What went wrong? 10 dead, more than 100 infected in University Hospital COVID-19 outbreaks

Middlesex-London Health Unit medical officer of health Dr. Chris Mackie says the University Hospital COVID-19 outbreaks are now associated with 10 deaths and over 100 cases.

He also told Global News that the health unit had provided documented advice to the London Health Sciences Centre at least five days before additional restrictions were finally announced.

Read more: Coronavirus: 4 deaths, record 46 cases reported in London-Middlesex

While the first outbreak was declared Nov. 10, additional measures on top of the standard outbreak response weren’t announced until Nov. 27.

By that time, the outbreak had already extended to five other wards and involved at least 61 cases.

“I can tell you that we have been giving LHSC advice on this Nov. 22, Nov. 26 — we’ve given lots of documented advice so it’s not as if nothing was happening in that meantime,” Mackie said on Let’s Talk London with Jess Brady on Wednesday.

“But absolutely, it would have been really helpful to understand the extent of this earlier so that we could have taken more definitive measures.”

Mackie said he’s “very happy” with the measures that are now in place. He said the health unit is “working with LHSC to make sure that they continue to be in place. And if staff are able to follow those then I think we will be definitely seeing a turn around the corner of this outbreak.”

On Nov. 27, LHSC announced it was postponing non-urgent, non-emergent surgeries and procedures, as well as several other measures that appear to be similar to recommendations made by the health unit three days earlier.

The measures included masking all adult patients, COVID-19 testing for all patients admitted to hospital, and limiting the movement of staff and physicians between units and hospitals.

LHSC also introduced visitor restrictions on Nov. 27, implemented as part of a directive from the MLHU. The restrictions prevented all visitation to patients at University Hospital during the current outbreak, except in cases where patients are “actively dying.”

Before that, one designated care partner per adult patient could visit daily for up to three hours.

“For the most part, people visiting patients in hospital, it’s not like 15, 20 years ago where it is truly a visit, dropping off some magazines,” LHSC chief medical officer Dr. Adam Dukelow said on London Live with Mike Stubbs.

“It’s actually people who are helping care for the inpatient, the person that’s in the hospital, both both physically and emotionally. We do not take it lightly when we have to restrict visitors and essentially caregivers from coming into the institution.”

Read more: LHSC lowers flags to half-mast as University Hospital COVID-19 outbreaks claim 6 lives

On Nov. 30, LHSC added that it would reduce ambulatory/outpatient activity at UH to only urgent and emergent needs and that it would be rescheduling all other clinic appointments as virtual appointments, whenever possible.

Dukelow told Global News that when it comes to measures “put in place in the past four or five days, the wish is that we would’ve been able to do that earlier.”

“But at the same time, we responded in that way as soon as the signal suggested that we needed to,” he explained.

Dukelow said that there was a key window “where we went from just a few cases to a number of cases” and it was at that point that LHSC realized “that this was more than, sort of, your ‘normal’ outbreak.”

He also addressed unverified reports that staff from various floors had recently held a potluck.

“We are actively looking into it. The first that our team, at least as far as I’m aware, our team had heard that was even a rumour was earlier on Monday,” he said.

“As soon as we were alerted to that (our team) started a line of investigation. Similarly, our colleagues at the health unit are also investigating it but we have no further information to confirm that  there was a potluck at any point in time that would be related to the outbreak, but are actively investigating it.”

When asked for comment, Mackie said his understanding is that the investigation at UH is ongoing.

“We certainly don’t have anything definitive,” Mackie said, “but if it was a situation where potlucks or house parties or other social gatherings were contributing to the spread, it would help explain what we’re seeing.”

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Dukelow previously stated on Monday that one potential factor in the extent of the spread of the virus within the hospital could be that staff don’t necessarily always work on the same units, so pre-symptomatic or asymptomatic staff could have “a shift on one floor one day and then another floor the next day.”

“We even know those that get symptomatic are asymptomatic for a couple of days before. So I’m 100 per cent confident that none of our staff or team members were working while sick,” Dukelow added on Wednesday.

“However, when you’ve been battling this virus and wearing lots of PPE for many, many months now, there’s no question that fatigue can play into it. And being in the hospital for 12, sometimes 16, 20 hours or longer at a time, there may be slippages in that.”

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According to the most recent figures from LHSC, 54 patients and 41 staff and health-care providers have tested positive for COVID-19 in connection with the outbreaks.

However, the Middlesex-London Health Unit said 47 staff and health-care workers and 50 patients are tied to the outbreaks.

Both had confirmed nine deaths associated with the outbreaks as of early Wednesday afternoon, though Mackie told Global News hours later that the outbreak had “crossed over into the 100 cases threshold” and that “we had a new death today so that total is now at 10.”

The MLHU also reported that in addition to patient and staff cases tied to the outbreaks, there are “a number of additional related cases in the community.”

While the health unit did not provide a firm update Wednesday on how many cases outside of patients and staff are tied to the outbreak, Mackie mentioned on Monday that, at that time, at least 11 secondary cases and one tertiary case were tied to the outbreaks.

Secondary cases generally involved family members or people within the same household, while the tertiary case Mackie mentioned on Monday involved “a staff person (who) spread to someone else who spread to someone else as well.”

Read more: ‘Learn from our story’: How a B.C. birthday became a COVID-19 superspreader event

In a statement on Wednesday, Mayor Ed Holder extended his “heartfelt and sincerest sympathies to family and friends” of those who’ve died in connection with the outbreak, on behalf of all London residents.

“We honour the lives of your loved ones, and we pray that their memories bring you peace, comfort, and strength during this time of great sorrow,” he said.

“Like many Londoners, I am incredibly saddened, and frustrated by what has transpired. The source of this outbreak remains under investigation by the London Health Sciences Centre, and I trust that investigation will be thorough.”

Holder also used the opportunity to stress that “London’s healthcare sector is comprised of thousands of women and men” who have been “on the frontlines every day, working extremely long hours, missing family members, and making significant sacrifices, all in an effort to save lives and bring comfort to those who are ill.”

“Those individuals deserve our deepest thanks and admiration.”

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