The first reported possible outbreak of COVID-19 (a coronavirus) in a long-term care facility, and the first reported case of COVID-19 in a healthcare worker — a caregiver in that facility, were announced by the Centers for Disease Control and Prevention on Saturday.
“Additional residents and staff of the [long-term care facility] who have not yet been tested for COVID-19 are reportedly either ill with respiratory symptoms or hospitalized with pneumonia of unknown cause,” the CDC said. The federal agency also reported the first U.S. death associated with the virus, of a man in his 50s.
Worldwide, as of Sunday, almost 87,000 people have been reported sickened by coronavirus disease 2019 (COVID-19), and more than 2,800 deaths have been reported.
Those words may evoke fear, but at Affinity Living Group, where Kevin O’Neil, M.D., is chief medical officer, the approach has been to be prepared but not panicked, he said late last week.
Influenza still remains a greater threat to senior living communities, workers and residents, he pointed out, citing statistics that there have been 29 million cases of the flu this year, resulting in 280,000 hospitalizations and 16,000 deaths. Affinity’s mandatory flu vaccination policy became effective with the 2019-2020 flu season.
Nonetheless, when it comes to COVID-19, Dr. O’Neil told me, “We do need to create a sense of urgency so people can prepare adequately.”
The Hanson Bridgett Senior Housing and Care Practice Group issued an alert Thursday in coordination with the American Seniors Housing Association, LeadingAge has compiled preparedness resources on its website, and AMDA-The Society for Post-Acute and Long-Term Care Medicine issued guidance Friday in consultation with the CDC.
Let’s take a closer look at how Affinity is putting plans into action; it could prove helpful to you.
Staff members already should be practicing infection control, Dr. O’Neil said.
“We don’t want to forget the basic infection control measures, like hand-washing,” he said. “It’s really important, especially for those in long-term care, to know that just casually rubbing your hands under soap and water is not effective. Hand-washing should be 20 seconds of really washing well with soap and water. I often tell people sing ‘Happy Birthday’ twice. That’s about 20 seconds long.”
Cleaning under the nails, using hand sanitizers and remembering to cover the mouth when coughing also are important, Dr. O’Neil said.
He has formed a committee at Affinity to prepare for possible COVID-19 in its communities and to respond in a coordinated way if it happens.
“I’ve often said geriatrics is a team effort; none of us can do this work alone,” Dr. O’Neil said. “It really does require all of us working in a truly interdisciplinary and professional way. And so we’re convening the department heads of all of our departments — operations, clinical, finance, facilities management — to either be on the committee themselves or have a designee, because it’s going to require preparations for all of us.”
Clinical departments will need to ensure that caregivers are educated and trained, for instance, and the facilities management department needs to ensure that personal protective equipment — such as masks and respirators — is available, he said.
Be sure to get buy-in from organizational leaders, he recommended. “I submit a weekly report right now to our executive leadership team to keep them abreast of what’s going on,” Dr. O’Neil said. “We’ll also be drafting regular updates from our multidisciplinary team.”
Regarding education, the CDC website is a good place to start, Dr. O’Neil said. Among other resources, the federal agency has published “Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities (LTCF).”
He also highly recommended a checklist that the CDC published to help communities and facilities plan for a different pandemic, one involving the flu; it’s entitled “Long-Term Care and Other Residential Facilities Pandemic Influenza Planning Checklist.” A planning checklist in the publication provides a step-by-step way for communities to identify what they’ll need in terms of people and resources to prepare, Dr. O’Neil said. “It’s really well done,” he added.
Communicating with staff, residents and families also is crucial, Dr. O’Neil said.
“As soon as this came out, we didn’t want people panicked but wanted them to feel comfortable that we’re preparing,” he said. “We sent letters to residents, family members, our associates and even our healthcare providers about the symptoms that could be suggestive of problem. The symptoms are very suggestive of the flu. So we put signage on buildings: ‘Please don’t enter if you were exposed to the flu recently or if you have symptoms of flu.’ ”
Affinity also will be asking people about any international trips they have taken or plan to take. The CDC has recommended that people avoid nonessential travel to areas such as China, Japan, Italy, Iran and Hong Kong, where prevalence of the virus is high relative to other areas, Dr. O’Neil noted.
“If someone has been exposed to someone who has traveled to those areas, we’ll ask that they make us aware so we can do a little further query about if they have any suggestive symptoms or if they could perhaps postpone that visit,” he said. Operators should encourage residents to stay informed of potentially problematic geograhpic areas, Dr. O’Neil added.
He also advised that communities keep in touch with local public health officials.
“It’s really important to stay in contact with local health department to determine if there is activity in the area,” Dr. O’Neil said. “Local health departments are really on top of this. They stay in contact with the CDC and other national organizations to determine if there are any additional public health actions they’re recommending, including active staff screening.”
Providers, he recommended, should screen over the phone new admissions and residents returning from the hospital or from another care setting. “If someone has symptoms, you don’t want them in the community,” Dr. O’Neil said.
If the COVID-19 ultimately finds its way to an Affinity community, he said, then an affected resident would be isolated in a single room and asked to wear a mask.
“We would contact the local health department and let them know we have a case,” and the resident’s healthcare provider would be contacted as well, Dr. O’Neil said.
“If someone is more ill, we would coordinate with the hospital and local paramedics,” he said, adding that individuals with the most serious cases probably would be moved to a hospital, but “you don’t want to have these people going by typical transport.”
Having relationships with entities that can assist on the clinical side is vital for senior living communities, Dr. O’Neil said.
“It’s likely the hospitals and skilled nursing facilities have greater clinical resources available to them,” he said. “That’s why for those of us who are in senior living and assisted living, having the right collaborative partners with clinical skills — healthcare providers such as physicians, physician assistants and home health teams — is really important.”
The National Institutes of Health announced this week that a COVID-19 vaccine is in the works, although it probably won’t be available for a year or so.
“That’s going to be the single best preventive measure when it becomes available,” Dr. O’Neil said. “In the meantime, it’s going to be very important for all of us to be prepared — not to panic, but we do need to create a sense of urgency so people can prepare adequately. And we shouldn’t forget the typical precautions that we recommend.”
I hope all of this information will be helpful to you as you initiate or continue with your preparations.