-term-care homes. In cases where the health unit did not report the number, the Star relied on local media reports or statements made by unit officials. The Star’s tally is therefore likely conservative.

A long-term-care home offers government-funded care, including 24-hour access to nursing and is part of Ontario’s health-care system. Where possible, the Star’s count has excluded any deaths listed in a retirement home, which is private-paid tenancy in which residents can purchase private health-care services.

Tragic and disturbing stories from long-term-care homes across the province have begun to emerge over the last week as testing for the virus has begun to confirm what many feared: COVID-19 is exacting a terrible toll on the province’s population of seniors.

As of Tuesday, Toronto Public Health was reporting 68 COVID-19 deaths in long-term-care homes in the city, including 23 at the privately run Eatonville Care Centre in Etobicoke, and 22 deaths at city-run Seven Oaks in Scarborough. On Tuesday, Almonte Country Haven, a long-term-care facility near Ottawa, reported its 18th death from the virus.

Earlier this week, Ontario Premier Doug Ford moved to ban long-term-care staff from working in more than one facility in an effort to stop the “wildfire” spread of the virus, but on Wednesday it was revealed that the emergency order won’t take effect until Apr. 22.

And on Monday, Dr. Theresa Tam, Canada’s Chief Public Health Officer, said close to half of all deaths related to COVID-19 were linked to outbreaks in long-term-care facilities. Ontario Public Health reported Wednesday that about 41 per cent of COVID-19 cases in Ontario are in people 60 years of age and older.

Speaking broadly on the ramifications of delayed reporting on deaths and outbreaks, Dr. Anna Banerji, a professor at the Dalla Lana School of Public Health, told the Star that not hearing about relevant information in a timely manner could mean it takes longer to “put steps in place to try to mitigate the issues.”

“If the local health unit is not on top of it, if there needs to be response at a federal level some of those delays (mean) … you don’t act in time,” Banerji said.

Banerji said that the increased workload facing public health employees is likely contributing to the delays.

“I don’t think this is intentional or with the attempt of being misleading,” she said, noting that she believes that the government is working hard to provide accurate information. “I think the problem is that there can be delays, because there’s many steps that go in place” and many people involved in processing the information.