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If anyone tells you that massive and deadly #COVID19 outbreaks in #LongTermCare are "inevitable," please tell them otherwise. We've managed 17 LTC outbreaks in Vancouver Coastal Health and have developed some useful measures, which we think are life-saving. 1/
Re^ this figure: The high part of the curve (the majority of cases) are due to two large early outbreaks. No other outbreak since has come close in numbers, and several have been halted. 2/
You will notice that the number of staff cases in our LTC system continues to trickle. *We expect to see this*, as COVID-19 is circulating widely. What we are *not* seeing is those cases, caught early, transmitting to large clusters of LTC residents and other staff... 3/
When it comes to LTC staff, monitor symptoms closely, test early, and test broadly, and support workers from immediately staying off of work for any compatible symptoms. It is well-known that symptoms can be very low-grade... 4/
As for contact tracing, *consider even a passing contact to be a close contact.* We have found transmission in instances of resident care as short as changing stockings, and transmission between staff with only 'lunchroom contact' is common... 5/
LTC resident contacts need to be isolated, declared symptoms or not. Staff contacts need to be off of work (and supported in this) immediately, regardless of symptoms. *Do not wait for contacts to become symptomatic; 'watchful waiting' is not your friend with the invisivirus. 6/
...We are now doing asymptomatic tests of entire floors/buildings/units, and the entire staff of a LTC when transmission is suspected. *This has routinely identified cases who otherwise would have gone undetected.* 7/
Finally (for now), 'test early and test broadly' applies to staff and residents alike. In the older adult #nursinghome population, diarrhea, fatigue, confusion, or 'they just didn't seem like themself' have all led to positive tests and successful prevention of spread. /8
Thx for reading. We'll put all of this into new guidelines, write-ups on findings, etc, but I want to share these notes quickly/everywhere. (Also, @docmoser, @geri_md_mom and I discussed #COVID19 prevention/care LTC with @allan_k_grillMD @famphyscan: ) 9/9
A good question and key underlying point, thank you @tickity_boo: https://twitter.com/MichaelSchwandt/status/1256979983555104769
