Nursing homes see spike in COVID

The number of Texas nursing home residents testing positive for COVID-19 has increased by more than 60 percent since the start of July, according to state data, raising concerns that protective measures still lag in facilities as the new coronavirus infects people across the state at a steep rate.

While the sheer rise in nursing home infections was alarming, it nonetheless represented a smaller portion of the state’s overall cases as greater numbers of young people have been infected. The number of Texans testing positive since the start of July increased by 77 percent. But experts were bracing for what may be a worse spike in nursing home cases to come.

Outbreaks in nursing homes typically follow outbreaks in communities, rather than the other way around, said David Grabowski, professor of health care policy at Harvard Medical School. Even with visitors still barred from skilled nursing facilities, staff can unknowingly bring the virus in and — without adequate precautions — cases can quickly balloon.

“That’s what makes so many of us nervous right now,” Grabowski said. “It starts in the community, but then once the staff bring it into the nursing home, that’s where the number of cases and fatalities really go up very quickly.”

As of Wednesday, the average number of newly infected nursing home residents over a seven-day period — and the average number of total new cases in the state over a seven-day period — were higher than ever, according to a Hearst Newspaper data analysis. (Cases at assisted-living facilities are categorized separately.)

Nursing home infections rose from a little under 6,000 cases as

of June 30 to 9,609 cases by Wednesday. About 70 percent of the state’s registered nursing facilities had reported an infected staffer or resident to the state at some point.

Still, as a share of total case numbers, reported cases at nursing facilities dropped from 6.5 percent on May 15 to 3.3 percent Wednesday. Many of the new cases across the state and Houston now tend to be younger adults, according to state and local data.

Some of the sharp increases in reported nursing home infections also came from older cases recently counted. More than 1,000 new cases were reported on July 13 but that was because of “a data lag resulting from a system error for some areas” for 13 days, said Kelli Weldon, a spokeswoman for Texas Health and Human Services.

There were 307 new deaths reported at nursing facilities since the start of the month, making up one-third of new state deaths during that same time period, according to the data. The 1,236 nursing home residents who had died as of Wednesday made up about 35 percent of the state’s deaths, down from the 40 percent they comprised in early June.

The continued rise in infections in nursing homes — where residents are particularly vulnerable to COVID-19 — shows that more testing is needed to keep the new coronavirus out, said Amanda Fredriksen, associate state director for advocacy for AARP Texas.

Family members haven’t been able to visit nursing home residents since mid-March, but staffers may get groceries, buy gas or interact with family after work — and some have no idea whether they’re infected when they return to their jobs, though they may have their temperature checked. Another problem is staffers circulating among various nursing facilities.

“We need regular, ongoing testing of staff, so that the virus is caught before — we’re not waiting until people are symptomatic,” Fredriksen said. “Until the state does regular, ongoing testing of staff in nursing facilities and assisted living facilities, and the virus continues to be present in the community, I think you’re going to see these … bumps.”

Gov. Greg Abbott — following a federal directive — ordered all nursing home residents and staff to be tested in May, but regular statewide testing was not implemented. Instead, Abbott announced a partnership with Omnicare to provide up to 100,000 tests with same-day results this month for longterm care facilities. They were being given on an as-needed basis, Weldon said.

“I think it’s more about, in this moment, what we can do for nursing homes,” said Greg Shelley, program manager of the Harris County Long-term Care Ombudsman Program at Cizik School of Nursing at UTHealth. He said it was imperative to ensure certain facilities had the necessary protective equipment for staff to treat sick residents safely.

Indeed, staff were growing strained and acquiring enough protective equipment remained a challenge, said Kevin Warren, president and CEO of the Texas Health Care Association, which represents several hundred long-term care facilities. But Warren believed it was also up to the community to do its part to stay vigilant and stop infections in the community from rising more and more.

“It’s going to take a collective ownership in order to reduce the spread,” Warren said.