Calls to reduce COVID-19 isolation for seniors in care as it may do more harm than good

After 10 days of preventive COVID-19 isolation in her room at a Montreal care facility, Joanne Beland's 84-year-old mother has more difficulty moving and expressing herself.

"My mother, she told me, 'I don't know if I'll still be able to walk when I've finished my 10 days,"' Beland said, adding that her mother now struggles to get out of a chair. "It's very difficult for them to maintain their mobility when they're confined in a room for 10 days."

Beland's mother, Lorraine, lives at the Ressource de la Montagne, an "intermediate" care facility in Montreal, which offers a higher level of care than a seniors residence but less than a traditional long-term care home.

Like in other residential care facilities in the province, residents are required to isolate for 10 days if a worker or another resident on their floor tests positive for COVID-19.

Beland, who chairs a committee representing residents at her mother's facility, said she agrees COVID-19-positive residents should isolate, but she says she worries a 10-day isolation period for others on their floor causes more harm than good.

Earlier this week, the users' committee at the health authority in west-central Montreal, which runs the facility where Beland's mother lives, sent a letter to both Quebec's health minister and seniors minister, calling for the isolation period to be shortened.

With high vaccination rates in residential care facilities, and evidence that the Omicron variant causes less serious illness, the physical and mental health impacts of the isolation period are too high, the letter states.

"The majority of seniors, they've already had their third dose of vaccine, they're well-vaccinated," Beland said. "It doesn't make sense to keep them in this condition, to confine them in their rooms for 10 days."

Beland says she doesn't think residents who may have been exposed to COVID-19 should be free to move anywhere, but they should at least be able to move around their floors -- especially if they test negative.

Her mother tested negative twice for COVID-19 during her 10-day preventive isolation.

"After two negative tests, it seems to me we could give them the chance to leave their rooms," Beland said.

For doctors who work with elderly patients, whether to reduce the preventive isolation period is a difficult question.

Dr. Sophie Zhang, co-president of an organization that represents doctors who work in long-term care facilities, says that while Omicron may be less serious than other mutations like Delta, it can lead to severe illness and death, especially among elderly people who are already sick.

"The question is, yes, whether preventive measures are worse than the actual infection," she said. "It's kind of tough to answer and I think it becomes kind of an ethical question, rather than a scientific question."

Zhang, who oversees 15 long-term care centres in south-central Montreal, says measures like the isolation period may have to be rethought because of the widespread transmission of COVID-19 in the community.

At one facility where she works, an outbreak was declared on Dec. 19 and has not yet ended, as new cases continue to be reported among staff members.

"Once there's an outbreak, we put in place a lot of measures -- restrictive measures -- on visits, on activities, on mobility within the facility," she said. "So all that is taking a heavy toll on our patients' quality of life."

For people who are older and sicker, not moving or moving less can cause loss of muscle mass even after a few days, she notes.

Reducing the isolation period, implementing more aggressive testing and changing the way outbreaks are defined all need to be considered, Zhang adds.

Dr. Quoc Dinh Nguyen, a geriatrician and epidemiologist at the Centre hospitalier de l'Université de Montréal, says that especially in larger facilities, residents can have their 10-day isolation periods reset when new cases are reported on their floors.

Nguyen points out testing could be used to lift isolation periods sooner.

Facilities, he adds, could also take into account their specific risk levels and the ability of residents to follow measures.

A regional approach may make more sense than a provincewide isolation policy, he says.

"We need to worry about the adverse effects of isolation measures," Nguyen said, adding that he also worries about the impact of relaxing measures too much. "Although I agree that it [Omicron] is not as severe as it used to be, it's still severe... We still need to be careful and we still need to put measures to reduce transmission."

- This report by The Canadian Press was first published on Jan. 20, 2022.