Community carrying large vaccination syringe
(Credit: Malte Mueller / Getty Images)

COVID-19 permanently changed the work environment and how care is delivered inside long-term care facilities, said noted infectious disease expert Deborah Birx, MD, to a nationwide group of senior care and housing providers Tuesday.

Birx led a webinar from the American Health Care Association / National Center for Assisted Living, LeadingAge, Argentum and the American Seniors Housing Association on lessons learned from COVID-19. She also forecast fall expectations and the way forward to protecting long-term care communities.

Along with COVID-19, senior living and care communities also need to consider the implications of monkeypox and the upcoming flu season for residents and staff, she warned.

First full flu-COVID season

Experts have learned that herd immunity cannot be obtained or sustained with the current vaccines. Unlike measles, polio and smallpox, which produced lifetime protection from disease, COVID-19 is proving that infection does not provide long-lived immunity, ensuring that COVID-19 is here for the foreseeable future, said Birx, the White House coronavirus response coordinator under former President Donald Trump. 

The implications for those who work with older adults are unmistakably somber.

“Herd immunity is not coming, and COVID-19 will remain a significant risk for individuals over 70, whether they are in senior care, living alone or in multi-generational households,” she said. “Even with the omicron booster, protection against infection will wane, and many seniors will not develop an effective immune response due to age and fragility.”

COVID-19 variants, she said, are not only highly infectious, but reinfection is common due to the short-lived protection of current vaccines. Recent studies, she added, show vaccine effectiveness wanes fairly rapidly, particularly in older adults.

“Over 50% of people have no protection against infection and reinfection, despite full vaccination, after 150 days,” Birx said. “My concerns, particularly in those over 65, is we’re seeing progressive waning — a fairly rapid drop off after 100 days — of infection against hospitalization and severe disease.”

Birx said the nation continues to see 450 to 500 people die daily to COVID-19, with a projected 250,000 deaths in 2022 alone. Hospitalizations, she said, are being driven by continuous community spread, making testing increasingly important.

Monkeypox also is adding onto concerns for long-term care, with the potential for staff members and visitors to unknowingly bring the virus into communities.

Layer on a flu season that is expected to be active, and the number of hospitalizations could easily overwhelm the healthcare system, the medical expert warned. She noted that 2022 will be the first year the nation will experience a normal flu season in combination with COVID-19.

“We’ve lost 1.1 million Americans, a lot of them over age 70,” Birx said. “COVID targets people over 70, and we’re still seeing that today.”

Long COVID worries

The biggest unknown with the pandemic is the effect of long COVID on disability and workforce numbers, Birx said. As of June, one in 13 adults in the nation reported long COVID symptoms, traits lasting three or more months following infection.

There is no definitive data showing that vaccines significantly protect against long COVID. With 4 million Americans already on disability due to long COVID, she said, it is anticipated that between 5 million and 15 million Americans will develop lingering symptoms. The chances of developing long COVID go up with each infection, no matter how mild, she explained. 

“It’s a real problem and is not being adequately addressed,” Birx said. “There is no definitive treatment. We don’t know precisely what causes it, or how to prevent it. Vaccines alone are not adequate.”

The way forward for operators

Rapid testing, she said, will be critical to preventing spread of disease in long-term care facilities. She added that providers should ensure that they have access to combination influenza / COVID-19 tests. 

She added that the delta and omicron variants of COVID were less fatal in the United Kingdom than in the United States due to testing; the UK tested at five times the rate that the US did. 

Birx also recommended that long-term care facilities implement masking and regular testing, as well as limit indoor gatherings, when any COVID-19 or flu activity is detected in a building. Workplace mitigation, she said, should be driven by local data.

“We have the 21st-century tools to ensure every American survives and thrives,” she observed. “We’re just not using them.”

Birx also supports the use of Paxlovid to treat COVID-19 and Evusheld to prevent infections.

“Using current tools to save lives, first we need to survive,” she said. “Then we can thrive.”