The Middletown Press (Middletown, CT)
Infectious disease specialist: ‘We know a lot more now’
Doctors: Conn. protocols in long-term care facilities have helped to prevent COVID cases spreading in elderly
When the coronavirus pandemic hit Connecticut, health care professionals and facilities that care for the elderly scrambled to deal with a virus that few people understood.
The lack of testing and personal protective equipment—on top of ignorance of the virus—caused the COVID-19 to spread among long-term care facilities and disproportionately hurt residents 80 and over.
“Unfortunately, early on in the pandemic, we didn’t have some of the measures early on to prevent that,” said Dr. David Banach, hospital epidemiologist and infectious diseases expert with UConn Health.
But the number of cases among younger age groups have surpassed those among Connecticut residents 80 and over.
That’s in part due to improved precautions in nursing homes and assisted living facilities and better knowledge of how the virus spreads and how to prevent it using strategies like masks.
“We know a lot more now,” said Dr. Paul Nee, an infectious disease specialist at Danbury and New Milford hospitals.
By July 27, 7,025 Connecticut residents 80 and over had gotten sick with the virus, making them
the second hardest hit age group after those 50 to 59.
But after that, cases among younger age groups started to surpass the elderly. Those who are 20 to 29 have the most cases of any age demographic, with 14,391 as of mid-last week.
Meanwhile, there had been 8,162 cases among those who are 80 or over. That’s a 16 percent increase from the end of July, compared to a 130.5 percent increase for those 20 to 29.
Older residents may also follow guidelines better than younger people.
“They’re continuing to do the social distancing and the measures we’ve learned,” said Cathy Howard, director of Griswold Home Care, which assists elderly people in their homes across the state. “The younger crowd, they’re feeling invincible and continuing to take risks when they should not.”
Turning around outbreaks
Some facilities continue to face outbreaks. This includes Masonicare Health Center in Wallingford, which had 31 cases and four deaths between Nov. 4 to Nov. 10, according to the latest state data.
But others turned it around thanks in part to testing becoming increasingly available.
“We have a lot more structure built around it, which is very important going into the winter,” Nee said.
Being able to test staff was a “game changer,” said Tim Brown, spokesman for Athena Health Care, which runs facilities across the state.
That includes Evergreen Health Care Center in Stafford Springs, which had the state’s first case in a nursing home. The center has had 67 cases and 20 deaths total, but only two since July 22, according to the state.
Access to personal protective equipment, which had been in short supply, helped, Brown said. Additional research into asymptomatic spread and the effectiveness of masks also prevented cases, he said.
“Certainly, had everyone been wearing masks earlier on, not just in the health care settings, but certainly the community, that would have alleviated some of the spread coming into our buildings,” he said.
In addition to health screenings, temperature checks and testing, Athena audits to ensure staff are following protocols and re-educates individuals, shifts or the entire building if people are not following the rules, Brown said.
Most Benchmark Senior Living assisted living facilities have not had any cases in the past week, according to state data.
The first person in Connecticut to die from the virus was living at Benchmark Senior Living at Ridgefield Crossing, which has had 55 cases and 29 deaths since March.
A Benchmark spokesperson described “aggressive, comprehensive and proactive action” to address resident and staff health.
“We have also continued to evolve our protocols as public health authorities around the world have discovered more effective approaches to mitigating the virus’ impact,” a spokesperson stated.
At Benchmark, people are tested every 14 days, while they are tested every seven days at facilities with active cases. The facility enhanced cleaning protocols and upgraded HVAC and mechanical systems to better filter air.
Benchmark created an advisory council of researchers, physicians, healthcare administrators and practitioners.
“These experts will review best practices and innovative approaches to avoid infectious diseases and help shape our policies, accordingly,” the spokesperson said.
Early successful strategies
Some facilities have fared better than others.
In Danbury, Hancock Hall has had only one case and one death, while Filosa Nursing & Rehabilitation had two cases and no deaths.
Jennifer Malone-Seixas, who administers Hancock and whose family owns both nursing homes, said the facilities implemented precautions early, preventing cases.
The homes banned visitors before the governor and told staff they would be paid if out sick, she said.
“Those two elements were very important from the beginning, before the region really knew what this looked like,” MaloneSeixas said. “Many of the same practices we’ve continued to this day.”
Being smaller, owneroperated facilities also helped them to be more “nimble,” she said.
“We don’t have to ask a corporate office, ‘Can we spend $ 10,000 on masks to increase our stockpile?’” Malone-Seixas said. “It’s just like, ‘Who’s got a credit card? Take it out.’”
Griswold had few cases among clients and one death, Howard said.
“We have been so fortunate,” she said. “I hope the caregivers continue to be as vigilant as they have been because I’m sure that’s the reason. And the clients, too. The clients have taken all the precautions to heart.”
Caregivers that lived at the home 24/7 were not required to wear masks, but did not leave the house, Howard said. Family members brought groceries.
“They didn’t want to leave because they were concerned that if they got infected, they could bring it to their clients,” Howard said.
At Filosa and Hancock, employees are screened for their health before going into the building. The questionnaire asks “dumb” questions, too, such as “Did you drive to work today?” to prevent staff from blindly answering, Malone-Seixas said.
Signs are also routinely changed to keep people’s eyes from glazing over, she said.
“We’re strategizing to keep everything fresh,” she said.
Concerns ahead
But experts fear increasing case rates across the state could hurt the elderly.
“Even though we’re seeing a higher proportion of cases in the younger population, there is still going to be that risk for infecting older and more vulnerable people,” Banach said. “We have to focus our attention on doing what we can to prevent that from happening.”
Brown said it will be important to prioritize nursing home staff for the vaccine and support testing in these facilities. Providing additional funding for emergency staff will also be important, he said.
Howard is particularly concerned about elderly clients who live with young and middle- aged family members, who may not be taking the virus seriously.
“We’re encouraging everyone to batten down the hatches again and treat this as you did in March, April and May,” she said.
Nee said Danbury Hospital treated older people this summer who got the virus from family members who went to parties or did not practice social distancing.
Treatment protocols have improved, giving older individuals a better chance of beating the virus, Nee said. But they may still need to be hospitalized.
“We’re going to put more stress on our health care system,” he said.
And they could still die from the virus.
“They’re still at high risk of mortality, even if things are better,” Banach said. “We still need to be aware that that group is going to be particularly vulnerable.”