After months of visiting their father alone at his Ottawa long-term care home, sisters Danielle Mongeon and Sylvie Besner were finally able to see him together this week.
Bernie Mongeon has lived in the city-owned Garry J. Armstrong home for three years, since before the pandemic made visits such a challenge.
Ontario eased that challenge somewhat on Monday, further lifting long-term care restrictions by allowing access to more caregivers and dropping vaccine mandates for visitors.
Besner, who is triple vaccinated, said staff and management at Garry J. Armstrong followed COVID-19 protocols “to the letter.”
Sisters Danielle Mongeon, left, and Sylvie Besner, right, visit their dad Bernie Mongeon in the Garry J. Armstrong long-term care home on Monday. (Ben Andrews/CBC)
“We heard so many horror stories about all the other homes — some homes that had, unfortunately, tragically, so many deaths,” Mongeon said. “For us, we were very happy because we knew that [staff] were always talking to the health people.”
A review of City of Ottawa records suggests ventilation may be another item on the list of protocols staff at Garry J. Armstrong followed “to the letter.”
But while Ottawa’s four municipal long-term care homes appear to have met or exceeded provincial standards, some experts are asking whether those standards need rethinking.
Comprehensive records
CBC News recently obtained comprehensive maintenance and construction records on the four homes the city runs: Garry J. Armstrong, Peter D. Clarke, Centre D’Accueil Champlain and Carleton Lodge.
The records include information on routine maintenance and major lifecycle renovations to heating, ventilation and air-conditioning. They also provide a clearer picture of work done during the pandemic to maintain indoor air quality in the homes, including filter upgrades to help remove tiny viral particles from the air.
The homes also installed standalone HEPA filter units in common areas at each building, said Dan Chenier, the city’s general manager of recreation, cultural and facility services.
CBC did not learn, however, how long after the start of the pandemic each home upgraded and installed the filters.
But according to an expert review of both the data and accompanying statement, the records indicate a history of public health compliance and studious maintenance — which may set these homes apart from many other congregate settings across the province.
“The fact that those records even exist already suggests that you might be talking about the top 10 per cent, 20 per cent of all long-term care homes in Ontario,” said Jeffrey Siegel, a University of Toronto engineering professor who studies ventilation.
Ventilation ‘neglected,’ expert says
In Canada, long-term care residents accounted for just three per cent of all COVID-19 cases but 43 per cent of COVID-19 deaths, according to the latest report from the Canadian Institute for Health Information.
According to the latest available data, the four Ottawa homes have weathered 28 COVID-19 outbreaks, totalling 374 cases and 13 deaths.
By comparison, a single outbreak in Ottawa’s West End Villa killed 19 residents and prompted a $16-million class action lawsuit from residents and their families.
With Ontario lifting a host of public health measures, some ventilation experts are asking what can be done to help prevent a future variant — or another virus altogether — from repeating the damage of early COVID-19 waves.
“Upgrades should probably be accelerated in the face of the next viral pandemic, which is a question of when, not if,” said David Miller, a Carleton University chemist and indoor environment expert who reviewed the city records.
“Planning for the next pandemic has to include attention to ventilation and filtration.”
It has been a tragedy what has happened in long-term care … and absolutely, ventilation was completely neglected.– Jeffrey Siegel
Although the four homes appear to meet provincial requirements, details like the placement of standalone filters are also important for fully understanding air quality, Miller said.
“They damn well better be doing an efficient job about the quality and the location of their portable filters,” he said.
The provincial standards were simply not designed to keep people safe during an airborne pandemic, other experts added.
“It has been a tragedy, what has happened in long-term care,” Siegel said. “There’s no other word to describe it other than an abject and total failure. And absolutely, ventilation was completely neglected.”
Long-term care homes, like Ottawa’s Garry J. Armstrong pictured here, must meet the ventilation standards of the year they were built. Some ventilation experts are asking if, for some congregate settings, those standards need to change. (Ben Andrews/CBC)
Early in the pandemic, Siegel said, several engineers and indoor air specialists had concerns about inadequate ventilation in congregate settings — but he and others had to balance the urge to raise the alarm with the risk of worsening labour shortages in an already understaffed industry.
Now, Siegel has no such concerns.
“If you look in the standards for long-term care homes, the stuff on ventilation and HVAC generally is a joke. Not only is it completely inadequate for any protection from infectious disease, it’s not even enforceable,” he said.
Government slow to act
Indoor air quality engineers and researchers recognized the importance of quality ventilation for reducing COVID-19 risk long before governments did.
Miller, for example, was one of nearly three dozen Ontario engineers and doctors who signed a letter in November 2020 calling on the World Health Organization to better inform the public about airborne transmission of the virus.
Compared to most of its international peers, Canada was late to acknowledge that risk.
The American Society of Heating, Refrigerating, and Air-Conditioning Engineers, the organization that writes ventilation labour standards in North America, released its emergency epidemic guidance in October 2021.
The chair of the society’s epidemic task force, William Bahnfleth, told CBC the society began preparing as early as March 2020 as if SARS-CoV-2 were airborne.
West End Villa, owned by Extendicare, is the site of the deadliest COVID-19 outbreak in an Ottawa long-term care home. (Stu Mills/CBC)
Engineer wants ventilation ‘sea change’
A group of Toronto researchers, including Siegel, also penned a pre-print article that found Public Health Ontario’s written pandemic guidance for long-term care homes did not once mention ventilation.
Siegel said this silence must change, especially since residents in congregate settings often lack direct control over their environment and may be more likely to be from racialized or marginalized backgrounds or vulnerable due to health co-morbidities.
Current standards require a building’s ventilation to meet the minimum level for the year it was built. In older buildings, that could mean owners are not legally obligated to upgrade an outdated system.
One solution would be a “continuous meeting of the relevant version of the current standard,” Siegel said, but he recognizes that would mean a “sea change” in the world of ventilation — mainly because it’s bound to get pricey for building owners.
Action is important, however, to protect long-term care residents from COVID-19 — or whatever virus comes next, he said.
As for Danielle Mongeon and Sylvie Besner, they’re just glad to be once again visiting their dad as a family.
“It’s really good for the soul,” Mongeon said.
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