As the COVID-19 pandemic hit the state, particularly southeast Michigan, it became clear that this virus is most severe to our senior citizens. A shocking 69% of all of Michigan’s confirmed COVID-19 deaths were people over the age of 70. The average resident in our nursing facilities is 82 years old, often with multiple medical conditions. Therefore, it is no surprise that these individuals are particularly vulnerable once the virus enters a facility.
Through June, 46% of the state’s nursing facilities have reported no COVID-19 cases, and a significant number have reported fewer than 10 cases. This raises the question of what causes the spread in some nursing facilities but not others. The answer to that question will help determine proper policy going forward to prevent and curtail the spread among this highly vulnerable population in this highly vulnerable setting.
Research recently released by Harvard Medical School and the University of Chicago has important findings related to COVID-19 in nursing facilities that not only help explain the primary factors causing the spread, but also what does not cause it. The studies conclude that the prevalence of COVID-19 in a community is the main predictor of the virus entering a nursing facility, with larger facility size also being a factor. It further shows that no correlation exists between significant COVID-19 outbreaks in nursing facilities and various measures of overall nursing facility quality, such as the national Five Star rating system that rates all nursing facilities based on surveys, staffing levels and quality measures.
According to David Grabowski, professor of health care policy at Harvard Medical School, “COVID-19 cases in nursing homes are related to facility location and size, not traditional quality metrics such as 5-star rating and prior infection control citations.”
Tamara Konetzka, professor of health services research at the University of Chicago, found “no meaningful relationship between nursing home quality and COVID cases or deaths.” Another study recently published in the Journal of the American Geriatrics Society reached the same conclusions.
Researchers from Genesis HealthCare, Brown University and Florida Atlantic University found that COVID-19 prevalence in the surrounding community and higher number of beds were the most significant and consistent predictors of large outbreaks and mortality rates among nursing facility residents — not a facility’s Five-Star Quality Rating or infection control citations.
At the onset of the pandemic, nursing facilities were not a top priority at either the federal or state level for adequate staffing, personal protection equipment (PPE) and testing. Attempts to control the outbreak and spread of COVID-19 in nursing facilities instead focused on identifying individuals who exhibited symptoms of COVID-19 and prohibiting their contact with residents and staff in nursing facilities. However, data from the Centers for Disease Control and Prevention (CDC) now show that individuals without symptoms — “asymptomatic” and “pre-symptomatic” individuals — infect multiple people without ever showing signs of the virus themselves.
Given that the virus is often spread by individuals who are asymptomatic, the research notes that if a community has a high prevalence of COVID-19, there is simply a greater risk of new nursing facility residents or staff serving as infection sources. Larger facilities accept more admissions and have more employees, thus they encounter more movement of people to and from the community.
This research tells us that the best way to prevent and curtail the spread of COVID-19 in nursing facilities is to do whatever possible to prevent it from getting a foothold from the larger community in the first place. Providing sufficient PPE for staff and conducting more testing with immediate results are critical to this effort. Only through broad and aggressive testing that delivers immediate results can facilities identify those infected — staff and residents — and quickly take appropriate measures.
Although the state of Michigan has recently implemented short- and long-term strategies to establish universal baseline testing and ongoing testing of all nursing facility residents and staff — a measure which we support — it still takes too long to receive the results. A new testing instrument to be distributed soon by the U.S. Department of Health and Human Services (HHS) promises to deliver results in minutes. If this works as suggested, it will give nursing facilities the capability to screen and test both residents and staff and provide the means to swiftly mitigate the spread of the virus.
Testing with quick results is also important to allow residents to visit with friends and family in person once again. Current restrictions have proven difficult for residents, families and staff. For visits to occur in a safe manner, adequate supplies of PPE and proper testing are essential.
We didn’t create this pandemic or choose to have it come upon us. There is no blame or finger pointing. We can make an enormous difference in the outcome of the COVID-19 battle in Michigan nursing facilities with the support from the state and our healthcare partners if we focus on the correct, research-driven solutions.
Please click HERE for further details on the research referenced above.
Health Care Association of Michigan