According to a Wall Street Journal account yesterday, the number of US coronavirus fatalities tied to long-term care facilities and nursing homes exceeded 51,000. “Death among senior-care center staff and residents appear to represent at least 40 percent of the overall count,” the newspaper reported.
The number of COVID-19 cases in these facilities is at least 250,000, as reporting lags and information is incomplete and untimely. Consistent with early clinical reports, the virus is lethal in this fragile population.
According to the report, many states are struggling to strike the right balance between allowing families of nursing home residents to reunite while preventing the virus from silently finding its way back into the quiet, dark corridors and still rooms. As the weather grows warmer, a few facilities have shifted to allowing outdoor visitation. The Centers for Medicare and Medicaid Services (CMS) has abdicated giving guidance in favor of the states, and local officials who are still unprepared to “reopen” are scrambling to issue new rules.
More concerning, Politico reported on Monday that only 50 percent of all US nursing homes had been through recent inspections, prompting CMS chief Seema Verma to issue a warning that states needed to complete their surveys by the end of July or face losing federal recovery funds. Findings published last week by CMS noted that of 5,724 inspection surveys released by the federal government this month, only 3 percent had found any discrepancies.
“These data show a dramatic and implausible decline in infection control deficiencies. Less than three percent of infection control surveys since March cited an infection control deficiency, and 161 of 163 of the deficiencies were classified as causing residents ‘no harm.’ Even if some additional deficiencies were cited but are not publicly reported because the facilities have appealed them, the number of reported deficiencies is startlingly low.”
Translated into plain English, this means that nursing homes are lying wholesale about the conditions that prevail in what have become deathtraps for tens of thousands of elderly people unfortunate enough to live in them, and the Trump administration is doing nothing about it.
Nursing homes have been a focal point of the coronavirus pandemic since it first began in the United States. On February 28, the public health department for Seattle and King County was notified of an elderly female patient recently admitted to a local hospital that tested positive for COVID-19.
A resident of a skilled nursing facility in King County, Washington, she first developed respiratory symptoms on February 19, which progressively worsened, necessitating oxygen, and was then transferred for emergent treatment on February 24 to a nearby hospital. She had high fevers, fast heart rate, labored shallow breathing, and was acutely oxygen-deprived. She also suffered from obesity, diabetes, and high blood pressure, including an assortment of other ailments. An astute clinician was able to obtain a COVID-19 test kit from the CDC that confirmed her diagnosis. She was intubated on February 25 but died on March 2.
A case investigation conducted by the CDC at the nursing facility found that by March 18, a total of 167 cases of COVID-19 had been diagnosed, of which 101 were residents of the facility and 50 staff at the nursing home. Fifty-five residents needed hospitalization, and 34 died. Additionally, by March 18, CDC found an alarming 30 long-term care centers had identified at least one COVID-19 case in King County. On March 13, CMS had ordered nursing homes to cease all visitations.
More than three months later, the United States has 2.2 million cases of COVID-19, with close to 120,000 deaths.
The application of a Trumpesque approach to all social functions of the nation appears to be par for the course, but one with deadly consequences for the most vulnerable population. Routine inspections of long-term facilities were paused in March. Instead, they requested focusing state resources on inspecting these nursing homes for infection control practices. Yet, two months into the shutdowns, state inspectors had barely visited half these care homes. Many conducted their surveys remotely.
Arguably, such a lack of oversight has contributed to the horrific rates of infection amongst nursing home residents as any accountability for ensuring essential controls has fallen by the wayside. This makes the prospect of “reopening” even more troubling.
In a report released on June 15 by the CDC, outcomes among 1,320,488 laboratory-confirmed COVID-19 cases from January 22 to May 30, 2020 found a cumulative incidence of 404 cases per 100,000 persons with equal distribution between genders. The elderly, specifically those over the age of 80, had the highest rate. Of 599,636 cases with known racial demographics, 45 percent of the total, 36 percent were white, 33 percent were Hispanic, and 22 percent were black.
As previously noted, chronic health conditions like heart disease, diabetes, and chronic lung disease were common, leading to higher rates of hospitalization among these cases. Overall, 14 percent of patients were hospitalized, 2 percent were admitted to an ICU. They also noted that 5.4 percent of confirmed COVID-19 patients had died. Those with underlying health conditions were 12 times more likely to die than those without chronic medical health issues.
With 18 states reporting a rise in new cases over the last week and several with more than a 50 percent day-to-day jump in new cases, concerns are rising that measures need to be reinstituted to regain control of these outbreaks. Dr. Anthony Fauci told the press Sunday, “It’s going to be really a wait and see. My feeling, looking at what’s going on with the infection rate, I think it’s more likely measured in months rather than weeks before restrictions can be rolled back.”
Meat processing facilities and prisons continue to be hotspots for large clusters of COVID-19 cases. While prison populations continue to be hotspots for the pandemic they are frequently disregarded by prison administrators and states. The Marshall Project, in association with the Associated Press, has been tracking the COVID-19 statistics in prisons. By June 9, at least 43,967 people in prisons had been tested and confirmed with COVID-19, an 8 percent increase over the previous week. Over 500 have died.
As of June 12, Ohio’s Marion Correctional Institution had 2,439 cases, Pickaway Correctional Institution in Ohio, 1,791 cases, Trousdale Turner Correctional Center in Tennessee had 1,316, Harris County Jail in Houston, Texas had 1,283, Lompoc Prison Complex in California, 1,114, and Cook County Jail in Chicago 1,057 cases. Overcrowded facilities, inability to maintain social distancing and lack of necessary hygiene supplies have created a disastrous situation for inmates.