Sunnybrook Health Sciences Centre is just the latest hospital to declare an outbreak of COVID-19.

A spokesperson confirmed to the Star late Thursday that two patients have tested positive on an in-patient surgical unit. They have both been transferred from the unit and “are being cared for with appropriate precautions,” said spokesperson Sybil Millar in an email.

The other patients in the unit have tested negative, and the unit is now closed to new admissions “out of an abundance of caution.”

But what does it mean when a hospital declares an outbreak of the disease?

With 29 reported to the province since January, you might be wondering, and worried about the impact on people with unrelated medical issues.

An outbreak is different from hospitals treating people infected with COVID-19. In an outbreak patients have come in for something else and gotten the novel coronavirus.

Trillium Health Partners, the hospital system made up of Credit Valley Hospital, Mississauga Hospital and Queensway Health Centre, has had four outbreaks of COVID-19, spokesperson Keeley Rogers said in an email.

“The source of these outbreaks vary, but our ongoing investigations suggest we are seeing both community spread and hospital spread,” Rogers said.

One was on a rehab ward at Credit Valley Hospital involving four patients in late March and is now over. Two are on different wards at Mississauga Hospital involving 10 staff and one patient. And the most recent, declared April 12, is on a mental health ward at Credit Valley, involving two patients.

There have been 29 outbreaks of COVID-19 in Ontario hospitals since Jan. 15, according to the publicly available data posted by the province. There were 146 cases reported as part of those outbreaks, 87 in patients, and 58 in staff. Nine patients died.

Pre-pandemic, hospitals have grappled with outbreaks of everything from the flu to the potentially life-threatening bacteria C. difficile.

“The current public health guideline for an outbreak is defined as when a unit has two or more patients who test positive for a respiratory illness (e.g. flu), acquired in hospital, within 48 hours,” said Rogers.

“There is currently no formal guideline specific to a COVID-19 outbreak.”

A health ministry spokesperson did not respond by deadline to a request for comment on this.

Without that guidance, Trillium Health Partners has adopted its own “more stringent definition for a COVID outbreak.”

“We are defining a COVID-19 outbreak as two or more patients and/or staff with confirmed COVID-19 identified within a five-day period where there is a reasonable epidemiological link between cases,” Rogers added.

So far, 73 staff members across three Trillium Health Partners sites have tested positive for COVID-19.

An outbreak can mean even more changes for patients without COVID-19 who are feeling the impact of protocols to stop the spread.

There are already strict no-visitor policies (with a few exceptions), and screening at the door in hospitals across the province. Non-urgent surgeries have been rescheduled.

But in many cases a COVID outbreak means no new admissions to the floor where it happened. That’s what’s been put into place in Mississauga.

The impacted hospitals there will also implement droplet precautions for all patients on the wards, basically treating them as if they all could have COVID-19. They are limiting staff members who usually rotate among multiple units to just one, contact tracing, and conducting “enhanced cleaning” of the units.

Outbreaks were also recently declared in two units at Burlington’s Joseph Brant Hospital, and in the intensive care unit at St. Joseph’s hospital in Toronto.

Jennifer Stranges, a spokesperson with hospital network Unity Health, said in an email that a patient at St. Joseph’s “who had recently been in the ICU was confirmed positive for COVID-19 after developing a new respiratory illness while in hospital.

“Over the weekend, two staff who were in contact with this patient also tested positive,” she said.

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“We have implemented all outbreak precautions in our ICU. All patients who were in the ICU last week at the time that this patient was identified have been swabbed and results have come back negative.”

All ICU patients are also on droplet precautions for the next two weeks.

“Admissions to the ICU will continue from in-patient areas,” she said. “At present, any patients coming to the Emergency Department requiring an ICU level of care will be transferred to another facility which will be reassessed daily as we monitor the situation.”

Two health-care workers and three patients have so far tested positive at Joseph Brant, according to a press release, and all patients on the units, along with staff and physicians who were exposed, have been tested.

The institution has taken “a number of immediate safety measures” including closing the unit to new patients, “enhanced cleaning” and more training on personal protective equipment.

The same hospital has a policy that staff who test positive for COVID but don’t have symptoms should “immediately” come back to work, which administrators say is consistent with provincial guidelines. The cause of the outbreak is still being investigated, a spokesperson told the Star earlier this week.

There was also an outbreak declared at Brantford General Hospital in the Palliative and Complex Care Unit during the weekend, which is now closed to new admissions.

Five health-care workers and two patients have tested positive.

David McNeil, the president and CEO of the Brant Community Healthcare System, said on a conference call with reporters Tuesday it was not connected to the availability of protective equipment.

An outbreak “is related to in-hospital transmission of a disease,” he said.

“And in this case we were able to identify transmission from a COVID-positive staff member that we had tested, to a patient that had been cared for by that staff member.”

He assured the public that they are safe coming into the hospital.

“We do have very good screening protocols in place,” he said. “We are testing staff, and we have put in place all of the control measures.”

All staff within the hospital system are now masked and they continue to do “deep environmental cleaning.”

“The fact that we’ve identified the cases very promptly should be reassuring, that we have the mechanisms in place to identify quickly,” McNeil added.

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