There's a whiteboard at Little Mountain Place in Vancouver — location of B.C.'s deadliest care home outbreak — for staff to count the days since the last positive case of COVID-19.
Two incubation periods, or 28 days, need to pass since the last known exposure for the outbreak to be declared over. The latest case was a staff member who tested positive on Jan. 9.
Overall 41 residents infected with the virus have died. Seventy-one staff and 99 out of 114 residents have tested positive.
Now, B.C.'s independent watchdog for seniors, Isobel Mackenzie, is investigating to see what went so horribly wrong.
"It is important to understand why the outbreaks we've seen at Little Mountain Place — and the other care homes that were not able to contain their outbreak — experienced such rapid spread so quickly. Especially when some care homes were able to contain the virus to a single resident or staff member," said Mackenzie.
She will review all care homes, but more specifically the ones that experienced major, fatal outbreaks such as Little Mountain Place, Tabor Village in Abbotsford, Lynn Valley Care Centre in North Vancouver and Langley Lodge.
Her investigation will look at the timeliness of declaring an outbreak, testing strategies, use of personal protective equipment and effectiveness of contact tracing.
Staff shortage, multiple introductions a factor
Little Mountain Place has held weekly meetings with families since the outbreak was declared on Nov. 22. In a recording from the latest meeting, held on Jan. 12, Vancouver Coastal Health said it will be doing its own investigation to examine contributing factors in the outbreak.
In the Zoom meeting, which was recorded by a family member and shared with CBC News, Vancouver Coastal Health medical health officer Dr. Michael Schwandt told families some outbreaks involve multiple introductions of the virus into the facility.
"So not just a rare worker who might become positive and introduce COVID-19 into a care home, but sometimes in a declared outbreak, successive and repeated introductions of COVID-19. So in these cases, we have multiple branching chains of transmission. Previously unaffected areas of the care home can suddenly become affected," said Schwandt.
At a news conference Jan. 4, Provincial Health Officer Dr. Bonnie Henry acknowledged the Little Mountain outbreak has been challenging and "incredibly lethal." She said it remains unclear why the virus seems to spread so much faster in some facilities than others.
In the Zoom meeting, staffing shortages were raised as a factor.
"We know from all outbreaks, and we've had over 50 in the region, that long-term care homes are operating close to the limits of staffing capacity even at the best of times," said Schwandt.
An outbreak exacerbates staff shortages as workers are diagnosed and need to quarantine at home, diminishing the care home's ability to implement proper infection prevention and control measures.
Little Mountain Place has had additional staff come in, but according to the facility's executive director Angela Millar, the care home will be back to its own staffing by the end of the month.
"We were blessed that so many staff from so many different areas of Vancouver Coastal Health came to support us in our time of need. They are now being redeployed either to other sites or back to their previous jobs," said Millar on the call.
According to the Canadian Press, Little Mountain Place sent an email to families on Nov. 20 that said an employee had contracted the virus and was in isolation. Following which, the health authority determined there was "minimal exposure risk" and an outbreak was not declared.
Instead, the care home was placed on "enhanced surveillance," visitors were still allowed and group activities continued.
An outbreak was declared two days later.
Millar insists no one knowingly worked with symptoms.
"Nobody wants to bring that in," Millar said during the video call. "I think if anything, the reports that I've heard it is after you think about it, you may be like, 'Oh, I was quite tired. I was working long shifts or my work is pretty heavy and I can have some body aches.'
"But no one has knowingly come to work with symptoms and no one who has been diagnosed with COVID-19 has continued to come to work at Little Mountain."
The care home relies on its workers actively self-monitoring for symptoms and undergoing screenings upon arrival at work, but Mackenzie and others have called for routine testing for staff.
She believes all staff and residents should have been tested immediately after the first employee tested positive since screening for symptoms is inadequate when asymptomatic people are contagious.
Vaccine and past infections bring immunity
Schwandt said residents should now have some immunity to COVID-19. Whether it's through receiving the first dose of a vaccine or from past infections.
A second dose is on its way for residents after the first dose was administered on Dec. 24. The majority of staff have also been vaccinated, he said.