In late February, during a lull in COVID-19 infections following Ontario’s second wave, Rob Chorley went to Mississauga Hospital to have a small, benign tumour removed from his spine.
The surgery, already twice postponed by physicians due to COVID, was a success, and Rob went home after three days, happy he would soon be able to move without pain. The 67-year-old retired Air Canada worker wanted to be well enough to play with his eight grandchildren once the pandemic had receded.
Five days later, a phone call from the hospital, a part of Trillium Health Partners, changed everything: An infectious disease physician told him he may have been exposed to COVID during his stay.
He and his wife soon tested positive, and within days Rob was struggling to breathe. For two weeks, doctors at Oakville Trafalgar Memorial Hospital worked to keep him alive. It was not enough. He died March 22.
“He did everything right, always very cautious, always following the rules,” said his daughter, Marlene Chorley. “He went into the hospital thinking he’d be safe.
“He was this bright star in our lives and now he is gone.”
Rob Chorley is one of thousands of people who caught COVID in Ontario hospitals and among the hundreds who died from such outbreaks since the start of the pandemic.
The Star has attempted to create an accurate tally of the number of Ontarians who died of COVID after acquiring the virus in hospital using a variety of incomplete public sources, but the true toll is unclear. Experts say a lack of transparency about the virus’s worst possible outcome makes it harder for hospitals to ensure they are making the right calls around infection prevention and control, and clouds the public’s understanding of the province’s overall pandemic response.
Taking a hard look at how many people caught COVID in hospital and died, they say, will bring us closer to answering one crucial question: Could we have saved more lives?
As of June 19, Public Health Ontario has recorded 569 hospital outbreaks, each defined as two or more laboratory-confirmed cases with a common epidemiological link within a 14-day period, resulting in 6,306 cases.
Between March 1 and Dec. 26, 2020, the agency reported there had been 297 deaths resulting from 232 hospital outbreaks. However, the province has not made a more up-to-date number public, meaning we don’t know the number of deaths in hospital outbreaks during the province’s deadly second and third waves.
To fill that gap, the Star spent the last month compiling those records that have been made available by Ontario’s 34 local health units, only a handful of which publish the data in outbreak-by-outbreak detail. Where these records were incomplete or missing, the Star asked the health units to provide a breakdown.
A few health units told the Star they could not share this information or told us to contact hospital administrators directly. In turn, several hospitals told the Star they could not provide this data or said to file a freedom-of-information request.
In total, these incomplete records reveal at least another 206 Ontarians have died in hospital outbreaks that either ended after Dec. 26, 2020, or were still recently active. This means at least 503 Ontarians have died after contracting COVID in a hospital since the start of the pandemic — meaning hospitals are Ontario’s third deadliest setting for COVID outbreaks behind long-term-care and retirement homes, although with far fewer deaths than those settings. This number is clearly an undercount, given that the Star was unable to obtain complete records from many public health units, including larger cities such as Hamilton and in Peel.
This stands in stark contrast to the detailed records the province publishes on cases and deaths in nursing homes.
“We need to understand everything we can about where, why and how COVID spreads if we want to be able to keep places safe,” said Colin Furness, an infection control epidemiologist at the University of Toronto. “If hospitals have weak points, if transit systems have weak points, if retail stores have weak points, the only way to fix it is to measure and find out how COVID is spreading.
“Know your enemy.”
For families of people who have died after acquiring COVID in hospitals, the lack of information on such outbreaks adds yet another layer to their grief.
Rob’s wife, Annmarie, said her family was told little about how her husband caught COVID in hospital. She said they were told he was exposed on Feb. 22, his last morning in hospital. They were then advised to get tested, isolate at home and monitor for symptoms.
After testing positive, the Chorleys were informed by Peel Public Health they were infected with the Alpha variant (B.1.1.7) of the virus. Annmarie said while they were advised how to monitor their symptoms and what to do if they got worse, they received few details about how Rob got infected, despite putting questions to hospital officials.
“How many other people were exposed during the same time period? Were protocols followed?” she said. “It’s our community hospital; I feel it’s important they be forthcoming and transparent.”
In a statement to the Star, Trillium Health Partners (THP) said it was unable to comment on specific patients, due to privacy concerns. However, a spokesperson confirmed THP, in consultation with Peel Public Health, declared an outbreak on unit 4J at Mississauga Hospital on Feb. 26, after identifying two patients with the virus.
“During the outbreak period, a total of six patients and two staff tested positive for COVID-19,” THP said in its statement, adding the outbreak, which was traced to a patient suspected to have acquired the virus in the community, was declared over on March 12.
Between March 2020 and May 2021, THP recorded 52 outbreaks involving a total of 191 patients and 223 staff at its two hospital sites, its unit at the Humber River Reactivation Care Centre and at the McCall Centre for Continuing Care at the Queensway Health Centre, according to a follow-up statement to the Star. At Mississauga Hospital, there were 25 outbreaks, affecting 95 patients and 96 staff, during the same period.
In the same statement, THP said between the start of the pandemic through to January 2021, 32 patients have died “due to COVID-19 or complications related to a COVID-19 diagnosis after likely acquiring the infection in hospital.” THP did not provide data on deaths after January 2021.
“THP is able to track deaths that occur in our hospital or when public health units, other healthcare facilities and families notify us,” the statement said. “This means it is possible we do not always have the complete list of people who have passed away due to this disease.”
Since the province does not provide a detailed breakdown of hospital outbreaks, it is unclear which regions or hospitals have high rates of hospital-acquired COVID cases.
During the reporting of this story, the two deadliest hospital outbreaks the Star found in Wave 2 and 3 were reported in York Region. According to York Region Public Health, 10 people died in an outbreak ending Jan. 21 at Richmond Hill Hospital, a part of Mackenzie Health, while another 10 people died after catching the virus at Southlake Regional Health Centre in Newmarket between Jan. 4 and March 5.
Both hospitals dispute these numbers. Mackenzie says the outbreak left six dead, while Southlake says nine died in its outbreak.
In a statement to the Star, Mackenzie Health said the outbreak that ended on Jan. 21 was declared after two asymptomatic patients who were admitted developed symptoms and exposed other patients and staff.
Southlake told the Star it was unable to determine how its outbreak began but once it was declared, the hospital closed the unit to admissions, put all patients on droplet and contact precautions and ensured staff continued to wear proper PPE and follow infection prevention and control protocols.
Deaths from hospital-acquired infections are not a new phenomenon. Infectious disease outbreaks happen every year in Ontario hospitals and are tracked by the province.
For example, a report published last month found 401 reported influenza outbreaks in Ontario hospitals over a 10-year period before the pandemic. The report, which used data from the same provincial systems that track COVID-19 outbreaks, found 2,296 influenza cases linked to those hospital outbreaks between 2007 to 2017, with about 55 deaths.
Dr. Andrew Morris, an infectious disease specialist at Toronto’s Mount Sinai Hospital, said attributing the cause of death for patients with a hospital-acquired infection is difficult. This has been particularly true of hospital-acquired COVID infections during the pandemic, when many people who come to hospital are already quite sick, such as those with end-stage cancer, bowel obstructions and severe infections, he said.
“If one of those patients gets COVID, and they die … is it an attributable death” to COVID? he said.
University of Toronto epidemiologist David Fisman said the province could have done more to prevent the spread of the virus in hospitals, especially in light of research that increasingly suggests the virus is predominantly spread through the air.
Fisman argues the threat of airborne transmission requires stricter measures, such as deploying rapid tests at intake to help quickly isolate suspected patients in rooms with good ventilation, or the mandated use of better N95 respirators in most situations, not just for some invasive procedures. These are the kind of steps Ontario hospitals would take in an outbreak of another known airborne disease, such as measles or tuberculosis, he said.
Regardless, the record of Ontario hospital outbreaks says that what was being done throughout the pandemic has not worked. “You have to make changes when your outcomes are poor,” he said. “You should not have hundreds of people dying in hospital of a communicable disease.”
The question of how COVID-19 mainly spreads — airborne through long-lasting aerosols or at close range via respiratory droplets — is controversial, and not just an academic debate. Earlier this year, the Ontario Nurses’ Association filed for judicial review to force the province to strengthen prevention rules inside hospitals, arguing the rule does not recognize the “grave risk” of aerosol and asymptomatic spread. That request was dismissed in May; an earlier push from Quebec health-care workers was successful in March.
For its part, the province says its guidelines are an “effective means of reducing risk of transmission irrespective of the relative contribution of larger droplets or aerosols to transmission.”
One nurse who believes she acquired COVID-19 on the job told the Star she believes there wasn’t enough education and protection offered to health-care workers by hospitals, at least initially. The nurse, who spoke to the Star on the condition of anonymity over fears of losing her job for speaking about her hospital, believes she was exposed while swabbing patients for the virus in the emergency department.
At the time, she says, she was only allowed to wear an N95 respirator when dealing with a confirmed case of the virus. “Otherwise, we were all told just to wear a procedure mask.”
The nurse, who had to be hospitalized while she fought the virus, said her hospital was not prepared for the first wave, but learned from the experience.
“With the third wave of COVID we did a lot better than at the beginning.”
In Ontario and internationally, some hospital outbreaks have occurred following lapses in infection prevention and control practices, such as staff gathering in break rooms, said Dr. Gerald Evans, medical director of infection prevention and control at Kingston Health Sciences Centre.
“We’ve learned that hospitals have limited space for people to safely distance themselves while they’re taking a break and that transmission tends to pop up in those particular circumstances,” he said, noting the two Kingston hospital sites have not experienced COVID outbreaks, amid low levels of community spread.
“We’ve certainly learned from some early outbreaks that occurred last year that this was a particular problem.”
Maintaining infection prevention and control practices becomes increasingly difficult when staff are tired and working flat out, Morris said.
“It would not surprise me to see the hospitals that were hardest hit in March, April and early May to be the ones that would also — even at this point in time in the pandemic — have struggles around infection prevention and control issues because of the emotional and psychological fatigue.”
Annmarie Chorley and her three children are still seeking answers about how Rob caught COVID at Mississauga Hospital.
And though she and her children watched through a window as critical care staff at Oakville Trafalgar Memorial Hospital tried to revive him after his heart stopped, Annmarie has a hard time accepting that her husband of 46 years has died. His death, she says, should have been preventable.
“He was plucked from our lives.”
Marlene Chorley hopes sharing the story of her father will bring to light that it’s real people — not just statistics — who have gotten ill and even died following a COVID outbreak in hospital. She says her father, someone who looked for the good in a situation, would want people to know what happened, hoping for change.
“I want them to be accountable for what they’ve done. I want them to put policies in place that will save someone else, and learn from my dad, so he didn’t die in vain.”
Article From: The Star
Author: Megan OgilvieHealth Reporter, Ed TubbToronto Star, Kenyon WallaceInvestigative Reporter
