May 16, 2020, “60% of Virginia’s COVID-19 deaths came from long-term care, but state code bars knowing which homes,” Roanoke.com, Luanne Rife
“As of Saturday [May 16], their deaths accounted for nearly 60% of the 1,002 Virginians claimed by the virus. During all this time, Northam has held thrice-weekly COVID-19 briefings that begin with points he wishes to address. Not once since announcing the task force has he used his opening statements to specifically address the plight of long-term care residents and their families who hunger for information….
The Kaiser Family Foundation has been gathering information reported by the states about cases and deaths in long-term care. Five states do not report this data, and not all provide the numbers of deaths.
In 36 states that report deaths, an average of 41% of their deaths were linked to long-term care. Virginia’s percentage was 59….
“We locked the facilities down in terms of visitors. We already had infection-control measures in place, but we put in additional measures,” said Keith Hare, CEO of the Virginia Health Care Association and Virginia Center for Assisted Living. “We knew that once the virus entered a facility, we really had lost half the battle.”
Hare said the majority of the people living in Virginia’s nursing homes are very poor and incredibly sick and frail, and they have multiple illnesses.
“From the beginning we have paid a fair amount of attention, as I think we should have, to hospitals and their ability to have supplies and testing and the support they need to meet the crisis. Meanwhile, the clear epicenter has been nursing homes,” [director of the Office of the State Long-Term Care Ombudsman, Joani] Latimer said.
These homes aren’t hospitals and did not have stockpiles of masks, gowns and other protection needed to keep staff and residents from contaminating each other. They are often understaffed, relying heavily on certified nursing assistants, who are among the lowest-paid health care workers. Many CNAs work multiple jobs to make ends meet, increasing the likelihood for cross-contamination across homes.
At the beginning of the outbreaks, Virginia’s health department, again citing privacy, did not allow homes to be notified when any of their staff were exposed to the virus at another facility. That restriction has since been lifted.
“We started in this virus without the level of personal protective equipment we needed. We tried to obtain additional supply lines. We were cut off,” [CEO of the Virginia Health Care Association and Virginia Center for Assisted Living, Keith] Hare said. “Then on top of that there had been significant lack of testing.”
Virginia has lagged nearly all states in testing per capita. Until mid-April, its testing strategy did not place long-term care residents on the priority list. A month before, the first residents of the Canterbury Rehabilitation & Healthcare in Henrico County were infected with the coronavirus. More than four dozen residents have died in that outbreak.
When the virus first appeared in the state, Virginia shipped its tests to the Centers for Disease Control. Slowly the state initiated its own testing in the state’s consolidated laboratory, but found that swabs, reagents and other supplies were difficult to get.
On April 20, Northam brought in Dr. Karen Remley, a former health commissioner, to coordinate the testing being done by the state, its universities, hospitals and commercial labs. Since then capacity has grown from about 2,000 tests a day to about 7,000 a day.
The additional capacity permitted homes with outbreaks to ask local health departments to do so-called point prevalence surveys, when all residents and staff are swabbed on the same day in order to determine how many are affected.
South Roanoke Nursing Home was one of the first in the state to ask for this survey after three staff members and a resident developed symptoms. The tests were administered April 23, but results were not known for nearly a week [May 1], and even then some were inconclusive.
By then, seven residents who tested positive had died. Three more were in a hospital and 33 others had tested positive. At least 10 residents have died.
Earlier this month [May], Northam said Virginia now has the capacity to do more of these surveys and is using the National Guard to help administer them. The health department said that it had identified 100 facilities that should be tested, but that they could do only a handful of surveys each week.
In response to a Freedom of Information Act request, the department reported that it conducted 42 point prevalence surveys from April 21 through May 10. Of these, 29 were in long-term care facilities. The others were in prisons, schools and workplaces.
The agency said that it had results for 13 of the surveys, and that an average of 230 tests were given for each survey. It did not provide information as to the total number of tests or the number of positive results, as it said that information is still being analyzed.
When asked last week if Virginia would test all nursing home residents in two weeks as recommended by the White House, Northam said, “That perhaps is a bit of an ambitious goal.”
Hare said Virginia’s hospital association and the state’s volunteer Medical Reserve Corps are helping with staffing across Virginia. The state has also helped to provide personal protective equipment and training staff on how to use it.
“I think the state has been frustrated that they couldn’t provide enough PPE because it could have prevented the spread,” he said.
About 50,000 Virginians work in long-term care.
““I am amazed at the courage of these individuals on the front lines. They went in to fight the battle….It’s one thing to know I have all the protection I need and we’ve got testing,” he said. “We don’t have the PPE. They knew it. We don’t have the tests. They knew it. We were learning how to isolate individuals after they contract the virus. They still went in, did their jobs and protected these residents and patients. That’s heroic.”…
“They are truly under siege. No one wants to be attacking them. They are at the battle lines and in many cases just heroically supporting the needs of the residents as best they can. They are in a tough situation, too,” she said. “We are all caught in this legal bind here that doesn’t seem to be serving the health interests of individuals.”…
Nursing homes are already required to report infections to the health department’s licensing division.
Assisted living facilities and group homes are not considered health care providers. They are overseen by the Department of Social Services and will not be required to report COVID-19 information publicly….
Northam plans to call the General Assembly back to Richmond in August for a special session to address the upheaval that the pandemic has had on the state budget.
It is possible they could allow other bills to be discussed. If not, the issue would need to wait until the regular session in January.”…
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“Staff writer Amy Friedenberger contributed information to this story. This article was written with the support of a journalism fellowship from the Gerontological Society of America, Journalists Network on Generations and the Retirement Research Foundation.”
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Additional source:
May 18, 2020, “Nearly 40% of COVID-19 Deaths Occurred in Nursing and Assisted Living Homes [Nationwide]," Heavy.com, Jessica McBride
“Virginia 60%”…
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