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Nursing properties create a "good storm" for Covid outbreaks as circumstances and deaths proceed to rise

Sr. Jeanne Arsenault will return to her room at St. Chretienne Retirement Residence, a home for Catholic nuns in Marlborough, MA, after breakfast on August 26, 2020. Arsenault contracted COVID-19 during the outbreak.

Craig F. Walker | Boston Globe | Getty Images

The coronavirus death toll in U.S. nursing homes at the start of the coronavirus pandemic was brutal and relentless.

The Life Care Center nursing home outside Seattle, Washington, made international headlines in March after the coronavirus hit its residents and employees, causing at least 123 infections and dozens of deaths. In New Jersey, officials discovered 17 bodies dumped in a makeshift morgue in a nursing home in April when Covid-19 deaths overwhelmed the facility.

Nursing homes in the US, home to the most vulnerable populations, quickly became zero for countless coronavirus outbreaks in the US during the first few months of the pandemic. While the outbreak subsided somewhat this fall, long-term care facilities in Covid-19 cases have seen the sharpest increase since at least the summer.

With new cases breaking record after record most days, infections in long-term care facilities hit new weekly highs in late November, according to the Covid Tracking Project, an organization launched by The Atlantic. More than 46,000 infections in these facilities were recorded in the worst week in six months. reliable data only goes back so far.

Although only 5.7% of all Covid-19 cases in the US were affected, residents and employees of nursing homes and assisted living facilities accounted for 39.3% of deaths, according to the Covid Tracking Project. This number is generally considered low as many nursing home deaths are usually reported with no underlying cause, doctors say.

The death toll in U.S. nursing homes for the week ending November 26 was over 3,000 – the highest weekly death toll since June, which resulted in over 100,000 deaths according to the Covid Tracking Project.

"I have compared nursing homes to a tinderbox. It takes one person, one person, to unwittingly get the virus into a facility, and it could kill several people and make many people sick," said Dr. Joseph Ouslander. a geriatrician at Florida Atlantic University who works as a nursing home clinician. Regardless of the precautions employees take, preventing outbreaks in nursing homes will be difficult, said Ouslander, who is also a professor of integrated medicine. "All of these elements of the perfect storm are there."

An advisory board from the Centers for Disease Control and Prevention voted on Tuesday 13th and 1st Tuesday to give the country's first doses of vaccine to health care workers and residents of long-term care facilities.

For this reason, according to Ouslander and other researchers, controlling its spread in the outside world is one of the most important lines of defense in protecting long-term care residents.

"We can only stop the cases and deaths in nursing homes if we stop the community from spreading," said Tamara Konetzka, a professor in the University of Chicago's Department of Public Health Sciences who specializes in long-term care research.

Community diffusion in the US is currently widespread. New cases are rapidly emerging across the country this fall, with hospital admissions for Covid-19 currently rising 5% or more in 38 states over the past week, according to a CNBC analysis of the latest data from the Covid Tracking Project. More than 13.7 million U.S. coronavirus cases have been confirmed with at least 270,000 deaths, according to Hopkins data.

Of the 46 states and Washington D.C. for which long-term care data has been regularly reported over the past two months, 44 cases are increasing.

The data also includes assisted living facilities where there is a risk that outside workers may bring the virus into the home, said Sheryl Zimmerman, co-director of the Aging, Disability and Long-Term Care Program at the University of North Carolina at Chapel Hill & # 39; s Center for Health Research. However, Zimmerman said that while care residents are often older, they are generally in better health than those in nursing homes.

In both types of long-term care facilities, residents are older. More than half of residents in assisted living facilities are 85 years or older, Zimmerman said. According to a 2015 report by the Centers for Medicare and Medicaid Services, more than 80% of nursing home residents are over 65 years of age.

This population group is particularly vulnerable to being infected by the virus – and dying. According to the CDC, the death rate from Covid-19 is 220 times higher among 75 to 84 year olds than among 18 to 29 year olds. Among the 85 year olds and older, the rate is 630 times higher.

Improvements have been made

If the experience of the Gold Crest Retirement Center in Adams, Nebraska is any indication, the surge in coronavirus cases in long-term care facilities this fall could be even worse.

Gold Crest was one of the first Nebraska facilities to record a case of Covid-19 in the spring, Executive Director Jeff Fritzen told CNBC. Gold Crest ended up with 20 cases, 12 in his assisted living unit and eight in his nursing home. Three residents died in those early months.

"When we had our outbreak here in Gold Crest in April, Covid was somewhat unknown in the area," said Fritzen, whose rural facility is about 30 miles south of Lincoln, the state capital.

In Gage County, where Adams lives, over 1,200 coronavirus cases have now been confirmed from around 21,500 people. Gold Crest has managed to protect its residents from Covid-19 – although more than a dozen employees have tested positive in the past three months, Fritzen said. You haven't had a single positive coronavirus case in a resident since April. He credits weekly Covid-19 tests with government-provided quick kits, wider access to N95 masks and other protective gear. This has given them a crucial layer of protection in the event that an infected employee works on one shift.

"I think testing changed the game," said Fritzen. "We can identify employees who have it and get them out of the building. We can test you for symptoms. We can test you when you are exposed."

While diagnostic tests and personal protective equipment are generally more readily available today than they were earlier in the pandemic, they are barely uniform across the country. "It's all over the map," said Konetzka.

"The problem is, it only takes one," said Fritzen. "It takes a worker to get the virus into the building and it's just trouble."

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