Open this photo in gallery Funeral home workers remove a body from the Centre d'hébergement Sainte-Dorothée, on April 13, 2020, in Laval, Que. There have been 26 deaths related to the novel coronavirus at the Sainte-Dorothée centre. Ryan Remiorz/The Canadian Press

Outbreaks at seniors’ homes have caused hundreds of deaths across Canada, close to half the COVID-19-related fatalities in the country, according to Chief Public Health Officer Theresa Tam.

And that number is only expected to keep rising, Dr. Tam said, despite the growth in cases slowing in the coming weeks.

“Almost all jurisdictions are essentially trying to deal with the outbreaks in long-term care facilities,” Dr. Tam said at a briefing Monday in Ottawa. “Even as the numbers of cases slows down, the number of deaths, unfortunately, are expected to increase.”

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In response to the worsening situation, the federal government published new guidelines on the weekend to reduce the spread of infections there.

Long-term care outbreaks have been particularly acute in Ontario and Quebec as officials in both provinces struggle to contain the spread of the novel coronavirus at hundreds of homes.

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In one tragic example, the Quebec coroner, health authorities and the police have launched investigations in the wake of the deaths of 31 residents, at least five of them related to COVID-19, at Montreal seniors’ home Résidence Herron. Owners of the home allegedly withheld medical files and staff left their posts amid an outbreak of the virus.

In Ontario, among the facilities with the worst outbreaks are Pinecrest Nursing Home in Bobcaygeon, where 29 residents have died; Almonte Country Haven in Almonte, which has had 16 deaths; Anson Place Care Centre in Hagersville, with 15 deaths; Markhaven Home for Seniors in Markham, with 10 deaths; and Lundy Manor in Niagara Falls, where 10 residents have died. Toronto Public Health on Monday reported a total of 50 deaths of residents at seniors’ homes. On the same day, the Eatonville Care Centre in the city reported 25 deaths of residents at that home. It was not clear Monday night if the Eatonville deaths were part of the overall Toronto total.

On Monday, The Globe and Mail contacted all of Ontario’s public-health units and learned of at least 182 deaths of residents of seniors’ homes due to the virus. However, not all the province’s 34 public-health units responded to The Globe’s questions.

At least 197 seniors’ facilities in the province have had one or more cases of COVID-19 in residents or staff. In Alberta, 29 of the province’s 46 COVID-19-related deaths were in people living in long-term care facilities, and British Columbia had 20 long-term care facilities with active COVID-19 cases. The province has seen a total of 69 deaths, with the majority of those associated with long-term care facilities.

In Quebec, a weekend inspection of the province’s 40 private nursing homes concluded with five of them being placed under government surveillance, Premier François Legault said Monday. The inspection was launched after the province learned of the Résidence Herron situation.

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Chief Public Health Officer Dr. Theresa Tam says the number of deaths in long-term care facilities will likely continue to rise, even as the growth of overall COVID-19 cases begins to slow. The spread of the virus in care homes has been at the root of half of the more than 700 deaths across the country. The Canadian Press

Other Quebec seniors’ facilities have also been hit hard since the start of the crisis. There have been 27 deaths from COVID-19 at the Laflèche long-term care centre in Shawinigan, 26 at both the LaSalle centre in Montreal and the Sainte-Dorothée centre, in Laval.

Mr. Legault said there will be inspections at all of Quebec’s 2,600 facilities for seniors “to make sure we have the situation under control.”

He said he was aware of media reports about the dire conditions in some facilities, including allegations that management at the Verdun nursing home had locked the doors to keep orderlies working beyond the end of their shifts. “That’s unacceptable,” the Premier said. “We can’t force people to do the impossible.”

Government officials and the operators of the Herron seniors’ home continued to trade accusations about who should bear responsibility for the problems there.

The local health authority started sending extra staff to Herron on March 29 but said the owners didn’t co-operate and it wasn’t until Friday that a court order gave officials access to the medical files. Herron management said the intervention from the health authority brought more confusion to the home.

The Premier acknowledged that there have long been staff shortages in nursing homes before the pandemic. Quebec has granted a one-time bonus of $4 an hour to workers dealing directly with patients but “even at $17 an hour, it’s not appealing enough,” the Premier said.

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The understaffing has worsened because some employees had to be quarantined after being exposed to the coronavirus and others have refused to work with COVID-19 patients. “I think it’s understandable, despite the protective gear, that some might have fears,” Mr. Legault said.

On Monday, Ontario Premier Doug Ford repeated his demand for all residents and staff in long-term care facilities to be tested for COVID-19, despite pushback from his own health officials who say it would be wasteful to test in homes where there are no current outbreaks. Mr. Ford said he spoke with Ontario Health CEO Matt Anderson on the weekend, who assured the Premier more tests would be done.

“I want to see every single long-term care home – resident and health worker there – tested,” Mr. Ford said on Monday at Queen’s Park.

The province last week updated its guidelines for long-term care and retirement homes, broadening the criteria for tests by including atypical symptoms and allowing for some asymptomatic residents to be tested in the case of an outbreak.

But Barbara Yaffe, associate chief medical officer of health, said testing everyone in the system would be difficult and could result in “wasting a lot of tests that should be done on other people who are in an outbreak situation.”

Dr. Yaffe said the fact that personal support workers and others are still working in multiple homes in Ontario is “definitely contributing to outbreaks.”

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“Changing that is not a simple thing. … I know it is being strongly considered.”

Health Minister Christine Elliott also said she is aware of some long-term homes where there are four residents in a room, lacking space to move residents around. She said the province is “looking at other options” to move people, including hospitals, but said “we want to make sure that we’re going to have the space in our hospitals, too.”

The federal guidelines that were released on the weekend, which are not binding, include limiting nonessential visitors to facilities, ensuring staff are trained in infection prevention and control and requiring employees to wear protective equipment when working with people who have suspected or confirmed cases of COVID-19.

But infectious-disease experts say much more needs to be done to address systemic problems at long-term care homes that make viruses so easily transmissible and outbreaks so hard to stop.

Colin Furness, an infection-control epidemiologist at the University of Toronto, said provinces need to be much more aggressive in testing staff members at long-term care facilities. Many people with COVID-19 have mild symptoms, which means widespread testing of staff members could help identify more cases before they have a chance to spread, he said.

Provinces should also ban the practice of housing multiple patients in one room to reduce the spread of infection, Mr. Furness said.

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“Two to a room is an incredibly bad idea,” he said.

These systemic problems have gone unrecognized for years and should have been dealt with long before the COVID-19 crisis, Mr. Furness said.

“The reality is that we as a society are so neglectful of people who are institutionalized in long-term care homes. We just don’t face it.”

Canada’s national COVID-19 fatality rate, or the number of people who die out of all identified cases, was about three per cent on Monday, but there are provincial differences. In B.C. and Ontario, the fatality rate is about four per cent, while in Alberta and Quebec it is about 2.7 per cent. Both provinces have some of the highest testing rates in Canada, which helps to keep the case fatality rate low.

In South Korea, which has been largely successful in slowing the spread of COVID-19, the fatality rate is two per cent, while in New York state, it is about five per cent, according to the Johns Hopkins Coronavirus Resource Center.

While some of the fatality-rate differences are likely due to the fact that some provinces are testing fewer people for COVID-19, Dr. Tam said it’s clear that long-term care outbreaks are “driving the severe outcomes in Canada.”

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“That is absolutely a key feature of this epidemic,” she said.

With reports from Les Perreaux in Montreal and Andrea Woo in Vancouver

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