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History Repeating Itself

Published on July 16th, 2020

The Atlantic had a great article explaining how America is back to making the same mistakes we made in March when we ignored science and the warnings of experts on how to stop the spread of coronavirus. Nursing homes were ill-equipped, both literally and figuratively, to deal with the pandemic, and federal and state governments took a hands-off approach until it was too late. The lack of government leadership and coordination has led to poor and delayed data collection on deaths and infections in nursing homes. CMS did not even require facilities to report coronavirus infections and deaths that occurred prior to May 8, even though the first nursing-home outbreak began in February.

The article mentions Melvin Hector, a geriatrician in Tucson, Arizona, who went into Sapphire of Tucson Nursing and Rehabilitation and found his patient in her room, wearing a surgical mask. She had been tested for COVID-19, but the results had not yet come back. When Hector asked for a mask for himself, he says a nurse responded, “We don’t have any.”

“I say to her, ‘You’re going into the room; the other staff are going in the room. She just went out to the hospital for a respiratory disease. And we don’t have any masks in the building?’” Hector recalled in a recent interview.

“They’re on order,” Hector remembered the nurse replying.

Sapphire ended their working relationship after Hector reported the situation to the Arizona Department of Health Services. Sapphire claimed that it had never suffered shortages of personal protective equipment, or PPE. In response to Sapphire’s statement, Hector said, “They lie.”

To Hector, the episode was a microcosm of the reasons why the United States has suffered so many COVID-19 deaths among nursing-home staff and residents. “Arizona is just one manifestation of a nationwide policy, an administrative policy to ignore this pandemic until it couldn’t be ignored,” Hector told me.

More COVID-19 deaths in nursing homes are likely, and they will have been preventable. American nursing homes are chronically short-staffed and, even prior to the pandemic, were doing a poor job of controlling infections. A Government Accountability Office report published in May found that more than 80 percent of nursing homes were cited for infection-prevention deficiencies from 2013 to 2017. About half of those homes had “persistent problems and were cited across multiple years.”

Adding to the challenge is that it’s not clear whose problem the nursing-home shortcomings are. Considering CMS is tasked with nursing-home safety, if the agency doesn’t “have enough resources, they should be going to Congress and demanding those resources,” Andy Slavitt, the former acting administrator of CMS under President Barack Obama, told me.

In response to a request for comment, CMS said that although the agency does oversee facilities, nursing homes are themselves responsible for the health of residents and should work with state governments to procure PPE. Authorities kept these facilities strapped for masks, tests, and other desperately needed equipment. The tragedy of even more nursing-home deaths will be worsened by the fact that they could have been stopped. Nursing-home covid-19 deaths may seem inevitable but according to interviews with dozens of nursing-home experts, it didn’t have to be this way. For example, some nursing homes in this country and other places have remained coronavirus-free.

Many nursing homes have likewise succeeded at keeping out the coronavirus. The Maryland Baptist Aged Home, a facility in Baltimore, avoided having any coronavirus cases. Its director, Derrick DeWitt, told me that in February, when the U.S. had just 15 known cases, he paused family visits and community meals, sent vendors and delivery drivers to a separate entrance, and brought in extra cleaning crews. The staff was trained on social distancing, screened regularly for their temperature and symptoms, and asked about their social activities. DeWitt, following the guidance of Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, and New York Governor Andrew Cuomo, said he ordered extra masks early, before they began to run out.

The federal government and nursing home industry could have learned from their previous failures on nursing homes. As COVID-19 ravaged care facilities along the East Coast all spring, officials in southern states, where infections are currently spiking, had months to prepare but they wasted that precious time seeking bailouts and immunity instead.

Joe Pioletti
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