HALIFAX -- Shared rooms and staffing shortages were among the key factors contributing to a COVID-19 outbreak at a Halifax long-term care home that killed 53 residents last spring, according to two experts who led an external review.

Nova Scotia infectious disease consultant Dr. Chris Lata and former British Columbia associate deputy minister of health Dr. Lynn Stevenson, say community transmission and inconsistent cleaning also led to the outbreak at the Northwood facility.

The review was commissioned by the province and the two experts' recommendations were released Monday in an executive summary. Lata and Stevenson recommend more support for the long-term care sector and that the province strengthen its response to infection prevention and control.

"There's no such thing as a zero-risk scenario," Lata told reporters Monday. "But we can mitigate risk."

The outbreak at the 485-bed Northwood facility between April 5 and May 2 affected 246 residents and 114 staff, who tested positive for COVID-19. Lata said although a lot of preparation had been done ahead of the outbreak, the size of the Northwood facility played a role in the contagion.

"The sheer amount of spread and the high percentage of asymptomatic transmission of this virus really impacted Northwood's ability to respond -- given it's incredibly high occupancy -- in a way that would have quelled this outbreak very quickly," Lata said.

The facility's capacity has to be reduced, Lata said. But, he added, coming up with a precise number of beds is difficult. He noted that Northwood had created a 30-bed ward for COVID-19 patients, which he said was quickly overwhelmed by the size of the outbreak.

All that can be recommended, Lata said, is that more space be created in an effort to help limit potential spread in the future. A broader review on the long-term care sector by the Health Department says immediate action should be taken to ensure rooms at long-term care facilities house no more than two residents.

Health Minister Randy Delorey told reporters Monday that since 2007, new long-term care facilities are built with single rooms and private bathrooms. More than 55 per cent of the rooms in the province are now single rooms, he said.

Delorey said there are now 90 beds that are being reserved at Northwood in the event of another outbreak. "We know that 30 wasn't enough for a major outbreak at a facility of that size and complexity, but what the final number should be we will have to dig a little deeper," he said.

Lata and Stevenson recommend the province and the long-term care sector review and update pandemic plans, create a mobile infection prevention and control team in each health zone to support facilities facing outbreaks, and hire more people to work in housekeeping and in resident services.

The experts also said an improved communications plan is needed for residents and their families when visitation is restricted.

The province said it would commit $26 million this year and another $11 million over the next two years to implement the recommendations.

"We know that there's more to be done, we know we have to do better and we are committed to doing so," Delorey said.

Northwood said Monday in a news release it would review the recommendations before commenting in any detail. The facility noted that it had already reduced its occupancy.

"We will maintain some shared accommodations for scenarios such as couples who want to live together, or those who prefer to have a roommate," spokesman Murray Stenton said. "It is essential that we learn from this experience and do everything we can to maintain the well-being of our residents."

Progressive Conservative Leader Tim Houston said the review in many ways "stated the obvious," adding that he believes there is still more that's not known about the outbreak because there wasn't the transparency of a full public inquiry.

NDP caucus chair Susan LeBlanc said she was disappointed there wasn't a recommendation of one person per room in long-term care facilities, saying there is plenty of evidence to suggest that would have an impact on infection spread.

Nova Scotia has reported 65 total deaths attributed to the novel coronavirus.

This report by The Canadian Press was first published on Sept. 21, 2020.