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Monday, July 15, 2024
Dr. Brown: Why isolation in nursing homes is a bad idea, despite Omicron

The scene was surreal on Dec. 30: just a few blocks from the Niagara Long-Term Care Residence where my wife resides, streets and stores were crowded with shoppers inside and outside lined up, most with masks on, some with noses poking out and packed together, eager for last buys.

The story that day was very different where, minutes before, I visited my wife in the Wellington Street care home where she and other residents were isolated in their rooms, apparently in response to the discovery that one resident and a staff member had tested positive for COVID-19.

Isolation or not, other residents aimlessly paced the corridors and still others sat in common rooms vacantly staring or dozing with no one paying much attention to them.

What was going on?

Last year at this time, our streets were even busier during the holiday season days before an earlier variant, Alpha (U.K.) struck, decimating long-term care facilities in early January 2021.

Despite strict public health measures, including isolating residents in their rooms, many developed COVID, some became clinically symptomatic, and several died. Luckily, one wing of the Niagara LTC facility was apparently spared.

Unfortunately, vaccines, which might have prevented the tragedies, were still not available for several weeks, by which time the local surge was beginning to wind down. But there was another tragedy – the cost of isolating residents in their rooms.

Residents with cognitive and memory problems in care facilities became more confused when they were isolated in their rooms for several weeks for fear they might become infected or infect others.

The cognitive and social cost to the isolated residents was real and lasting – and, in retrospect, was probably not worth the cost of isolation, given that many developed COVID anyway.

Now, in the face of the exponentially spreading Omicron variant, the Ontario government, health minister and their advisers are skittish and worried that what happened to nursing homes last January, might happen again: the Omicron variant might sweep through, threatening residents with illness or even death.

That was reason enough for homes to try to keep the virus out by testing staff and essential workers daily, and requiring both to wear properly fitting N95 masks coupled with plastic shields and gowns.

This time, however, there are three major differences. First Omicron is several times more catchable than the U.K. variant was and given the fact that early on one resident and staff member at Niagara LTC tested positive, the chance this variant would spread throughout the facility was high, no matter what protective measures were taken, including isolation. (In fact, as of Tuesday, 14 residents and 14 staff were infected.)

Second, so far, Omicron appears to be significantly milder than were the Alpha and Delta variants, especially for the fully vaccinated

My understanding is that well over 90 per cent of current residents are fully vaccinated and most have received booster shots. If so, the evidence strongly suggests that a full course of vaccination, with the added protection of a booster shot, should offer very good protection against clinically significant infections, even for the elderly.

The worst part of this story is that isolation of demented patients is never a good idea. Nearly a year ago when my wife was isolated for the first time, it was a very disorienting experience for her as she already was struggling to make sense of others and the space she lived in.

What happened to her, happened to other residents in those several weeks of isolation.

Evidence from the earliest cases in late December to as recently as Jan. 3 at Niagara LTC suggests that cases among the mostly elderly residents have been doubling roughly every 24 to 48 hours, similar to rates reported elsewhere for Omicron without the strict control measures imposed here.

Late on Jan. 4, I learned that some residents and staff members who tested positive, developed minor symptoms and so far, hopefully nothing worse. If so, that would be consistent with early data elsewhere that the vaccinated have little to fear from this variant, even if they're frail and elderly.

However, the fact that this variant managed to slip through surveillance testing and obligatory wearing of N95 masks, plastic shields and clean gowns by staff is worrying for the future should a much tougher variant emerge.

I’m glad I can visit my wife, but my guess is the toll on what remains of her capacity to make sense of her world might be made worse by unnecessarily isolating her and others in the same boat.

In my opinion, that’s cruel now and was nearly a year ago. But at least last winter we were learning about what did and did not work and best care standards.

What wasn’t learned last year, was the human cost to residents of isolation. That was and is a serious problem not addressed by most of the “experts” in this pandemic.

This time, there’s little excuse for isolating residents in their rooms in the vain hope any long-term care facility can keep this virus out or spreading within wings. Isolating residents probably won’t contain the virus and only make life more unbearable for residents and those who care about them.

The question this time around isn’t simply about public health but humane care.

Dr. William Brown is a professor of neurology at McMaster University and co-founder of the InfoHealth series at the Niagara-on-the-Lake Public Library.  


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