In Halton one infection at a nursing home is considered an outbreak and they are all over it

News 100 redBy Pepper Parr

May 11th, 2020

BURLINGTON, ON

Her name is Deepika Lobo.

She is a medical practitioner who has the honorific Dr. in front her name.

She is an Assistant Medical Officer of Health with the Region of Halton working as the medical lead on the COVID-19 pandemic.

Educated as a doctor in India where she worked for a year as a GP, Dr. Lobo came to Canada and earned her public health degree at McMaster University. She has also earned an MBA at McMaster.

Deepika Lobo

Dr. Deepika Lobo, Assistant Medical Officer of Health with the Region of Halton working as the medical lead on the COVID-19 pandemic.

Lobo directs a team of 220 people who have the job of doing what they call “case management”.

The media refer to it as tracking and tracing, that is – identifying those who have been in contact with a person infected with COVID-19.

“We know the disease is transferred from person to person” she said.  “When we determine that a person has been infected we want to know two things:

1: Who the infected person come into contact with in the last 48 hours and

2: who have they been in contact with for the last 14 days.

It is these people who might be the next person to become infected.”

More than 150 people are assigned to this case management work.

Lobo continues to explain: “Once we have them identified as an infected person, we begin trying to get in touch with the people they have been in contact with: these are the people we are now very concerned about.

“Sometimes the infected person has only been in contact with one or two people. They may have already begun self-isolating.

“Some of the contact was very casual – there is no need to dig deeper.  We have learned to differentiate between high risk and low risk exposure.

“We explain to the infected person what they have to do – they have to self-isolate for that 14-day period during which the disease is going to grow.  We quickly become aware of the personality we are working with and determine just how much they know about the disease; more often than not the person wants to know as much as we can tell them.

“They are usually very thankful that someone is reaching out to them.

“We counsel them while they recover from the infection on their own.

“Our task is to constantly assess and follow up every other day with the infected person who is self-isolating.”

What Lobo hasn’t had up until very recently is software that will serve as a massive data base the case management staff can refer to and add information to so that when there is a staff rotation (these people have to get some rest) there is a fully detailed report on the people who are self isolating.

Mountainview

A nursing home with a 30 year reputation lost 11 of its residents.

The biggest concern is managing the “outbreaks”. Some public health practitioners see four or five cases of infection at a long term care or nursing home as an outbreak. In Halton one infection at a nursing home is considered an outbreak and they are all over it.

“When there is an infection in a nursing home” said Dr. Lobo, ” we know that it was brought into the institution – who brought it in and who have they been in contact with is something we need to know.” It is a desperate race to track that down and time is their worst enemy.

“Telephone calls are made, people are not at home, call backs are made by staff all trained not to alarm people.

“Sometimes the person with the infection hasn’t been in contact with very many people; one perhaps two. Other situations the person with the infection has been in touch with as many as 30 people. That’s when the rush is on to get in touch with every one of them, enter them into the system and begin asking questions.

“All it takes is one infected person to be in contact with 20 people and within that twenty people there are five who have been infected – you can see where this takes them.”

Lobo emphasizes that it is vital to get in front of these situations when they are sometimes far behind. It is a race – and the consequences are measured in peoples lives.

“When there is a case that has a bearing on an institutional setting – the immediate objective is to contain it and ensure that it doesn’t surge out of control.

“It is in situations like that that tough measures have to be put in place which people often don’t understand and don’t appreciate.

“Staff resources are shifted to drill down and learn who has been in contact with the infected person and work out from that person.”

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The paramedics came through in a major way – it hadn’t occurred to anyone to use these people.

The work for the team is exhausting – asked for her best experience so far Dr. Lobo pauses – then almost bursts when she explains “the paramedics suggested that they could do some of the testing. What really made a huge difference was the way the paramedics have come through for us by going to people’s homes and testing for the infection.

“They have 2500 of those tests – sometimes as many as 200 in a single day.

“That testing is vital – and it takes trained manpower to do it properly.

“It never occurred to us to call upon the paramedics – the said they could do it – and they did.”

Asked what the worst experience has been – there was another pause – then a recognition of those who were lost.

The pace at which this disease is racing through some locations is almost frightening.

The staff she has have to be both managed and trained. We learn something every day that we ensure is shared with everyone.

The case management people develop relationships with the people they are talking to at least every second day; it is a relationship that is under stress from the start – the job is to manage the stress and not let it take over.

There are 46 nursing homes – long-term care residences in the Region. Lobo is amazed that there have been just three outbreaks – one of which was tragic, 11 lives were lost in what was a quality operation.

Lobo has handled intense situations in the past – “but never on this scale”

Asked how much longer is this likely to go on – Dr. Lobo said “we don’t know. We are a day to day operation.”

When will they celebrate the end – “no idea”, she said, “we just hope it is soon.”

The regional public health units are directed by the province – they determine the overall direction – The Region follows that direction.

The staff have learned to support each other – they rely on one another for emotional and mental health support. These people have families at home – they volunteer hundreds of extra hours.

The province will decide to open things up a little – just a bit – we then wait that two to four weeks to see if there is an uptick or a spike in infections. If there are – the province might decide to cut back and re-impose restrictions.

Lurking in the background is the wish – a hope for a vaccine.

To date there have been 23 deaths in the Region; 11 of which were in institutional setting.

Dr.  Lobo said there have been at least 40 guidance papers written and prepared for those who have to do this work in the 34 Public Health Units in the province; directing and supporting the people who do the slogging work – listening closely to what the infected people are saying; assuring them as well as supporting them.

Few people in the Region know that there are that many people working exceptionally long hours to identify infected people and ensure that they self-isolate.

They look forward to the day when they can see there was not one new infection reported – then that curve will have been flattened.

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1 comment to In Halton one infection at a nursing home is considered an outbreak and they are all over it

  • Mariette DSouza

    Congratulations dear Dr. Deepika LoboWe are proud of you. May God Almighty shower you with his choicest blessings and give strength to render your services during this crucial period. Take care and stay safe.