The head of the Saskatchewan Health Authority says infection practices, PPE policies, low staffing levels and four-person rooms may have contributed to the massive spread of COVID-19 during an outbreak at the Extendicare Parkside care home in Regina.
"We think there were multiple components to that," SHA CEO Scott Livingstone said Thursday when asked what accounted for the severity of the outbreak at Parkside, where 20 residents have died.
"You've already seen, through our response, some of the things that were highlighted that needed to be put in place to support care [there]," Livingstone said of the SHA taking over operations at Parkside last week.
"So that's infection control practices up to the SHA standard, the additional PPE. Staffing levels within the facility, because of some of the things that were going on during the outbreak, weren't normal. And then looking at just the structure of the facility, the number of four-bed patient rooms is not conducive to slowing down the spread of a virus as aggressive as COVIID-19."
More calls for inquiry
More groups have called on the Saskatchewan government to launch a public inquiry into Extendicare's handling of the oubreak. The Saskatchewan NDP and the Canadian Union of Public Employee Local 5430 joined in a call first made Wednesday by the Saskatchewan Union of Nurses.
"The [Parkside] outbreak and the outbreaks we have seen in several long-term care facilities since the beginning of the second wave of COVID-19 are years in the making," Saskatchewan NDP Leader Ryan Meili said in a release. "The government refused to take needed action, including the recent refusal to call on the Canadian military for assistance, and now Saskatchewan families are paying a heavy price."
Livingstone was also asked Thursday if the SHA thinks there needs to be an inquiry. He said it's not for the health authority to decide, but if one were to occur, "we would like to see it look at our relationships with long-term care providers that are outside of the auspices of the health [and] how programs are operated within those facilities as it relates to standards that are created by the SHA."
Parkside is a private home owned by Extendicare, a publicly-traded company.
Livingstone said the health authority is reviewing how many of the 150 long-term care homes in the province might be "potentially higher risk" in terms of COVID-19 spread.
"For example, they have multiple bedrooms, like four residents per room, or they're an older facility where there may be ventilation or where we have seen potential breakdowns or challenges with respect to the use of infection control practices."
'Extremely poor' ventilation found at Parkside
On Wednesday, Extendicare said several areas of its Regina Parkside care home were recently found to have "extremely poor" air flow.
"What that means, we're not sure," Extendicare regional director Ron Parent told residents' families.
"In the meantime, out of an abundance of caution, we have chosen to provide staff N95 masks and have brought in scrubbers, which is helping with filtering the air and keeping the air moving within the home."
A majority of the private home's original 200 residents and many staff have tested positive for COVID-19 over the course of the four-week outbreak.
While the number of active cases among residents has decreased in recent days, five new active cases among staff were reported in the last day — despite workers wearing PPE and being trained in proper infection control measures.
Previous statements on ventilation
Parent's comments on Wednesday added to a mixed record of statements about the building's ventilation system.
A 2019 inspection report found that "the facility is old and in need of replacement due to pending infrastructure and large system (HVAC) failures."
Questions about air quality were also noted in 2013.
In recent town halls with families in late November and early December, Extendicare voiced no concerns about air flow at Parkside.
"It all seems to be working," senior administrator Jason Carson said on Dec. 2. "We've had no concerns about that within the facility. I've had no contractors on site doing any repairs."
Parent added that maintenance is done either "monthly, quarterly or seasonally," and that filters are changed "at the very least quarterly or more and more frequently."
"Fresh air is completely exchanged once to twice every hour," Parent said. "We're pretty confident that [the system] does mitigate any possible spread."
Fans that could potentially spread droplets were turned off, Carson said.
Asked on Dec. 9 if Extendicare believed the ventilation system was adequate, Parkside administrator Dan Shiplack said the company has an annual contract for preventative maintenance.
"I do believe the air exchange ratio is five times each hour," he said.
Contractor hired to assess system
Over the past weekend, officials from the SHA — whose takeover of Parkside will last until at least Jan. 15 — met with Carson to analyze the air flow in the building.
"From that analysis, it was identified [in] several areas within the home that the air flow was extremely poor," Parent said on Wednesday.
"We are going to be partnering up with a local contractor to identify what are some of the concerns with the current ventilation system and then take steps based on that report."
Nazeem Muhajarine, a professor of community health and epidemiology at the University of Saskatchewan, said a ventilation system is "another thing that I think you need to keep an eye on" in an outbreak setting, in addition to PPE use.
"All of these commonly known and understood [measures] since the pandemic has arrived should have been taken into consideration and put it into practice," Muhajarine said.
Company responds to PPE claims
Parent said workers have been getting medical-grade masks since before the outbreak.
"The masks have been provided by the SHA since if not April, maybe earlier than that. And we've been sourcing out some of the other supplies to our own medical vendors, whether it was gowns, gloves, face protection and the like," Parent said.
"There are still a few residual items that become a little bit more difficult to provide staff. And that's just not in Saskatchewan, but across other provinces."
Tracy Zambory, the president of Saskatchewan Union of Nurses, said members were instructed to wear the same PPE throughout a shift.
Shiplack addressed that claim Wednesday.
"Earlier on, we were looking at just burn rates, so we were trying to decrease the amount," Shiplack said. "But as we learned and as the summer went on and certainly to where we are today, I will absolutely assure anybody that that is not the case. If people need five masks a day, we have sufficient PPE for that to happen."
Union says some volunteers refused to go back
The Canadian Union of Public Employees Local 5430 said it's been tough getting members to volunteer to work at Parkside.
Two union members who did go for a couple days refused to go back, citing low staffing levels among several reasons, president Sandra Seitz said.
"Even with SHA coming in and implementing their standards, they still aren't at their expectations," Seitz said. "They don't feel that the protocols are being followed by the staff that are there. The rooms are crowded, very overcrowded."
The 2019 Parkside inspection report found that "the current design, with a large number of four-bed rooms, does not meet current standards of care or resident and family expectations for a home environment."
On Wednesday, Extendicare was asked by families if it was giving any thought to limiting rooms to only two or three residents. Parent said the company is discussing that with the SHA.
"That is something both groups feel would be beneficial," he said. "We just haven't landed yet."
According to a 2017 Parkside inspection by health officials, "Infrastructure is the main issue facing this home, especially relating to four bed wards and the associated issues with infection control in this environment."
The next year, according to the 2018 inspection report, a resident asked, "When are we going to get a new building?"
The 2019 inspection report noted that Extendicare had proposed replacing the building and "is awaiting a response from the SHA and [the Ministry of Health]."
Laura Gallant, a spokesperson for Extendicare, has previously told CBC News the company would need the province's support to build a new home and "operate the licensed beds within it, in alignment with SHA requirements."
"This support from the government could include sustainable operating funding, a share of capital funding, and funds for any incremental beds allocated to enhance capacity and ensure operational efficiency. This approach is consistent with what occurs in other provinces," Gallant wrote.
"We have been in ongoing discussions with government to seek their support. While we have not yet received any approvals to our proposals, we remain committed to doing so and recently reignited these discussions earlier this year ahead of the second wave."
Extendicare is on the Toronto Stock Exchange. According to its website, the company has paid its shareholders dividends throughout the pandemic and for at least the last eight years.
A recent CBC News analysis found that Extendicare was one of at least 13 publicly-traded companies whose year-to-date net income increased when compared to 2019, even as it received $82.2 million in support from the Canada emergency wage subsidy program (CEWS).
On the surface, Extendicare's request for capital funding is "counterintuitive with the private sector model," said Greg Argue, a strategic planning consultant in Regina who has been closely tracking the pandemic in Saskatchewan.
"My experience is that the private sector seeks to offload its costs on government in order to improve its bottom line."