This week a new executive order in the State of Connecticut is mandating weekly testing for the SARS-Cov-2 virus which causes COVID-19 for staff across nursing homes, senior housing, and assisted-living centers. The testing will begin later this month.
"This is good news. This fixes the current major health problem of non-testing of staff at nursing homes and other senior living centers," stresses Dr. Patrick Coll of UConn Center on Aging and UConn Health's medical director of senior health. Coll also cares for nursing home residents and is the medical director of a local long-term care facility.
Nursing homes across Connecticut, just like the rest of the country, were hard hit by the COVID-19 virus. In fact, more than 60% of COVID-related deaths in the state have occurred in the vulnerable nursing home resident population who have significant care needs and comorbidities. This death rate is mirroring the nation's experience with approximately two-thirds of COVID-related deaths occurring among older adults.
"The biggest risk factor for serious illness or death as a result of COVID-19 is biological aging, with older men suffering from multiple chronic diseases being the most vulnerable," says Dr. George Kuchel, director of the UConn Center on Aging. In addition, there are increased rates of infection and death from COVID-19 among minority populations, particularly black Americans.
The first major virus outbreak in the U.S. was in a Washington state nursing homes back in February. The virus continued to spread in nursing homes in Connecticut and across the country even with early, strong mitigation efforts of protective PPE worn by staff, resident and staff temperature checks, visitor restrictions, and isolating patients inside their rooms. Even with protective PPE, nursing home staffers have very close daily contact needs with nursing home patients such as helping them to the bathroom.
"Nursing homes were designed for a pre-COVID-19 era, for example most patients sharing double rooms. This close physical proximity of residents in nursing homes has created an incubator situation for the virus causing COVID-19," says Kuchel.
"Nursing homes were and still are the main battleground for COVID-19," says Coll. "The primary vector for the spread of COVID-19 has been asymptomatic staff in nursing homes. You can have COVID and not know it and many staffers work at more than one facility."
With testing gearing up now for nursing home staff, Coll hopes frequent testing of both residents and staff will allow COVID-19 positive patients to be cohorted together and be cared for by dedicated staff, which will help decrease the virus' future spread.
Importantly, Coll recommends that resident isolation in nursing homes needs to start to be eased and family members, even if we have to begin to test them too, need to be able to regain access to their loved ones for emotional and mental health wellbeing.
"We are at a tipping point," says Coll. "The risk of continued isolation due to COVID-19 is going up and we need to pay close attention to this issue. Residents have been isolated in their rooms for more than three months. This is taking a significant toll on our older residents both physically and psychologically with the potential for severe health ramifications."
Coll is recommending, that with certain safeguards in place, long-term care residents get back to social dining, recreation and family visits as soon as possible.
There are still some big unknowns when it comes to COVID-19.
"One thing we still don't know is when a COVID-19 positive patient really stops being an infectious risk," says Coll as some research is showing it may remain in the body and its excretions for months.
According to Kuchel a greater future push for more older adults to remain at home could help reduce the spread of COVID-19 and other similar types of outbreaks in the future.
"In Connecticut we still have people living in long term care institutions who may be able to return back to the community with the right help," says Kuchel. "Dr. Julie Robison, professor in the UConn Center on Aging and her staff have a long history of working with colleagues in the state's Department of Social Services to make such transitions possible through the Money Follows the Person Program."
He adds: "Most importantly, COVID-19 will and absolutely must change how we will provide care for older adults in the future. To that end, it is critical that the state creates a task force to see how we can best prevent the next health crisis involving older adults in nursing homes, since if it is not COVID-19, there is no doubt that there will be another such pathogen for us to confront in the future."
While we await the development of a protective vaccine to prevent COVID-19, Kuchel and his colleagues at the UConn Center on Aging will soon be starting several clinical trials to find ways of better protecting the high-risk older adult population by targeting biological aging.
"Such geroscience-guided research efforts will soon be focusing on the major risk factor of aging by seeking to improve immune system responses in older adults as a way of preventing COVID-19 and its most severe outcomes," says Kuchel.
