Parbs Bains had a "sinking feeling" when she heard a single staff member tested positive for COVID-19 at her grandmother's care home.
On Nov. 20, Little Mountain Place sent an email to families that said an employee had contracted the virus and was in isolation. A Vancouver Coastal Health medical health officer determined there was "minimal exposure risk" and was not declaring an outbreak, it said.
Instead, the health authority placed the home on "enhanced surveillance," including heightened monitoring of residents, hypervigilance in screening visitors and stronger infection control practices. Visitors were still welcome and group activities were continuing, the email said.
Bains felt certain that this was the beginning of the end for her 89-year-old grandmother.
"I was like, 'This is it.' I was bawling because I just knew this was going to be it," Bains recalled.
The facility declared an outbreak two days later.
It has become the deadliest care home outbreak in British Columbia. Ninety-nine out of 114 residents have been infected and 41 of those have died, including Bains's grandmother. Seventy staff members also tested positive, but most have recovered.
Two families are questioning whether some deaths could have been avoided if the home had taken stronger measures immediately after the first case was identified. They also say that a hard-working but understaffed nursing team struggled to keep residents isolated and care for those who were sick as the virus spread through the facility.
During a Zoom call with her grandmother after she contracted COVID-19, Bains said another female resident entered the room and began hugging and kissing the elderly woman on the forehead. After several minutes, a nurse rushed in and ushered the other resident out, she recalled.
Bains said that while she didn't know if the other woman had the virus, it alarmed her that residents were able to wander between rooms without staff immediately noticing.P
On other occasions, Bains said her grandmother's oxygen tubes were out of her nose and she would desperately yell for help over the Zoom call. Nurses told her that her grandmother was actually one of the fortunate ones because her room was close to their station, Bains said.
Bains said she is "so angry" at the way the outbreak was handled.
"Something had to have gone wrong at Little Mountain Place ... for this to be so lethal," she said.
Little Mountain Place referred questions to Vancouver Coastal Health, where Chief Medical Health Officer Dr. Patricia Daly said the provincewide standard is that outbreaks are not automatically declared when one staff member tests positive.
The health authority determines whether the employee was in the care home during their infectious period and whether they potentially exposed other staff or residents, for example by not properly using personal protective equipment, she said.
If there is no evidence of exposures, the authority places the home on "enhanced surveillance" and monitors for other cases, she said. Some testing may be done, and group activities continue but must always follow a COVID-19 safety plan, she said.
Declaring an outbreak every time a single staff member tests positive would be too hard on residents who suffer when they are isolated and their visitors are restricted, Daly said.
"We're trying to find that right balance."
Vancouver Coastal Health said there was no mass testing of all residents and staff after the first case was identified. It was only on Nov. 22, after a resident tested positive and the outbreak was declared, that full-facility testing was done, it said.
Daly said broad testing is not always necessary because it depends on the risk and timing of potential exposures.
At Little Mountain Place, it became clear transmission occurred before the initial case was identified, she said.
She said during an outbreak, residents are supposed to stay in their rooms, but it is very challenging for patients with dementia to follow those rules. Staff are advised to monitor residents who wander but not to lock anyone in or restrain them, she said.
"Keeping residents with cognitive impairment in their rooms, that has been a common challenge across all facilities in all of our outbreaks," Daly said.
Bains and another relative, Bernadette Cheung, have demanded an investigation of the care home's response to the virus.
Daly said she received a letter from a family member last week and has ordered Vancouver Coastal Health's licensing team to conduct a review once the outbreak is over.
The team will examine whether the home is following regulations under the Community Care and Assisted Living Act and, if not, will require it to develop a plan to address those gaps. In very rare cases, reviews by the team have led to a change in management, Daly said.
B.C. Seniors Advocate Isobel Mackenzie said she wants to see routine testing of all staff members at care homes. At Little Mountain Place, all staff and residents should have been tested immediately after the first employee tested positive, she said.
Screening for symptoms is inadequate because people can be asymptomatic and contagious, she noted.
"The fact that more people were infected two days later, if you had tested everybody before then, you'd have caught some people," she said. "You would have been able to isolate them if they were residents or you would have been able to pull them from the roster if they were staff."
Dr. Bonnie Henry, the provincial public health officer, said Monday the province is "looking at" regular rapid testing of staff in care homes. Ontario started doing rapid testing at long-term care facilities in November.
Cheung, whose grandmother died of COVID-19 at Little Mountain Place and has been outspoken about her concerns, said Health Minister Adrian Dix called her on Monday. She said he promised an "intense review" of the outbreak and to follow up again with her about his conversations with the care home and the health authority.
The ministry did not immediately respond to a request for comment.
Though the conversation was light on details, Cheung said she appreciated his empathy.
"That gives us hope, at least, that it is a priority for him."
She said she has also received confirmation from Vancouver Coastal Health that her formal complaint against the care home will proceed.
Cheung has criticized the care home for not being transparent with families. She wants to know more about why the health authority determined there was "minimal risk" of exposure from the first infected staff member and declined to declare an outbreak on Nov. 20, she said.
"Essentially, we're being kept in the dark and it raises concerns and even suspicions," she said.
