To stop all potential lines of transmission of COVID-19 between nursing homes, the Ontario government’s emergency order restricting the movement of workers to one facility should be enacted immediately, say infectious disease experts.

Premier Doug Ford announced a new measure Wednesday that prevents people who care for seniors, such as personal support workers, nurses and cleaners, from working in more than one setting, including long-term care homes and retirement homes. But the prohibition won’t come into effect until April 22, meaning there remain plenty of opportunities for COVID-19 to continue to spread between facilities until then.

“Any transmission chain that you keep going, including personal support workers going from one area that could potentially be high prevalence — a high proportion of residents or other workers infected — to another one means that you’re facilitating transmission between the two locations,” said Todd Coleman, epidemiologist and professor in health sciences at Wilfrid Laurier University. “In terms of an emergency order, it really should be enacted immediately, not a week from now.”

The emergency order was announced as part of the unveiling of the provincial government’s COVID-19 action plan for long-term-care homes, which includes ramping up testing for symptomatic residents and staff, as well as those who have come into contact with confirmed cases of the virus. The government says it will provide more training for staff working in “outbreak conditions” and re-deploy staff from hospitals and home and community care to long-term care homes.

The government says it will also protect the jobs of long-term-care workers who have to give up employment at one care setting in order to work in just one location.

At Queen’s Park Thursday, where opposition parties again warned the delay could cost the lives of vulnerable seniors, Long-Term-Care Minister Merrilee Fullerton defended waiting until next week to implement the emergency order.

Moving faster could create staff shortages in the face of increasingly deadly outbreaks and rising numbers of infections in nursing homes struggling to keep up with patient care, said Fullerton, a former family doctor.

“Some employees will have to choose … and they need time to give their employers their decision,” she told reporters.

Fullerton added the government exempted nurses, personal support workers, kitchen staff, cleaners and others who could be supplied by temp agencies because nursing homes need “flexibility.”

She said there will be “stringent screening” of such workers and that some nursing homes were already restricting staff from working at other long-term-care facilities.

Ontario’s Chief Medical Officer of Health Dr. David Williams, warned Thursday that rushing to stop the movement of workers between facilities could be detrimental.

“Because if you flip it quickly, you may end up losing a half or a third of the staff in an institution and then you end up with residents not get any care,” he said.

Dr. Samir Sinha, director of geriatrics at Sinai Health System and the University Health Network, said he assumed when the government brought in the emergency order that it would be effective immediately.

“Every day is crucial. We’re losing lives every single day,” he said, noting that British Columbia, which saw the first case of community transmission in Canada in early March, restricted long-term-care workers to one facility two weeks ago.

That province has since made personal support workers provincial employees, thereby allowing them to collect full-time wages while working at one long-term-care home.

Such a move has provided stability in a profession characterized by low pay and a lack of benefits, necessitating many personal support workers to work at multiple facilities to make ends meet, Sinha said.

“These are things that we have well established in hospitals. So a typical nurse at Mt. Sinai hospital isn’t working extra shifts at other places. Why? Because they already have a full-time job with paid sick leave and benefits that actually pays a reasonable salary,” he said.

As for the impact workers unknowingly infected with COVID-19 could have on a seniors home, Sinha pointed to a recent report by the U.S. Centers for Disease Control and Prevention looking at a COVID-19 outbreak in February at a long-term care facility in Washington state. The report found that staff members working in multiple facilities, as well as inadequate infection control, helped spread the virus through the home. More than 120 residents, staff and visitors to the home were infected with COVID-19. Thirty-seven people died.

The head of the organization that represents Ontario’s 41,000 personal support workers says the government could stop the movement of her members between homes by immediately creating full-time positions and providing wage increases, much like what occurred in B.C.

“If you want to keep them where they are, they need full-time positions and benefits and they need to be self-regulated. They need to have that badge of pride and they need to be recognized for the job they do,” said Miranda Ferrier, president of the Ontario Personal Support Workers Association.

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Ferrier said by allowing personal support workers to self-regulate, the profession would attain a similar standing to that of nurses or doctors, which also self-regulate.

While she agrees with epidemiologists who say that movement between facilities should stop immediately, she says there has to be full-time hours available so that personal support workers can make a living.

“There has to be some monetary aspect for the personal support worker so they don’t lose half of their income,” she said.

Dr. Isaac Bogoch, an infectious disease expert based out of Toronto General Hospital, said restricting long-term care workers to one facility sooner rather than later is desirable but noted that “there’s a lot of preparation that needs to go into this.”

“We appreciate lives are at stake,” he said. “But I can guarantee it’s a lot harder than flicking a light switch and making this happen.”

With files from Rob Ferguson

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