Novel coronavirus, or COVID-19, which began in December in Wuhan City, Hubei Province, China has quickly spread to virtually all parts of the globe, with more than 214, 890 confirmed cases reported to-date. Older populations appear to suffer poorer outcomes from the disease than younger populations. The vulnerable elderly who also have underlying conditions, such as heart disease, diabetes, lung disease, or a weakened immune system due to cancer or other conditions are considered higher risk for severe illness. Thus far, eight out of every ten COVID-19 deaths in America have occurred in persons aged 65 and older.
Life Care Center Nursing Home, Kirkland, Washington
This virus spreads very quickly, placing residents of nursing homes and long-term care facilities at particularly high risk. A COVID-19 outbreak was first reported in February at Life Care Center, a Seattle area nursing home, and the first U.S. death from COVID-19 was in one of its male residents who was in his 50s and had underlying comorbidities. At least 30 COVID-19 related deaths have now been attributed to this facility.
The U.S. Centers for Disease Control and Prevention (CDC) provided a detailed report on March 18th about how the outbreak proliferated through Life Care Center in Kirkland, Washington. Public health authorities in the Seattle area conducted surveillance of local nursing homes and long-term care facilities and found that staff came to work with symptoms of illness, often worked in multiple facilities, and did not follow protocols for protecting themselves when caring for an ill resident. Facility inspections revealed a shortage of personal protective equipment (PPE) and alcohol-based hand sanitizer. Administrators did not initially believe the illness outbreak was coronavirus, and once it was suspected, there was limited ability to confirm through tests.
Burlington Health and Rehab Center on Pearl Street currently has the largest cluster of COVID-19 cases in Vermont. As of March 23rd, 14 residents and one staffer have been confirmed to have the virus. Four residents who tested positive for COVID-19 died the previous week.
According to the commissioner of the Vermont health department, proper infection control practices and procedures were being followed when the outbreak occurred. The facility is now separating high-risk patients from those who are low-risk, and are considering relocating short-term residents who are there for rehabilitation purposes.
Prevent Introduction of COVID-19 into Nursing Homes
Within the last week new visitation restrictions have been placed on long-term care facilities across the U.S. in an effort to prevent this highly vulnerable population from becoming infected with COVID-19. All non-essential healthcare workers and outside visitors are banned from entering nursing home facilities until further notice. Exceptions may be made for compassionate care visits during end-of-life situations. Screening of compassionate care visitors should be conducted to ensure they are free of fever and/ or respiratory symptoms and they will be required to wash hands and wear PPE, including face masks. Compassionate care visitors, including clergy and bereavement counselors with fever and/or respiratory symptoms will not be allowed to enter the nursing home, even during end-of-life situations.
Healthcare workers must be screened for fever and respiratory symptoms at the beginning of each shift. If any staff member is noted to have fever, dyspnea, sore throat, or cough, they will be required to wear a face mask and return home to self-quarantine. Screenings should be implemented for all residents who display respiratory symptoms or fever. All resident group activities, including communal meals, games, crafts, parties, worship services, and music gatherings should be cancelled until further notice. Residents have been instructed to implement social distancing and increase hand hygiene. Routine inspections to ensure compliance with all recommendations have begun in Washington state, California, and New York, and will be extending to other states in the coming days and weeks. A COVID-19 Preparedness Checklist for Nursing Homes has been created by the CDC to help those who care for this population follow proper safety measures.
Article updated 3-24-20
Centers for Disease Control and Prevention: Preparing for COVID-19: Long-term Care Facilities, Nursing Homes
Centers for Medicare and Medicaid Services: CMS Announces New Measures to Protect Nursing Home Residents from COVID-19
Centers for Medicare and Medicaid Services: Guidance for Limiting the Transmission of COVID-19 for Nursing Homes