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Why Have Nursing Home Outbreaks Continued?

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by

James A. Bacon
in

by Carol J. Bova

In a July 29 tele-press conference, Dr. Norman Oliver, Virginia’s Commissioner of Health, said, “We’ve made a concerted effort at testing in nursing homes and other congregate settings. … We’ve done 456 such point prevalence surveys [PPS] covering all of our skilled nursing facilities and correctional facilities.”

As of June 5th, the Department of Health had recorded 224 outbreaks with 5,230 cases in long term care facilities (LTCF) — nursing homes, assisted living and group homes — and 30 outbreaks in correctional facilities with 1,568 cases.

By August 5th there were 100 more outbreaks with 3,090 additional cases in nursing homes and similar facilities, and 18 more in correctional facilities with another 1330 cases.

That’s a total of 372 facility outbreaks, 11,218 cases, from the 456 facilities where PPS testing was carried out. There have been no recent statements on what impact the PPS testing had in reducing cases. Did the testing come too late in the pandemic, or did outbreaks occur in spite of the testing because of infection control failures?

The VDH 2020 News Releases don’t mention how many infection control assessment inspections have been made in nursing homes or anything about the results.

With the controlled environments of long term care facilities, it makes no sense that the outbreaks should be continuing unchecked.

Note: VDH shows the only total number by Health District for all outbreaks and outbreak cases. Statewide, besides LTCF and Correctional facilities, the other three categories of outbreaks included in the list are:

Congregate Settings: 221 outbreaks, 3041 cases
Healthcare Settings: 48 outbreaks, 405 cases
Educational Settings: 29 outbreaks 126 cases

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16 responses to “Why Have Nursing Home Outbreaks Continued?”

  1. James A. Bacon Avatar
    James A. Bacon

    Testing is only half the battle. The big question is what you do with the testing information once you get it.

  2. Baconator with extra cheese Avatar
    Baconator with extra cheese

    Last time I checked tests can take up to 2 weeks to get results. If privacy issues keep employers from letting other employees know someone is positive after a 2 week wait the damage is already done.

  3. Steve Haner Avatar
    Steve Haner

    https://www.vdh.virginia.gov/coronavirus/covid-19-daily-dashboard/

    Click the “outbreaks” tab. (They don’t want to make it EASY for you to see their failures.) There is the link to the outbreak data on the VDH website. As you can see on the daily table, it’s been steady all along. July and early August look quite similar to May. In fact July 22’s 19 new outbreak locations is the daily record so far. I’d call this out of control by any measure. But of course all of us face the risk of deeper restrictions since all that is usually reported is the aggregate numbers, not the real source of the new cases.

    I’ve been watching the CDC data. With the higher number of cases in younger people the “death by age” data is shifting a bit, but over 75% of deaths are still individuals 65 or older (it had been just above 80%). As you can see from the VDH data page, the case fatality rate inside the nursing homes is the highest by far (and BTW still 0 deaths from any outbreak in an educational setting.)

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      So the Virginia state government is yet again lying to its citizens about the failing health of their fellow citizens as a result of the state’s incompetence, and/or the state’s failures to live up to its bogus claims.

      In short, a massive state coverup in Virginia regarding deaths of its citizens has going strong in Virginia since the middle of last March and it continues at full throttle, unabated, while many die.

      1. Steve Haner Avatar
        Steve Haner

        Quite a detailed web-based reporting system for a “cover-up”. But it is fair to say they don’t want to highlight the failures to protect these facilities, which in fairness may be nigh on impossible.

        1. Reed Fawell 3rd Avatar
          Reed Fawell 3rd

          “Quite a detailed web-based reporting system for a cover-up.”

          Quite to the contrary Steve. Concocting “detailed web-based reporting systems” are the most effective kind of cover-up because this tactic fools the reader into believing they are reading and thus learning the know the truth when they in fact they are being mislead.

          Thus, many state institutions in Virginia – education, and health particularly – have become masters at generating these sorts of cover ups and lies by deploying this deception, misinformation, and propaganda, as “legitimate” information published within official state reporting portals for public consumption.

          This tactic now is also commonly used by the mass media, that disguises it’s lies, biases, and political agendas and ambitions, as “NEWS.”

          1. Steve Haner Avatar
            Steve Haner

            Yes, returning to yesterday’s topic I just howl with laughter when the talking head news idiot parrots “there is no evidence of problems with mail voting.” People that stupid and blind shouldn’t be allowed to have kids or car keys.

        2. djrippert Avatar
          djrippert

          Neigh on impossible? Maybe for incompetent plantation elite politicians like Northam. Not so hard in Maryland ….

          https://coronavirus.maryland.gov/pages/hcf-resources

  4. TBill Avatar
    TBill

    I do not understand why the nursing homes are hit so hard in our area. It does not seem to be happening here in Pittsburgh area, where we are taking care of my elderly mother, in part to keep her out of a nursing home during illness.

    Most of the zip codes here have only one or two deaths, despite many elderly. Virginia apparently is keeping secret the deaths per zip code, but if they did report that data, my zip code in Ffx probably has a lot of deaths, and they are probably nearly 100% nursing homes.

    Virginia takes the position the data analysis is sensitive top secret, so we are not told any explanation.

  5. ARL Avatar
    ARL

    The reason the outbreaks continue is because there isn’t lockdown. Caregivers work with multiple patients, go home, come back, and the cycle continues. With the lag between tests and results means 1 asymptomatic person can give it to many by the time an infection is found out. The system is ‘leaky’ but there are no fixes because of the amount of personal, close-in care that is required.

    1. cjbova Avatar
      cjbova

      ARL: The “personal, close-in care” is why infection prevention and control measures are required at all times, not just for the pandemic. If a nursing home or assisted living fails to follow those requirements, they put patients and staff at risk. James C. Sherlock has written extensively here on BR about the staffing shortages. He has “documented the extreme lack of citations by VDH inspectors for nursing home nursing staffing violations” and written about the need for improved state regulations.

      Pre-pandemic inspections documented deficiencies in basic procedures like handwashing, glove use, contamination of clean laundry. If you don’t have enough people to supervise and see that procedures are taught and carried out, or if shortcuts happen because staff have too many patients to care for properly, the disease will spread, even under lockdown conditions.

    2. TBill Avatar
      TBill

      ARL that might be true, but then that might get into sensitive explanation some might consider politically incorrect or racist hence the lack of interpretation of the data from officials.

  6. LarrytheG Avatar
    LarrytheG

    Not just Virginia…………

    Florida’s Elder-Care Facilities Buckle as Covid-19 Deaths Climb Aug. 5, 2020

    Experts warn that without the ability to test staff every time they arrive, there is no way to fully insulate the facilities

    MIAMI—Florida was one of the earliest states to lock down elder-care facilities in the coronavirus pandemic, and the move helped stave off widespread deaths at such centers in the spring. But as the state contends with a surge of new infections, those defenses have faltered, triggering a fresh round of government interventions.

    Daily fatality counts from elder-care facilities in Florida climbed to their highest level so far in the past week, with the seven-day average reaching 56 on Monday, about triple the average a month ago, according to an analysis of state data by The Wall Street Journal. Total long-term care deaths rose to 3,155 on Monday, representing about 42% of the state’s 7,526 fatalities overall, in line with the national trend. Confirmed cases among long-term care residents have plateaued in recent days.

    In June, the state began requiring facilities to test staff every two weeks. But public-health specialists say that unless the centers test staff, vendors and others for the virus every time they arrive, there is no way to fully protect the elderly residents. Staff members may become infected at home but not show symptoms, and then come in close contact with residents

    https://www.wsj.com/articles/floridas-elder-care-facilities-buckle-as-virus-deaths-climb-11596628812

    1. cjbova Avatar
      cjbova

      And the fact that 204 of 701 Florida nursing homes are rated at below average has nothing to do with the virus statistics, right? Without looking at the reports, there’s no way to tell how many “average” had staffing or infection control problems that allow the virus to spread.

      Consider this, how is it possible that hospitals caring for the most seriously ill COVID-19 patients aren’t hotbeds of contagion? Could it be they follow infection control procedures?

  7. LarrytheG Avatar
    LarrytheG

    If we look broadly and across the country – we find nursing home problems and one of the issues is caretaker mobility:

    ” The deadly outbreak of the coronavirus at a Kirkland, Washington, nursing home in early March 2020 set off a nationwide scramble to better protect the vulnerable elderly. The U.S. Centers for Medicare & Medicaid Services (CMS), the federal regulator of nursing homes, promptly issued a new rule that restricted visitors from entering facilities.

    What hasn’t been addressed is the mobility of nursing home caregivers, and how that is exacerbating virus breakouts. Not only are nursing home staff coming and going to their jobs, a significant portion are also working at more than one facility.

    UCLA Anderson’s M. Keith Chen and Elisa F. Long, and Yale University’s Judith A. Chevalier find that workers who shuttle between different nursing homes are serving as spreaders.

    In a working paper, the researchers estimate that if workers had the incentive to stay put at one facility, outbreaks at nursing homes could be reduced by an estimated 44%. That would obviously have an impact on the alarming death toll at nursing homes.
    ….
    The researchers provide empirical heft to what was well-known by major stakeholders. In March, just as CMS was putting nursing homes on lockdown, a report from the Centers for Disease Control and Prevention (CDC) mentioned care providers’ working at multiple locations as a likely source of virus spread. A study by New York State estimated that about one in four nursing home workers tested positive and thus were likely a main source of virus spread.

    The culprit here is a system that effectively encourages (if not outright forces) workers to shuffle among multiple facilities. Many nursing homes rely on staffing services to deliver workers on a just-in-time/just-as-needed basis, rather than directly hire full-time staff.”

    https://www.anderson.ucla.edu/faculty-and-research/anderson-review/nursing-networks-covid

    ….. staffing services… hmmmm

    I would think that a care provider who is going to work in multiple facilities would not be a good thing no matter the other infection-control practices.

    I’m actually a little surprised that the CDC itself has not provided guidelines that address this… CMS actually did lockdown facilities from “visitors” but apparently not caretakers who work at multiple facilities.

    And you probably find this to be the case at more urbanized facilities and less so in more rural areas… right?

    Sometimes I do wonder about all of this… are we really trying to find out what the problem is?

  8. cjbova Avatar
    cjbova

    FOR IMMEDIATE RELEASE – August 7, 2020
    Maria Reppas, Communications Director, Maria.Reppas@vdh.virginia.gov
    Sharp Increase in COVID-19 Data for August 7 Due to Data Backlog
    From Previous Two Days

    (Richmond, Va.) — Today, the Virginia Department of Health (VDH) announced that the COVID-19 data numbers that will be posted on Friday, August 7 will contain a significant increase due to a data backlog from earlier in the week.

    Today’s data will indicate 2,015 new cases. This figure includes information that should have been reported on Wednesday and Thursday of this week as well as the regular numbers for Friday.

    Late Thursday, VDH’s Office of Information Management, which helps manage VDH’s COVID-19 databases, identified and rectified the technical issue, which was a system performance configuration.
    ——————-
    Today’s numbers include 11 new outbreaks.
    2 in Long Term Care Facilities – 35 cases
    6 in Congregate settings – 36 cases
    1 Healthcare settings – 5 cases
    0 in Correctional Facilities – but 48 new cases
    2 Educational Settings 12 cases

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