Residents in Canada’s long-term care (LTC) homes were particularly affected during the first two waves of the pandemic, which led to very high rates of severe illness and death.
How the first three waves unfolded in Canada’s LTC homes
||LTC resident deaths
||Impacts on LTC residents and interventions
|The first wave March 1, 2020, to August 31, 2020
Dominant SARS-CoV-2 strain: wild-type (original)
- 74% of Canada’s COVID-19-related deaths during this period occurred in LTC settings (2, 3).
- The total number of resident deaths was 5,948 (4).
- Ontario and Québec reported a higher number of deaths compared to other provinces (4).
- Facilities were not well prepared to deal with outbreaks.
- There were shortages in personal protective equipment (5).
- The onset of the pandemic was marked by fewer physician visits to LTC homes and fewer transfers to hospitals for the treatment of chronic conditions and infections (3).
- There were staffing shortages due to healthcare workers being infected with COVID-19. For this reason, Ontario and Québec requested the assistance of the Canadian Armed Forces (CAF) to assist with the severely impacted homes (6). The CAF reported inadequate infection prevention and control practices (e.g., insufficient medical supplies and training, personal protective equipment not available) in Ontario LTC homes (7).
- There were no vaccines available.
|The second wave
September 1, 2020, to February 28, 2021
Dominant SARS-CoV-2 strain: wild-type
- Deaths remained high, with 61% of Canada’s COVID-19-related deaths occurring in LTC homes during the second wave (2, 3).
- The number of deaths was 5,204 in LTC residents (4).
- Some provinces, including Quebec and Nova Scotia, managed to reduce deaths compared to the first wave, while others faced an increase in mortality among residents (4).
- This wave saw greater community spread and more LTC homes experiencing outbreaks, meaning a higher number of residents were infected (2).
- There were reported shortages in personal protective equipment in 2020 (5).
- Up until December 2020, roughly four out of every five nursing homes were regularly testing residents and staff for COVID-19 (8). Provinces like Ontario have been testing since May 2020 and rapid tests were made available in long-term care homes in November 2020 (9, 10).
- Because of the high death count in the first wave, LTC residents were identified as a top priority for vaccination by the National Advisory Committee on Immunization (NACI). Between January 15 and March 31, 2021, 95% of LTC residents in most jurisdictions had received their first dose of the vaccine, compared with only 3% of the general population (2, 11).
|The third wave
March 1, 2021, to August 15, 2021
Dominant SARS-CoV-2 strain: Alpha (higher transmissibility than wild-type)
- There was a major reduction in the number of COVID-19 deaths among LTC residents (5).
- The total during this wave was 505 deaths (4).
- In fact, the number of deaths reported in LTC homes during the third wave fell below the expected number for that time period, based on the average of the last five years. (4)
- The reduced number of deaths may be attributed to vaccines and improved infection and control measures (5).
- Many facilities reported regular use of masks, gloves, or gowns. There was also a reconfiguration of furniture, regular testing for SARS-CoV-2 among staff, visitors, and residents, and/or an increased use of virtual care services (5).
* Note that data from August 15, 2021, onwards for the other waves were not available at the time of writing. As of July 5, 2022, there were a total of 39,725 deaths in long-term care homes in Canada (12).
Figure 1 : COVID-19 deaths in long term care (LTC) homes per 100,000 people by pandemic waves.
(Adapted from Canadian Institute for Health InformationSources used by CIHI:
National Institute on Ageing. NIA Long Term Care COVID-19 Tracker , 2020–2021 (pandemic LTC deaths). Accessed August 17, 2021.
Alberta Health Services, accessed October 8, 2021, and Saskatchewan Ministry of Health, accessed September 14, 2021 (pandemic LTC deaths).
Statistics Canada. Population estimates, 2020. Accessed August 17, 2021.
, as accessed on 08/31/2022) (4).
Older people have experienced higher rates of severe disease and death due to COVID-19 throughout the pandemic
Figure 2 : Age distribution of COVID-19 deaths, hospitalizations, and ICU admissions in Canada as of September 16, 2022 (1) (adapted from Health Infobase Canada, as accessed on 09/21/2022).
By September 16th, 2022, the cumulative toll on older Canadians since the start of the COVID-19 pandemic had been very heavy:
- People over 70 years of age accounted for 82.1% of the total number of COVID-19 deaths reported in Canada, with those aged 80 years and older accounting for 60.7% (1).
- People over 70 years of age accounted for 49.7% of all hospitalizations associated with a SARS-CoV-2 infection in Canada, and 34.9% of intensive care admissions. Of these, people aged 80 years and older comprised 29.3% of all hospitalizations and 11.7% of all intensive care admissions (1).
Figure 3 : COVID-19 weekly deaths from January 1, 2022 to September 1, 2022 in Canada across age groups (adapted from Health Infobase Canada, as accessed on 09/01/2022)