Nursing Home Resident COVID-19 Deaths Plunge But New Variant Poses Another Test for Operators

While nursing home COVID-19 death rates have plummeted – with just 1,000 nursing home resident and staff deaths reported over the past four weeks – some health care experts don’t think the sector is out of the woods quite yet.

Between February 20 and March 20, 1 out of every 80 nursing home residents were diagnosed with COVID-19, while about 12,000 workers tested positive for the virus. This represents a nearly 90% drop in nursing home infections since the omicron peak two months prior, according to an analysis by AARP released this week.

The rates, however, are similar to those reported in the summer of 2021, before the delta variant wave, and the fall of 2021 before the omicron surge, AARP notes.

While the new variant’s impact on case counts and deaths in the nursing home sector has thus far been relatively minimal, with cases already picking up across the northeast, health officials are urging operators to avoid becoming complacent as the next wave may already be here.

“We expect to see this virus have new variants. That’s what the way viruses work and the evolutionary pressures for new variants will be more infectious and/or escape existing immunity,” Dr. David Gifford, chief medical officer for the American Health Care Association, told Skilled Nursing News. “And so we just have to remain vigilant just like we do every year with influenza, and other respiratory viruses.”

In anticipation of the next Covid wave the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) on March 22 sent a letter to the U.S. Health and Human Services (HHS) Secretary Xavier Becerra, requesting an extension of the Public Health Emergency (PHE).

The request was made in part due to the rise in Covid variant cases.

The emergency order was extended on Wednesday for at least three more months.

“This pandemic is far from over. A surge of cases of the BA.2 variant in Europe threaten a COVID resurgence in the United States … It is clear that we are not out of the woods yet,” Parkinson wrote. “The weekly tests the federal government ships to long term care facilities are incredibly helpful, but during Omicron it was not enough, and nursing homes and assisted living communities had to compete against other businesses and members of the public to find the additional tests they needed.”

The World Health Organization said it will continue to closely monitor the BA.2 strain as there has been a rapid increase in levels of the variant in the northeast, the New York Times reported.

Dr. Noah Marco, chief medical officer for the Los Angeles Jewish Home, admitted he’s not ready to take his foot off the gas just yet.

“We’re seeing this three to four month cycle and unfortunately, because of the large number – 30% of our world – is not vaccinated that has created the opportunity for these variants,” he told SNN. “It grows and mutates at the expense of someone else.”

An additional concern is the impact a new wave will have on nursing home visitation policies moving forward.

The Centers for Medicare & Medicaid Services (CMS) has eased up nursing home visitation policies as the number of Covid cases in facilities fell significantly. But the recent emergence of both the delta and omicron variants has caused certain restrictions to return and tighten back up in some states.

“The one thing we have to still talk about and debate and learn from this in the future is what we can do that’s more patient-centered and allow people to [decide] for themselves what degree of risk they want to take,” Marco said.

Balancing safety and resident comfort

Nursing home visitation policies have been in flux since the pandemic began. Residents and their families have pushed to loosen some of the visitation restrictions enacted, while health officials have adopted a more cautious approach for the at-risk populations that reside in these facilities.

Marco said the federal government has taken a very “paternalistic approach” to protecting seniors and senior communities, leading to a trade off between reducing the transmission of the virus, and the damage that has been caused by social isolation.

As the virus’s spread has reduced dramatically in nursing homes, restrictions may have eased – but this generation of seniors is expected to have been dramatically impacted by social isolation. Some facilities have even looked into investing in behavioral health in anticipation of the effect the pandemic will have on older adults and facility staff.

While the sector must remain vigilant, Marco hopes to see more consistency with visitation policies as operators balance safety and comfort.

“We’ve gone through three large waves,” Ignite Medical Resorts CEO Tim Fields told SNN. “We’re expecting at some point there might be another wave, the good news is that the waves that have been coming have been getting less and less potent, meaning they’re not causing as much sickness.”

Gifford worries whether nursing homes will be made a priority going forward.

“We need to make sure that the medications that are out there are available for us,” he said. “Personal protection equipment seems to be okay, but it’s two to four times more expensive than it was during the pandemic.”

Administering booster shots is another way operators have looked to be more prepared for another wave.

People over the age of 50 who have received an initial booster dose at least four months ago may now receive another, the Centers for Disease Control and Prevention (CDC) announced last month, though nursing home booster clinics haven’t been as much of a priority as some in the industry would like.

While staff and resident vaccination rates are high, 87.7% of residents and 86.5% of staff, booster rates haven’t quite kept pace – 77.1% for residents and 45.6% for staff, according to recent CMS data.

Northeast surge

At one time Mission Health Communities CEO Stuart Lindeman would have said the Covid pandemic would be over when there was no more virus in his facilities, but now he admits that it’s still very much a part of everyone’s lives and it’s likely going to stay that way for the foreseeable future.

“Most of our buildings don’t have virus in them but I think as long as these variants are continuing and we continue to talk about the boosters, there’s still an emergency situation,” he said. “I’m less worried about it today than I was a year ago because we’re a lot more educated.”

With new coronavirus cases still low but rising sharply in recent days, the city of Philadelphia announced this week that it will reinstate an indoor mask mandate a little more than a month after lifting it, becoming the first major U.S. city to do so.

The decision comes as cases are ticking up across the country, fueled by the BA.2 variant. The national increase is so far relatively small — about 3 percent over the last two weeks — but the growth in cases in northeastern cities like New York City and Washington, D.C., has been significantly steeper.

Facility staff and visitors must wear masks upon entering the facility and in public spaces within the building, per previously established guidance. When visiting with their loved one in a more private setting — if there are no major health concerns — they can remove their mask during that visitation period.

However, with the new indoor mask requirement in Philadelphia, visitors at facilities within the city might have to wear a mask the entire time but providers are waiting for more clarity, according to the Pennsylvania Health Care Association.

A look at National Healthcare Safety Network and John Hopkins University data from March 20 shows resident cases throughout the state of Pennsylvania were at 146 total cases for nursing home residents and 5,113 for the general population of the state. However if previous waves are any indication, a rise in nursing home resident cases may soon follow.

In other states in the northeast, including New Jersey, New York and Massachusetts, omicron BA.2 now makes up more than half of the reported cases, according to data from the CDC.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN this week that while he recognized that Covid cases were trending up again in the U.S., he could not precisely predict what the latest variant will do.

He told CNN that the country needs to to a point transmission wise that’s “low enough that it doesn’t disrupt our population or the economy, our daily economic, workplace and social lives, which means it has to be low enough that it isn’t a serious threat to the health of the nation.”

“We are certainly seeing the beginning of a surge of new infections,” Fauci said. “It depends on how high we go up in the surge, and it depends on whether the surge is associated with an increase in severe disease.

Covid cases are trending up again in the country, driven by the growth of the new variant with the latest estimates from the U.S. CDC showing it caused 86% of the new cases nationwide.

The country is now averaging about 38,000 cases per day.