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Get Out of The Nursing Home

Published on April 25th, 2020

Harvard epidemiologist is warning that nursing homes are no longer the best place to house vulnerable elderly patients.  Michael Mina, an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health and its Center for Communicable Disease Dynamics, said that he believes the coronavirus that causes COVID-19 is more transmissible than previously thought. It has been difficult to keep it from spreading in a number of settings, including hospitals, cruise ships, and nursing homes.  Even with current restrictions on visitors, he said, employees regularly moving in and out of the facilities means it’s likely that additional cases will occur.

“I do think as many people as we can get out of these homes, [it] is probably better,” said Mina, also a Chan School associate professor of immunology and infectious diseases and associate medical director in clinical microbiology at Brigham and Women’s Hospital’s Pathology Department. “I think that this is an extraordinarily transmissible virus. I think it’s more transmissible than we recognize and actually preventing it from spreading within nursing homes is an extraordinary feat.”

Mina said he recognized that some nursing home residents don’t have acceptable alternative living arrangements. Absent relocation, he advocated giving the facilities resources for stepped-up surveillance, such as testing employees every few days to keep the virus from entering and nipping in the bud any outbreaks that do occur.

A virus that has already spread widely in the population requires a different response than one whose spread involves the cases already found through current testing, Mina said. If the virus has already infected many more people than testing to date has shown, that would mean that the very serious cases in hospitals today are a small portion of the total number, and that pouring resources into contact tracing might not be the best policy. If millions of people have already been infected and recovered, that would mean that the population is on the path to herd immunity — the threshold at which the level of immunity in a population naturally inhibits further transmission.

On the other hand, he said, if the current testing has captured somewhere close to the true number of cases, that would mean the virus is more virulent, with a significant proportion of cases becoming serious. It also means that efforts to suppress the virus through contact tracing are important.

“We still don’t know if this virus has infected say, 300,000 Americans or 15 million Americans,” Mina said. “And, until we really understand that difference, it’s very, very difficult to know how many people we need to be testing.”

Mina said recognition of the need for serological testing problem is widespread in the scientific community and a variety of companies are at work on them. The tests will likely take different forms, from those that must be administered in a doctor’s office to something like modern pregnancy tests that could be sold in packs at the local pharmacy and used at home.

“We have to get to an order-of-magnitude-understanding of how many people have actually been infected,” Mina said. “We really don’t know if we’ve been 10 times off or 100 times off in terms of the cases. Personally, I lean more toward the 50 to 100 times off, and that we’ve actually had much wider spread of this virus than testing … numbers are giving us at the moment.”

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