Not Enough PPE, Too Many Deaths: States Struggle to Stop COVID-19 in Nursing Homes

“I have yet to talk to a nursing home that has adequate PPE and adequate staffing,” one doctor told NBC10

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As the new coronavirus continues its spread across the greater Philadelphia region, one particularly vulnerable group is being infected – and dying –  at high rates: people in nursing homes.

The news is not surprising, given that the Center for Disease Control and Prevention identified people 65 and older, and those in long-term care facilities, as being the most susceptible to serious illness due to the virus. However, the numbers are nonetheless alarming.

In Philadelphia, 137 of the city’s 264 coronavirus-related deaths – or 52% – have been reported in nursing homes, city health commissioner Dr. Thomas Farley said Thursday.

“Nursing homes continue to be the sites that this epidemic has hit the hardest,” he said.

The problem, though, extends beyond the confines of the city of Philadelphia.

In Montgomery County, at least 2,313 people have been infected with the virus and 128 have died. In the county’s nursing homes, 556 people and 315 staff members have been infected with the virus.

Eighty-four Montgomery County residents have died from nursing homes, Dr. Valerie Arkoosh, chair of the Montgomery County Board of Commissioners, said Thursday.

Statewide, at least 3,290 nursing home residents, as well as 394 workers have contracted the virus, according to the Pennsylvania Department of Health. Another 365 have died. For comparison, the total number of deaths in the state was 774 as of Thursday.

But even those numbers are on the low end; Philadelphia and Montgomery County, for example, have reported far more nursing home deaths than are on the official state count.

Deadly clusters of COVID-19 have taken a toll at nursing homes and long-term care facilities across the country.

In New Jersey, meanwhile, the crisis in nursing homes was recently laid bare when police found 17 bodies at a Sussex County facility. “Long-term care facilities, not just in New Jersey but … around the country have really turned out to be a weak link in the armor against this awful virus,” Gov. Phil Murphy told NBC10.

Dr. Joshua Uy, a geriatrician and associate professor of clinical medicine at Penn’s Perelman School of Medicine, said that while underlying health problems certainly contribute to COVID-19’s severity among older people, a lack of personal protective equipment and the unavoidable close contact that happens within nursing homes have compounded the issue.

For example, he said, residents need help from aides to dress, eat, bathe and use the bathroom.

“I think the biggest factor in a congregate living setting is that you have prolonged personal care in a setting where you can’t socially distance, and then you don’t have the right PPE to make that type of contact as safe as possible,” Uy said.

Murphy echoed that fact and said his state has been working on measures like providing more personal protective equipment to workers and limiting visits at nursing homes.

Pennsylvania Department of Health spokesman Nate Wardle also highlighted his state’s efforts in providing personal protective equipment like masks, gloves, gowns and face shields to counties, hospitals and nursing homes.

“We have been working to push personal protective equipment to all of our long-term care facilities in Pennsylvania and sent that equipment to all facilities as of [April 3],” he said, adding that the state has been “in constant communication with facilities of concern” to provide them with help, and that “many” testing sites prioritize nursing home residents and workers.

In Philadelphia, Farley, the health commissioner, said city health officials have held routine conference calls with nursing home administrators and owners, including demanding that staff wear masks at all times.

Yet Uy, who also works in Philadelphia’s Renaissance Healthcare nursing home, said many facilities still do not have the needed protective equipment.

“I have yet to talk to a nursing home that has adequate PPE and adequate staffing,” he said, adding that some nursing homes “are doing virtually no testing because they have no access.”

Uy acknowledged that, given the risk, some families might want to take their family members out of nursing homes, especially at a time when many facilities are banning visits to prevent spread.

Though that may seem appealing, he pointed out that there is still a chance of patients contracting the virus from family members and that many people are in nursing homes because they have debilitating conditions that require specialized care. Removing them could be “quite detrimental”, he said.

Families worried about their loved ones in nursing homes can ask about infection control practices, Uy said. They may ask if the facility has a universal face mask protocol, what the staffing level is, how much PPE is available and if they’ve stopped communal activities like group dining and recreation.

Still, Uy said he understands families’ concerns and is himself worried.

“Nursing homes can’t succeed at doing this on their own; they need material support from health systems and the department of health because I think the curve is flattening for the city, but I don’t think it’s flattening within nursing homes,” he said.

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