Toronto Western Hospital is declaring a fifth outbreak after five health-care workers from its emergency room tested positive for COVID-19, with the first case dating back to three weeks ago, hospital officials have confirmed.
University Health Network, which includes Toronto Western, is currently using the newly published provincial definition for a COVID hospital outbreak, defined as at least two cases within a 14-day period where both could have “reasonably” acquired their infections in the hospital. There are more than a dozen active hospital outbreaks in the city right now but this is the first to involve emergency room staff, according to Toronto Public Health.
Dr. Erin O’Connor, deputy medical director for UHN’s emergency department, only learned of the five ER cases late Tuesday night — a day after she spoke to the Star for an article where she stressed her ER was a safe place for patients, despite outbreaks in other parts of the hospital.
She said she still believes this to be true because of stringent controls that protect patients from health workers who could be infected. But the news that five of her colleagues have tested positive has been difficult to absorb.
“These are our colleagues and our friends and it’s certainly a worry for everyone,” said O’Connor, speaking to the Star Wednesday morning. “It really hits home when it’s your direct colleagues and people you see every day.
“It’s been a pretty upsetting 12 hours or so.”
In a memo sent to staff on Wednesday night, UHN said there is now mandatory testing for all emergency department staff, with employees who worked between April 20 and May 13 asked to go to a “rapid swabbing clinic.” The memo said it is not always necessary to fully close a unit during an outbreak but measures being put into place include decluttering, enhanced cleaning, restricted traffic, and “PPE coaches” who will help staff with donning and doffing their personal protective equipment, physical distancing and “proper mask etiquette.”
The five ER cases include a mix of clinical and nonclinical staff, said Dr. Susy Hota, UHN’s medical director of infection prevention and control. But Hota would not specify their exact roles, citing privacy concerns. O’Connor said none were among the 89 doctors or four physician’s assistants who report directly to her, though her department is also staffed by more than 130 nurses, personal support workers and a variety of other employees.
Hota said she first learned of the cluster Tuesday afternoon after it was flagged by the occupational health and safety department — even though the first case stretches back to the week of April 20. Until last week, Hota had served as lead medical consultant to the occupational health team but said that department is now undergoing restructuring.
The employee tested negative for COVID despite having symptoms, Hota said. But they were later retested and found to be positive as a part of broad screening efforts implemented by UHN in the wake of the recent COVID outbreaks.
“My belief was there was a false negative test initially. We know that tests are not perfect,” Hota said. “That is why that first individual came to light later than we would have liked.”
The other cases were subsequently identified, with the most recent one turning up last week, Hota said. She declined to share specific dates for when each person was tested or when their individual results were confirmed, citing concerns it could identify them to their co-workers.
But she acknowledged the three-week lag between the first case and when hospital officials identified the cluster. “That’s quite a span of time of positive results coming in and I can’t really answer why it is that the delay occurred,” she said. “I’m not really sure why it played out the way it did and that’s being explored right now.”
Hota said at least four health workers were symptomatic when they tested positive, with investigations still underway for the fifth. One person was hospitalized but has since been discharged, she said.
Investigators are also looking into whether any patients may have been infected. But Hota said the risk to them is “quite low” because staff would have been wearing both a mask and face shield during patient interactions, in addition to practising other infection-control measures.
UHN believes it is now doing more staff testing than any other hospital, including of asymptomatic staff, so officials do expect to find more cases as long as COVID is circulating in the community. So far, 3,743 staff tests have been performed at UHN with 97 of them — or 2.3 per cent — turning up positive.
So far, the outbreaks are all being considered separately but investigators are certainly looking into whether there might be a connection between any of them, Hota said.
“It would be hard to not wonder … if these are all related,” she said. “Right now, I’m not seeing that yet but investigations can take a while.”
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As of Tuesday, 73 hospital outbreaks have been reported in the province, involving about a quarter of Ontario’s 225 hospital sites.
In the field of infection prevention and control (IPAC), the term “outbreak” is used to describe a pattern and enables health-care organizations to take additional measures. The decision to declare one, however, is particularly tricky with COVID, in part because some people don’t show symptoms and the long incubation period makes it tough to determine whether an infection was actually acquired at the hospital.
There are also competing concerns when it comes to publicizing a hospital outbreak. While transparency improves patient safety and trust, doctors also worry about scaring people away from seeking urgent care, a problem that would only amplify the harms caused by the pandemic. The day after Toronto Western’s first outbreaks were publicized, visits to the emergency room dropped by 40 per cent.
IPAC experts say outbreaks tend to occur when there are breakdowns in protocols — a risk that is almost certainly heightened during an unprecedented pandemic, when staff are tired and new protocols have been introduced around personal protective equipment (PPE), which is in limited supply.
And despite practising vigilance around patients, hospital staff still need to rest, drink and eat — all moments that might involve them co-mingling or removing their masks.
According to a Toronto Western health-care worker, who asked not to be identified because they weren’t authorized to speak on the record, a place where “staff might be exposed to each other without appropriate PPE is in the lunchroom” — a small space they described as being roughly the size of a master bedroom in an average-sized Toronto home.
O’Connor said the lunchroom had already been redesigned to promote physical distancing but since these new cases were announced, a second lunchroom has been opened up, with clearly-marked spots for where people can safely sit and eat.
She said the fact UHN is now doing broad testing of employees, including those who are asymptomatic, should serve to reassure the public because it means the hospital is taking steps to identify issues that would otherwise be missed.
“I would not be horribly surprised if you did this voluntary testing at any other organization (and) some asymptomatic positives would also crop up,” she said. “You only find what you’re looking for.”
O’Connor said she can understand why people would be worried by these outbreaks at Toronto Western. But she hopes people will still seek help from hospitals whenever they find themselves in need of care.
“I think what is important is that people know that we are being very, very honest with them and that we are giving information when we have it,” she said. “We are taking those extra steps to find a problem that’s there and so for me, that actually gives me reassurances. I would still tell a family member to go to Toronto Western and I will still go to my shift every day with confidence.”