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Dear All: I've received many emails and phone calls today from staff today regarding the nursing home outbreak in Scarborough. As per Catherine's email yesterday, this type of outbreak is a normal occurrence in long-term care homes, especially in the fall and winter months. Unfortunately, the death rate due to respiratory viruses for this particular population is always high. While we are hearing media reports of additional deaths from this outbreak, it's important to note that these are occurring in patients who have already been sick with the virus for several days. These are not new cases. The outbreak itself was essentially over before it was picked up by the media this past weekend. You may also hear of other outbreaks in other nursing homes--these are not linked and again, this something we would expect as we head into the fall. Last year, there were many such outbreaks across the city with similar death rates. So why all the fuss? The majority of concern regarding this outbreak stems from the fact that there don't seem to be any beds to transfer the ill patients to hospital. Hospital EDs and medical wards appear to be backed up around the city . Other than this, hospitals in Scarborough are operating normally and staff and patients are going about as they always do. So what should we be doing about this? The same things we have been doing for the past two years. Patients with febrile respiratory illness should be placed in droplet precautions +/- contact precautions. The Ministry has suggested we use contact precautions in addition to our usual droplet precautions. I am fine with this additional step, especially given the general concern out there. Early calls to use SARS-like precautions with these patients were quickly corrected. There is no need for us to do any additional screening than we already do i.e., assessing each patient we see for possible communicable symptoms and wearing the appropriate precautions. The bottom line: it's business as usual for hospitals and emergency rooms. Finally, while this outbreak is not influenza, it drives home how serious respiratory virus outbreaks can be. The good news is that in the case of influenza, we can actually prevent such things by getting our flu shots. I will keep you all updated as the news unfolds. Michael
Sent by Dr. Michael Gardam, Director of Infection Prevention and Control