A worker who had close contact with someone who travelled abroad was one of the first to be suspected of carrying a highly contagious coronavirus variant into Barrie’s Roberta Place long-term care home, health officials said Thursday.
The worker followed all precautions, was tested regularly, but did not initially show symptoms.
She went home to self-isolate immediately after showing symptoms, but it was too late.
The infection spread through the home, with 55 people showing symptoms in the next two days, sparking an outbreak declaration. The speed of the spread caused alarm among local health experts, who thought something else must be at play.
“It was very early on that we were certainly contemplating, this has to be the variant,” Simcoe-Muskoka District Health Unit Associate Medical Officer of Health Dr. Colin Lee said Thursday.
As of Thursday afternoon, 122 of the home’s 130 residents have tested positive, along with 74 staff members whose infections are still considered to be active.
Twenty-five residents have died so far and five others remain in hospital.
The person who the worker considered to be the index case at the home travelled abroad but not to the home countries of the three known coronavirus variants of most concern – The United Kingdom, home of the B.1.1.7 variant, South Africa, the home of the 501Y.V2 variant and Brazil, where the E484K mutation was first detected.
“The first case had close contact with someone who did travel outside the country and then came back and became ill while quarantining,” Lee said, declining to name the country due to privacy concerns.
But Lee said there is also the possibility that the yet to be definitively identified variant was already circulating in the community.
"Certainly there's always a possibility that it was in the community already and it somehow got in because, you know, as much as everyone is trying their best to prevent transmission through (infection prevention and control) practices, this virus is very stealthy and can get through human behaviour"
The six variant cases appeared to be deviations from the dominant “wild” strains of coronavirus in Ontario found during standard PCR test processing using samples collected on nasal swabs.
All have been forwarded along to undergo complete genomic sequencing, which will definitively identify which variant they were infected with and where it came from.
The sequencing will be completed in the next several days.
There are a total of 15 confirmed cases of the UK B.1.1.7 coronavirus variant in Ontario, including four cases in York Region and London that have no known travel history to the UK or close contact with anyone who travelled there.
Ontario Associate Chief Medical Officer of Health Dr. Barbara Yaffe said the four cases with no travel history are enough for her and other officials to assume there is community transmission occurring.
She said Public Health Ontario plans to complete a “point prevalence study” soon, where some or all samples processed on a given day are run through additional testing and genomic sequencing, to see how prevalent the known coronavirus variants of concern are within the province’s COVID-19 caseload.
Lee said the discovery of mutations in Roberta Place staff and residents tells him the variant is likely circulating in communities.
“I am afraid the cat is sort of out of the bag now and by evolution and spread this will potentially become a dominant strain in the next weeks or months.”
The South African and UK variants are believed to be about 50 per cent more transmissible than other wild variants of the virus.
They generate exponentially higher viral loads in subjects and appear to bind more easily with human cells, increasing the number of people they infect in each exposure.
While the variants are believed to be more contagious, there is no evidence to suggest they cause a more severe infection.
The spread of the virus in the home has placed a high burden on staff members tasked with caring for surviving residents.
Lee said some staff members are voluntarily self-isolating from their families when they return home after work.
In the home, some routine activities are being delayed because there aren’t enough healthy staff to perform them.
“I do know that there are certain activities - medical duties that need to be done - they're having to prioritize it - what used to be done every couple of hours needs to be stretched out,” Lee said.
Geriatrician Dr. Samir Sinha told CP24 it is likely up to a third of those residents infected at Roberta Place will die.
"On average 1 in 3 of them will end of up dead, there will probably will end up being 30 to 40 people dead by the end of this."
Roberta Place’s COVID-19 vaccines were rerouted away to “priority areas”
Dr. Lee also confirmed Thursday that Roberta Place’s original allotment of Moderna COVID-19 vaccines, which were due to be administered around the same time that the variant reached the home, causing the severe outbreak, were diverted to areas with higher prevalence of long-term care outbreaks.
He told reporters that homes “in areas around the GTA received Moderna (vaccine) that was destined for us.”
This was part of a bid to get at least the first dose administered to all long-term care homes in York, Peel, Toronto and Windsor Essex by today.
Without Moderna vaccine doses, Lee said they brought Pfizer vaccine doses to the home last weekend, once they received guidance on how to safely transport them.
They inoculated 135 staff members and 21 residents with first doses.
He said that if they had vaccine availability sooner the outbreak at Roberta Place would have been “less severe.”
“If we had a vaccine a month before we went in on Saturday, I think this outbreak would have been much less severe.”
Sinha said the fact that the coronavirus reached the home just as vaccinations were about to be deployed is tragic.
"This was preventable. We had enough vaccine available in our province to be able to vaccinate every single long-term care resident as of Dec. 21," he said.
"Those deaths and these cases and this outbreak could have been entirely prevented had we been on the ball."