Nursing cases and deaths in nursing homes are getting worse

After breakfast, senior Jeanne Arsenault will return to her room at the St. Chretienne Retirement Residence, home of Catholic nuns in Marlborough, Massachusetts, on August 26, 2020. During the epidemic, Arsenault fell ill in COVID-19.

Craig F. Walker | Boston Globe | Getty Images

The death of the coronavirus in a U.S. nursing home at the beginning of the coronavirus epidemic was brutal and ruthless.

The Life Care Center nursing home outside of Seattle received international news in March after the coronavirus infected residents and staff, resulting in at least 123 cases and dozens of deaths. In New Jersey, civil servants discovered 17 bodies in an makeshift morgue in a nursing home in April when Covid-19 fatalities suppressed the facility.

Nursing homes, home to the most vulnerable in society, soon became zero ground due to the myriad coronavirus epidemics in the United States in the first months of the pandemic. While the epidemic subsided somewhat this fall, long-term care facilities have seen the most intense growth in Covid cases since at least the summer.

As new cases set a record after most days, infections in long-term care facilities reached a new weekly peak at the end of November, according to data from The COVID Tracking Project, an organization launched by The Atlantic magazine. More than 46,000 infections were registered in these facilities during the most severe week of six months; reliable data only goes back that far.

Although they accounted for only 5.7% of Covid cases in the U.S., project data tracked residents and employees in nursing homes and assisted living areas accounted for 39.3% of deaths. That number is generally considered low, as many deaths in nursing homes are usually reported for no reason, doctors said.

Last week ended Thursday, U.S. nursing home deaths exceeded 3,000 – the highest weekly death since June, and the number of cumulative deaths exceeds 100,000, according to the tracking project.

“I likened nursing homes to a landfill. It takes a man, a man, to unconsciously bring the virus into a facility, and it can kill more people, get a lot of people sick,” Dr. Joseph Ouslander said. a geriatrician at Florida Atlantic University who works as a clinician in a nursing home. No matter what precautions staff take, it will be difficult to prevent epidemics in a nursing home, ”said Ouslander, who is also a professor of integrated medicine. “All the elements of a perfect storm are in place.”

The Advisory Board of the Centers for Disease Prevention and Control voted 13-1 on Tuesday to give the first doses of the vaccine in the country to healthcare workers and residents of long-term care facilities.

Therefore, according to Ouslander and other researchers, controlling spread in the external community is the most important line of defense in protecting long-term care recipients.

“We can’t stop the cases and deaths of nursing homes unless we stop the spread of the community,” said Tamara Konetzka, a professor at the University of Chicago who researches long-term care.

The community is now widespread in the United States. New cases grew nationwide with a quick clip in the fall, and the number of hospitalizations for Covid-19 last week was 5% or more in 38 states, according to a CNBC analysis of data from the latest COVID Tracking Project. According to Hopkins, there have been more than 13.7 million confirmed cases of U.S. coronavirus, and at least 270,000 deaths have occurred so far.

Of the 46 states and the District of Columbia for which long-term care data have been regularly reported in the past two months, 44 of these cases are experiencing an increase in cases.

The data also includes supported residences, which are similarly at risk of outside staff possibly bringing in the virus, said Sheryl Zimmerman, co-director of the Aging, Disability and Long-Term Care Program at the University of North Carolina Chapel. Hill’s Health Services Research Center. However, Zimmerman said residents in assisted living, although often elderly, are generally in better health than in nursing homes.

In both types of long-term facilities, residents are older. More than half of those living in subsidized residences are 85 years of age or older, Zimmerman said. More than 80% of those living in nursing homes are over the age of 65, according to a 2015 report by the Medicare and Medicaid Services Center.

This demographic group is particularly vulnerable to obtaining Covid – and to death from the virus. According to the CDC, the rate of deaths caused by Covid between the ages of 75 and 84 is 220 times higher than among those aged 18 to 29. For those aged 85 and older, this rate is 630 times higher.

Improvements have been made

If the experience of the Gold Crest Retirement Center in Adams, Nebraska indicates that the increase in coronavirus cases inside long-term care facilities could be even worse in the fall.

The gold coat of arms was the first facility in Nebraska to record the Covid-19 case in the spring, CEO Jeff Fritzen told CNBC. The Golden Coat of Arms resulted in 20 cases, 12 in supported housing units and eight in nursing homes. Three residents died in these early months.

“When we had an eruption here in April at the Gold Crest, Covid was somehow unheard of in the area,” said Fritzen, whose rural facility is about 30 miles south of the state’s capital, Lincoln.

There are more than 1,200 confirmed cases of coronavirus out of roughly 21,500 people in Gage County, home to Adams. The Golden Coat of Arms has managed to protect its residents from Covid-19 – despite having given more than a dozen positive results in the past three months, Fritzen said. Since April, none of their residents have had any positive cases of coronavirus. It credits weekly Covid-19 testing with government-provided quick kits, wider access to N95 masks and other protective gear. This provided them with key protection in the event that an infected worker gets into a shift.

“I think testing was a game changer,” Fritzen said. “We are able to identify the employees who have them and free them from the building. We are able to test for symptoms. We can examine if they are exposed.”

While diagnostic tests and personal protective equipment are generally more available than before in a pandemic, they are hardly uniform across the country. “It’s on the whole map,” Konetzka said.

“The problem is that you only need one to add,” Fritzen said. “An employee has to bring the virus into the building, and that’s just trouble.”