In nursing homes, Covid-19 deaths and infections spike, as vaccinations lag

The brutal data slipcovidnhomestatsdec20-300x271 in and out of the headlines. But the terrible toll of the coronavirus on the aged, injured, and sick in institutions is increasing in unceasing and unacceptable fashion.

Not long ago, HIV-AIDS activists crusaded against the public’s ignoring a lethal infection with the stark saying: Silence=Death. Is it becoming necessary to intone this about the relentless but seemingly tacitly accepted, coronavirus-related mortality, sickness, and suffering of those in long-term care?

As NPR reported:

“The last week of December was the deadliest yet for people in nursing homes with more than 6,400 deaths … Coronavirus vaccines are reaching more and more facilities, but many worry they won’t come soon enough to stave off a lot more deaths.”

Let’s put that toll in perspective: In one week of the holiday month, the coronavirus killed more frail people in institutions than there are undergrads enrolled at Georgetown. The disease claimed the lives of just about more long-term residents in December than there are students enrolled at George Washington or Johns Hopkins.

Dig into the data and it may grimmer than the broadcasters’ depiction.

Federal officials have estimated that 8.3 million Americans were receiving services in various kinds of long-term care, mostly nursing homes, but also hospices, and assisted living communities of different sorts.

The privately funded Covid Tracking Project estimates that by Dec. 31, 29,000 long-term care facilities had racked up 1 million-plus resident and staff infections — meaning roughly 1 in 8 of the nation’s most vulnerable have been sickened by a disease that the White House downplayed, dismissed, or ignored for much of 2020.

The tracking data from the consortium run by the Atlantic Magazine reported this grim U.S. fact:

Less than 1% of America’s population lives in long-term care facilities, but as of Dec. 31, 2020, this tiny fraction of the country accounts for 38% of U.S. Covid-19 deaths.”

In Maryland, the deaths have been statistically worse, at 48% of the coronavirus total. In Virginia, they are 46% of the total, while in the District of Columbia, they amount to 22%.

NPR’s Alisa Chang interviewed long-term care experts, including owners, operators, and academics. Here’s a slice of the conversation, along with her journalist-colleague Will Stone:

Tamara Konetzka: Unfortunately, even though we’ve been at this for so many months, not that much has changed.

Stone: That’s Tamara Konetzka, a professor who studies long-term care at the University of Chicago. She says the research is clear. Even the best-run nursing homes are not impervious to outbreaks when there’s a reservoir of disease in the surrounding city or town.

Konetzka: All along, it’s just been delusional that we could have these areas with high community spread and somehow protect long-term care residents. It just doesn’t work.

Stone: Staff come and go. Some work at multiple places. And residents move in and out too. The vaccine is a key turning point, but Konetzka says it’s not a magic bullet.

Konetzka: I think it’ll dramatically reduce the number of deaths that we see. But will it eliminate the problem? Not yet.

Stone: There will need to be multiple rounds of vaccination to deal with the churn of staff and residents. In Pennsylvania and many states, at least half of all Covid deaths are linked to long-term care. Zach Shamberg leads an industry group in the state. He says nursing homes, which have struggled to get PPE [personal protective equipment], remain desperate.

Zach Shamberg: Since Day One of the pandemic, we have fought for one thing, and that’s prioritization. And it’s no different now than it was 10 or 11 months ago.

Stone: Some of Shamberg’s members aren’t scheduled to get the vaccine until late January or even early February. Elaine Ryan with AARP says there just hasn’t been enough transparency about nursing home outbreaks and now vaccines.

Elaine Ryan: It is an American tragedy. It’s a national disaster. It’s not that we don’t know how. There is a lack of accountability.”

Another key data point to consider about the coronavirus and long-term care comes from the federal Centers for Disease Control and Prevention, which posts information about the nationwide roll-out of the virus vaccine. Yes, the data can take time to report and it may fall behind. The numbers also may reflect the current plans (which President-elect Biden has said he will reverse) of holding back supplies to guarantee that patients get the required two doses of the currently available vaccine.

But the CDC, as of Jan. 7, reported that ~3.8 million doses of vaccine had been provided to private, commercial pharmacies that the federal government has contracted with specifically to vaccinate long-term care residents. The pharmacies had given the first dose of the vaccine to 603,000 residents and staff at nursing homes and other similar facilities.

The snail’s pace of the vaccination programs has resident advocates fuming.  Dr. Michael Wasserman, past president of the California Assn. of Long-Term Care Medicine, which represents doctors, nurses and others working in nursing homes, told the Los Angeles Times:

“Clearly nobody cares if old people die. We could get all of these places vaccinated quickly if we approached it the right way.”

The newspaper also reported:

“Wasserman blames the federal government for failing to set up a streamlined plan and directly oversee delivery of the vaccine. Instead, crucial decisions about who gets the shots first have been left up to state and local governments, and the work of actually administering the shots has been left to large national pharmacy chains — CVS and Walgreens …”

While the pharmacies defend their work, which started up in December, critics also question the paper blizzard required to vaccinate the vulnerable, the Los Angeles Times reported:

“Among the obstacles is bureaucracy: the sheer amount of labor required to fill out forms and upload data to ensure consent was obtained and that each dose is tracked. ‘It’s just crazy,’ said Jeff Sprinkle, administrator of the Lake Minnetonka Care Center, a home with only about 20 residents in Deephaven, Minn. When a crew showed up to administer the shots in late December, they had six people with them, more than could safely fit in the small break room used for the vaccinations given social distancing requirements. And three of those people were there only to “input information into their database,” Sprinkle said. It took 7½ hours for the team to vaccinate everyone, a task that could have been completed by a single nurse in the same time without all the paperwork, Sprinkle said.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by neglect and abuse at nursing homes and other long-term care facilities. These enterprises were part of an industry that already had significant problems with the quality and safety of their care, notably with issues in basic hygiene, infection-control, and staffing.

The pandemic, however, has laid bare the paltry official oversight and forward thinking about how our society must care for the aged, injured, and chronically ailing. The shambolic federal coronavirus response, including the failed efforts of nursing homes’ chief regulator, the federal Centers for Medicare and Medicaid, has been a nightmare to see. New officials cannot arrive too soon. They need to kick into an exponential gear the vaccination efforts and inspections at long-term care facilities, working with federal expertise and support for overwhelmed state and local officials.

The political partisans in Congress finally must stand down for their dubious efforts to shield long-term care owners and operators from legal liability from neglect and abuse in their facilities, as judges and juries will justly determine the wrongdoing in cases filed in the civil system. Deciding whether to pursue lawsuits against nursing homes and other facilities over their pandemic-era treatment will force residents and their loved ones to make difficult choices.

Lawmakers and regulators also need to engage a rapidly graying America to ask how we can prevent a similar calamity in long-term care, and how we can provide millions of people with safe, affordable, efficient, and excellent treatment and residences after long, productive lives. We’ve got a lot of work to do.

Credit: Graphic, The Covid Tracking Project
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