4 reasons why despite vaccines, Sask. nursing homes are still largely off-limits to visitors

Kenn Clark and his partner haven't been able to see his mother-in-law, Hilda Frisky, since last October. He's worried about the 84-year-old's mental health.

"She was buried in a dark place for quite a while," Clark said. "She wouldn't come out of her room, she wouldn't go eat, she wouldn't do any activities. And some of the talk that we were receiving in conversations with her was very not warm and fuzzy."

Frisky is a resident of Arborfield Special Care Lodge. As in all care homes in the province, visitation has been severely limited at the home in Arborfield — a town about 230 kilometres northeast of Saskatoon — since mid-November because of the risk of spreading COVID-19.

"We are working with the Saskatchewan Health Authority (SHA) and constantly monitoring the situation, but at this time no date has been set for changing this policy," a spokesperson for the Ministry of Health said this week. 

On Tuesday, Premier Scott Moe signalled the rules on household gatherings might be relaxed soon but said nothing about long-term care homes. 

Clark says health officials should allow masked visitors — especially now that 91 per cent of Saskatchewan long-term care residents have received their first dose of a COVID-19 vaccine, while 53 per cent have received both doses.

"My mom and dad both passed away years ago," Clark said. "I couldn't imagine not being able to go see them. A year in the life of my mother-in-law at this age is like 10 years in our lives."

But there are several reasons why health officials may remain reluctant to open the doors again, according to Cory Neudorf, a professor of community health and epidemiology at the University of Saskatchewan. 

Here are four of them. 

1. Some residents have refused vaccines

Doses were offered to all long-term care residents, but an unknown number of them declined the vaccines, according to the ministry.

On Tuesday, the ministry said nine per cent of residents didn't receive vaccines either because they refused them, weren't available to take them or had "a change in health status."

The ministry did not provide a breakdown of those categories. On Wednesday, the health authority said it does not track its vaccine data to that level of detail.

Allowing visits in long-term care homes again depends, in part, on the number of people immunized in each home, Neudorf said.

"Do they have a large enough percentage of people immunized to reach some true herd immunity?" he said. "Then secondly, how do you protect those people who've chosen not to be immunized?"

Clark said vaccine refusers shouldn't be holding up the line of visitors.

"If someone wants to refuse it then, I'm sorry, they shouldn't get the same consideration," Clark said.

"I don't want my mother-in-law in a place [where] one person is obstinate and won't take it [and] we can't go visit because of that one person. That's baloney."

2. Not all residents have received 2 doses

The efficacy for both the Pfizer-BioNTech and Moderna vaccines jumps from the "low 90s" after 14 days for people who have had one dose to 94 or 95 per cent for people who have had two, according to Dr. Tania Diener, the Saskatchewan Health Authority's lead medical health officer for immunization.

Neudorf said the province has done a good job of getting at least one dose into a large percentage of seniors.

"But we're still getting the second dose in," he said.

Clark said residents who have received two doses should be allowed to receive visitors.

"Let them have their family come visit. Why can't they do that?"

3. There are still some unknowns about vaccines

While early vaccination results are encouraging, COVID-19 has re-entered some facilities where people were immunized, Neudorf said. 

There's also the potential for immunized people to still pass on the virus to others, he added. 

"The early results seem to show that, yes, they're still shedding virus, but not as much as if they were un-immunized," Neudorf said. "That's good news. But it's still something we need to watch for.

"You could end up with people who have been immunized but inadvertently are still capable of spreading the virus to others. That will become less and less of an issue most of the population gets immunized."

4. Risks from staff traffic, community spread, variants

The immunization rate of other people going into long-term care homes is also key, Neudorf said. 

"Staff of long-term care and places caring for COVID-19 patients have been prioritized for immunization, but it's not mandatory," Neudorf said.

"So it depends on what coverage rate we are getting and what is the rate of COVID in the community itself. That affects the likelihood that a staff member might end up inadvertently introducing it."

In mid-January, early in the first phase of Saskatchewan's vaccine rollout, the province said only a small percentage of health-care workers were declining the vaccine.

The SHA said Wednesday it did not have an up-to-date breakdown.

"Although COVID vaccinations are strongly encouraged for everyone, they are not mandatory. Note that once you become eligible, you are always eligible and vaccination rates may yet change," an SHA spokesperson said.  

Neudorf said the province's recently announced plan to broaden its use of rapid testing could bolster the case for visitations in long-term care homes, but the province still needs to remain cautious in light of variants of the coronavirus that causes COVID-19, some of which are more transmissible.

"We could very easily see a third wave of COVID strike very rapidly in this province within March and April. And that throws all these other plans out the window."

Clark says his mother-in-law's spirits have lifted now that one visitor (a different family member) has been allowed to visit her at Arborfield Special Care Lodge.

But he says the uncertainty around allowing wider visitation is becoming increasingly tough to accept. 

"You can't keep telling seniors that for … six, seven, eight months and expect them to keep swallowing it," he said.