COVID-19 Hits Long-Term Care Patients Hardest

COVID-19 is still spreading, even as many students are returning to school.

The virus has infected well over 5.5 million people in the U.S. with over 174,000 deaths. While some population segments are doing better, the most vulnerable are still at great risk.

The latest statistics reported by the New York Times reveal while only 8% of all US COVID-19 cases are from long-term care facilities, 41% of the total COVID-19 deaths come from these facilities.

In at least 20 states, half the deaths are from nursing homes. States like New Hampshire (81%), Rhode Island (79%) and Connecticut (73%) have the highest percentage of COVID-19 related deaths that happen with long-term care patients.

The Centers for Disease Control and Prevention and The Center for Medicare Services have guidelines and plans for nursing homes and long-term care facilities.

Some of these recommendations include things like a dedicated full-time person trained in infectious control and prevention, alternate visitation models and expanded testing.

At present, it is unclear what kind of resources these facilities have already and what resources they need to continue fighting this virus.

The U.S. has over 17,000 nursing homes with a typical census of around 25 patients.

Many of these facilities do not have the additional resources to battle COVID-19. It is a financial problem. There simply is not enough money.

Small nursing homes already run on a shoestring budget. Other facilities simply do not have the staff. Hospitals and long-term care facilities have faced a nursing shortage for decades. This often-ignored problem has now reached a tipping point.

Dedicated staff cannot take off. The need to be extra vigilant during this pandemic has pushed nursing home staff to their limit; no extra staff are available in the event key personnel get infected or even exposed.

Exposures can cause a 14-day quarantine period for much needed employees, but an infection could take someone off the floor for months.

The problem is three-fold.

First, the public is not taking the issue seriously.

Long-term care facility patients who are infected with COVID-19 are five to six times more likely to succumb to the disease.

This population segment already faces serious health challenges. The coronavirus simply raises that to epic proportions. The mortality rate for the average infected American is 3.1%.

This, in and of itself, should cause the public to take this pandemic seriously. When one factors in the grave risk to older patients, especially those in long-term care, we should be sounding alarms and sirens.

The most serious call to take action comes from John Hopkins, which has tracked COVID-19 cases and mortality rates all over the world.

They have detailed several industrialized countries like Belgium (12.4%), the United Kingdom (12.8%), Italy (13.8%), France (11.9%) and Mexico (10.9%), which have excessively high COVID-19 mortality rates and many of these have access to the same advance therapies as the U.S. These rates are approaching the mortality rate of the 1918 flu pandemic.

While it is too early to compare the mortality rates of COVID-19 with that of the 1918 pandemic, a lot can be learned from that crisis.

The flu pandemic of 1918 had a 10% mortality rate and did not have access to today’s advanced therapies.

Many experts link the high mortality rate to the poor application of public health policies like hygiene, limitation on public gathering, social distancing and quarantines.

Others point out most of the world was focused upon the first world war and not the public health crisis.

It is difficult to determine what best practices should have been over 100 years ago, but it is clear the use of personal protective equipment, isolation of vulnerable populations and social distancing would have greatly reduced the mortality rate.

The same is true for COVID-19. We do not know when a safe vaccination will be available or when new medical technology will come online.

What we do know is that good public health strategies reduce the rate of infection and saves lives.

Second, not enough resources are being directed to our smaller nursing homes.

Those in nursing homes are vulnerable populations who deserve to be treated with respect and dignity. Helping them get more resources is part of that.

From ancient times, the moral value of a society has been judged based upon how it treated its most vulnerable populations.

It is not only the moral thing to do, it is the smart, utilitarian approach. As more and more nursing home patients become infected, it increases the risk for nurses and staff who work in those facilities.

These employees then run the risk of infecting their spouses and children who then take the virus to work or school.

Third, there is a lack of timely, reliable data being provided by the CDC and Department of Health and Human Resources.

Some of the best data available to the public comes from John Hopkins or media outlets like The New York Times, which have taken the time to compile mass amounts of data from different states and in some cases individual facilities.

The lack of publicly available data does two things.

First, it slows the development of best practice. What public health strategies are the most effective? Which ones failed completely? We have problems confirming the answers to these questions since data comes out slowly or not at all.

Second, it generates a lack of trust in the work of public health officials. This causes the public to question the wisdom of the administration or simply ignore public health policy altogether.

For example, most Americans know COVID-19 is more dangerous for older populations, but they have no clue how devastating it has been or the high mortality rates in Western Europe.

Those that have seen these statistics are not even sure if they are reliable, due to mistrust of the government.

It is time we have a serious discussion about the risk our most vulnerable populations face during this pandemic.

In order to do that, we must take the threat seriously. Then, we need to look at the most accurate and reliable data so we can determine which resources will help reduce the risk for our hardest hit segments of society.