Toronto Public Health officials are keeping a very close eye on COVID-19 outbreaks at six long-term care homes and one retirement home in the city.

Two residents have died in the outbreaks. A COVID-19 outbreak is declared when there are two or more confirmed cases in one facility.

Eight other long-term care homes and one retirement home in Toronto have had a single confirmed case each, which means no outbreak has been declared. Two of the eight facilities have gone through 14 days with "full precautions" with no further spread of the virus.

Dr. Elizabeth Rea, associate medical officer of health, said in an email to CBC Toronto on Monday that Toronto Public Health (TPH) officials take these outbreaks "very seriously" because residents of such homes are vulnerable to infectious disease.

"We are concerned about all COVID-19 outbreaks in long-term care homes," Rea said.

"We know that any infectious disease can spread more easily in congregate settings, but long-term care homes are especially concerning for COVID-19 because these residents are generally older and more vulnerable to infection," she added.

"Many people living in long-term care homes have compromised immune systems or chronic health conditions. Long-term care home outbreaks reported in other jurisdictions have sometimes involved multiple deaths. These are situations we must take very seriously."

Nine residents of the Pinecrest Nursing Home in Bobcaygeon, Ont., have died from COVID-19. (Evan Mitsui/CBC)

At the Pinecrest Nursing Home in Bobcaygeon, Ont., about 150 kilometres northeast of Toronto, nine residents have died and 24 staff members have tested positive for the virus.

As of 9 a.m. on Monday, the outbreaks in Toronto have occurred at:

Seven Oaks, with 23 confirmed cases involving 14 residents and nine staff members. Two residents have died there.

St. Clair O'Connor Community Inc., with six confirmed cases involving three residents and three staff members.

Extendicare Bayview (SouthWest Unit), with four confirmed cases involving two residents and two staff members.

West Park Long-Term Care Centre, with two confirmed cases involving a resident and a staff member.

Chartwell Gibson Long Term Care Residence, with three confirmed cases involving three residents.

Rekai Centre at Sherbourne Place, with four confirmed cases involving four residents.

Terrace Gardens Retirement Residence, with three resident cases.

Rea said all of the Toronto long-term care homes with outbreaks are taking direction from TPH and have implemented protocols to prevent the virus from spreading further.

All residents who live on a floor or unit with a COVID-19 case are placed in "room isolation" and staff provide care while using personal protective equipment. Staff protect themselves whether a resident has symptoms or not.

"This is a strong precautionary measure to further limit spread to additional residents or staff on an outbreak unit," Rea said.

At each home with confirmed cases, an outbreak management team has been set up with participation from public health officials and it meets daily.

Measures now in place at these homes include:

Room isolation.

Enhanced cleaning, especially of high-touch surfaces.

No visitors.

Enhanced surveillance and monitoring for illness among staff and residents.

Cancellation of group activities.

Rea said workers in these settings are also at risk, and instructions from the city to all residents to practise physical distancing is an attempt to prevent health-care workers from getting sick.

"Community spread of COVID-19 also puts the workers who provide such essential care at our long-term care homes at risk​, pulling them from their work at a time when they are very much needed," she said.

"Protecting our most vulnerable — and the health-care workers and others who provide care for them — is one of the major reasons why we have strengthened our actions around physical distancing."

Rea said TPH has told staff at long-term care homes with outbreaks that they should not be working at other health-care facilties as a precaution to limit the spread. Once a single case is confirmed, this staff restriction is put in place, she said.

To help residents deal with isolation, staff members are helping them use technology like FaceTime and Skype to connect with family members who cannot visit.

