When you look at British Columbia so far, there is quite a difference in the probability of an outbreak in a contracted care home versus a health authority owned and operated care home. That is a very clear pattern that's established. I think 8% of the outbreaks are in owned and operated sites, yet owned and operated sites are 37% of the sites. There is quite a difference here.
The PPE issue is, I think, complicated because part of it is the lack of understanding of the appropriate use of PPE. This is something strong clinical leadership can help in a care home setting. It's not clear. When we get all the data and we can sort through all of it and look for the patterns around that strong clinical leadership, for me, one of the litmus tests is when I hear a care home talk about N95 masks and the care home has no outbreak. You don't use an N95 mask in a situation where there is no outbreak.
There is the issue of the supply, writ large, and then the appropriateness of the use of PPE, irrespective of the supply. When we talk about our not being prepared.... I've spent 20 years in delivering both home care and long-term care, and here is my observation: We completely underestimated—for want of a better term—the freak-out factor.
We are accustomed to outbreaks in long-term care. We handle them every year. We had 185 of them last year in British Columbia. We have protocols and we notify, but those are influenza and norovirus. We completely underestimated that, when it was COVID-19, we needed....
This is where I think that, in British Columbia—because we had the first outbreak and perhaps because in the first outbreak the care home wasn't able to respond—public health got in there and saw how quickly it needed to get in there and take control, and then was able to keep doing that. I think that is what has happened in British Columbia. It is public health's going in right away. When I look at what has happened in other parts of the country, that wasn't as quick off the ground, in part because we had the first outbreak here.