Deborah Birx: Long-term care must prepare for, protect against, prevent COVID-19
Providers must rally together to protect residents in senior living communities and nursing homes from COVID-19, former White House Coronavirus Task Force Coordinator Deborah Birx, M.D., said Wednesday.
Birx, now a senior fellow at the George W. Bush Institute, addressed senior living and care industry leaders and professionals about the state of COVID-19 in the nation during a webinar sponsored by the American Health Care Association / National Center for Assisted Living, the American Seniors Housing Association, Argentum, LeadingAge and Direct Supply Senior Living Advocacy.
She explained that she recently had become more familiar with long-term care as her 96-year-old father recovered from a shattered pelvis.
“I didn’t know the frontline of nursing quite the way I do now, and all the work it takes to move these clients, keep them comfortable and keep their skin in good condition,” Birx said of her experience. “I know how important the work is now.”
Masking will continue to be critical in long-term care settings, she said, adding that she hoped that booster shots will be given directly to communities and facilities.
“I know every nurse there is capable of giving these shots,” Birx said. “It’s a perfect way to make sure all members of these facilities are boostered if they need to be boostered.”
In the meantime, she said, it’s important for each community and facility to have a plan, test proactively, use effective infection control and ensure that staff members are alert to community spread in their areas.
“You have the muscle memory. You know what to do,” Birx said. “It’s about supporting your staff so they don’t lose the good morale they have right now and the feeling that they went a long way to get vaccinated. But even though they are vaccinated, they can transmit the virus to others. That is difficult for people to digest right now.”
The path of the coronavirus
Birx spoke about the path of the coronavirus through the nation over the past 18 months, as well as what could happen in the fall and winter.
Showing graphs charting the virus’ course in 2020 and early 2021, Birx said that the current coronavirus surge is spreading very similarly geographically to last summer’s surge, but with a more rapid increase in cases, and more movement between states due to the delta variant. The variant is significantly more contagious, with viral shedding occurring more quickly than with the original virus.
“This raises significant concerns for fall and winter, making it critical to prepare and plan now,” she said. The healthcare community has learned a lot from the past 18 months, Birx added.
The vaccines, she said, provide significant protection from severe disease, hospitalization and death. What’s unclear, however, Birx added, is how well the vaccines protect older adults in their 80s and 90s and those with underlying conditions. The vaccines also weren’t studied for their protection against disease transmission, although researchers are looking at that aspect now, she added.
Last year’s summer surge, Birx said, revealed asymptomatic and community spread. Staff members could become infected, be asymptomatic and unknowingly spread the virus in the assisted living communities and nursing homes where they worked.
An issue, she said, is that the amount of testing being performed has dropped dramatically. COVID-19 testing peaked with 2 million tests daily in December 2020 and January 2021, falling to a low of 300,000 tests per day just four weeks ago.
“We’ve lost eyes on asymptomatic spread, and we lost the ability to really call this viral spread early, so that governors and mayors could mitigate early,” Birx said. “If you don’t mitigate at first evidence of viral spread — if you don’t cohort and you don’t protect at the earliest time — when you have a very infectious virus, it spreads very rapidly.”
Although positive tests are increasing among all age groups, the rate is lowest among those aged 65 or more years, she said, adding, however, that positive case rates still rose in this age group, from 1% to 2% just four weeks ago to 7% today. What’s more concerning, Birx said, is that hospitalization rates are highest among those over 70.
“It very much is following that the primary risk to hospitalization is still the elderly,” she said. Informing residents and their families about what to expect and what to begin to think about is paramount to saving lives, Birx said. The delta variant, she said, is three times as contagious as the virus spreading last summer and fall.
“You can be exposed to less people and still get infected,” Birx said. “When you have a variant that is three times as contagious, you can do three times less exposure and still get infected. That’s very important for residents and family members to understand.”