CDC OPTIMISM IS SHOT IN THE ARM
Families excited about new guidelines easing restrictions on vaccinated people
After almost a year of quarantining, the children of Marina Bunce got to hug their grandparents for the first time in what seemed like forever. It was a long embrace — about two minutes.
After all, they had a lot of postponed hugging to make up for.
“It was very special,” the Redondo Beach native said about the moment, which she caught on camera. “I captured this look on my daughter’s face of just pure relief. It was really magical.”
For many grandparents and their families, being separated physically from loved ones without such simple moments of affection as hugging or holding hands has been heartbreaking. Mental health professionals are quick to point out the pandemic’s impact on the community’s mental
health has been nearly as devastating as its physical toll, fueling increases in the risk of suicide, divorce, substance abuse and domestic violence.
Recognizing these issues, the Centers for Disease Control and Prevention on Monday issued guidance that said vaccinated people can gather with other vaccinated people indoors without wearing a mask or social distancing.
The recommendations also say vaccinated people can come together in the same way — in a single household — with people considered at low risk for severe disease. That includes, in the case of vaccinated grandparents, visiting healthy children and grandchildren.
“With more and more people vaccinated each day, we are starting to turn a corner,” said CDC Director Dr. Rochelle Walensky.
Walensky called the guidance a “first step” toward restoring normalcy in how people come together. She said more activities would be OK’d for vaccinated individuals once caseloads and deaths decline further, more Americans are vaccinated and more science emerges on the ability of those who have been vaccinated to get and spread the virus.
The CDC is continuing to recommend that people who are fully vaccinated — defined as two weeks after a final dose — still wear masks, avoid large gatherings and physically distance themselves from others when out in public. The CDC also advised vaccinated people to get tested if they develop symptoms that could be related to COVID-19.
The CDC’s guidelines don’t carry the weight of law, but they should inspire state and local governments to follow suit by easing their own restrictions.
In Southern California, many counties are still in the most restrictive purple tier, but are advancing toward the state’s less-strict red level. And the benchmarks for attaining that status are easing. Under the new framework, once the state hits 2 million vaccine doses distributed in the hardest-hit communities — which will likely occur this week, officials said Monday — counties only need to reduce cases to below 10 per 100,000 population to advance out of the purple tier rather than the previous mark of 7 cases per 100,000.
As of Monday, L.A. County was at 7.2 cases per 100,000 population per day, Orange County at 7.6, San Bernardino at 9 and Riverside at 11.3.
As increasing numbers of residents get vaccinated — OC Health Care Agency Director Dr. Clayton Chau told county supervisors recently that at least half the county’s seniors had been inoculated — some are resuming pre-pandemic activities, with precautions.
In L.A. County, Public Health Director Barbara Ferrer said officials would be reviewing the CDC guidelines and updating the county health order today.
As of this week, L.A. County had vaccinated more than 2.4 million people, with more than 800,000 of them receiving second doses. This week the county was administering 312,000 more shots, including 53,700 Johnson and Johnson one-dose vaccines and 48,000 doses through mobile clinics.
The CDC’s announcement did not have a direct impact on long-term care facilities — but it was followed on Monday by directives issued by the California Department of Public Health, which aim to expand opportunities for in-room visits and physical touch. It was one year ago this week that nursing homes and other long term care facilities in the state were first closed to visitors as a result of the coronavirus pandemic.
The state recommended a “cautious and gradual lifting of certain restrictions,” while still remaining vigilant for potential outbreaks. Specifically, the guidance allows for visitations as long as visitors adhere to certain restrictions:
• They must be screened for fever and COVID-19 symptoms, wear appropriate face covering and wash their hands.
• Even fully vaccinated visitors must wear PPE if it’s appropriate.
• If a visitor had known contact with a confirmed positive person, the visit must be rescheduled.
• In purple-tiered counties, visitors must also show a negative coronavirus test result within two days of the visit regardless of their vaccination status.
Karen Klink, whose mother is a resident of Silverado Beach Cities Memory Care Community in Redondo Beach, is hopeful she can soon visit her 86-yearold mother in her room — and hug her. Both she and her mom have been vaccinated, she said.
She said she hoped the center would allow such a visit soon in light of the new guidance. A manager at Silverado did not immediately return a call Monday.
The residential care facility, which had its last COVID-19 case clear up a couple of weeks ago, began offering patio visits again this week for the first time since the end of November, Klink said. Such visits have to be scheduled so staff can coordinate and monitor the meetings. Klink has her first patio visit in months slotted for Wednesday.
On Monday, she visited her mother, who has moderate dementia, the way she has since the end of November, from outside her closed window.
“It’s been difficult to watch my mom be so sad, watching her get more depressed, more anxious, more scared and not be able to see her in person, or hug her, even if I get a visit on the patio, I can’t get close to her,” Klink said before the visit.
The state’s new guidance allows vaccinated residents to have in-room visits regardless of the tier, noted Deborah Pacyna of the California Association of Health
Facilities, which represents about 900 nursing homes and 400 intermediate care facilities for those with developmental disabilities.
Unvaccinated or partially vaccinated residents can have in-room visits if they’re in any tier but purple, which is the most restrictive.
Pacyna called the guidance a “great move in the right direction for residents and families.”
“It’s the first step in meaningful re-unification,” she said via email.
Indoor visitation, however, must meet certain guidelines. For example, vaccinated residents can meet with vaccinated visitors in the purple tier as long as the visitor tests negative for COVID-19 within the prior two days.
The testing requirement for those in purple-tiered counties concerns Maitely Weismann, co-founder of the Southern Californiabased Essential Caregivers Coalition, who helps care for her mother in an assisted living facility in Los Angeles County. Most counties in California, including L.A. County, were still in the purple or most restrictive tier as of Monday.
“How does a daily caregiver support their loved one?” she asked. “If they get tested every two days, that’s cost and time-prohibitive. We augment the care in the (assisted living) home and that is being completely disregarded.”
She noted that caregivers don’t consider themselves to be visitors.
Weismann said she appreciated that long-term care facilities must now enable visits to be conducted with “an adequate degree of privacy” and should be scheduled at times convenient to visitors, such as outside of regular work hours.
According to the guidance, all visitors and residents should wear masks during their visit and should stay six feet apart.
Fully vaccinated visitors can have “brief, limited physical contact with the resident,” such as a hug, holding hands and assisting with feeding or grooming.
Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform, said the state’s guidance is “progress,” but called the testing requirement in purple-tiered counties “exceptionally burdensome.”
“We do not require staff to get tested every two days before they come to work,” he said. “I think it’s unfair to require so much more for visitors than from staff.”
Nursing home staff are at greater risk for infection because they go from resident to resident providing intimate care while visitors are there to visit only one resident, he said.
“It doesn’t make sense to ask vaccinated visitors to have more limits on their ability to see their loved ones than unvaccinated staff members,” Chicotel said, noting there is no requirement that staff members be vaccinated.
The real problem is not so much the state’s guidance, however, but counties and facilities, he said. Since June 6, California has mandated outdoor visits and indoor visits in large communal spaces in these facilities, but those rules have largely been ignored, he said.
“Until counties are required to go along or can be convinced to go along, there are still going to be tons and tons of residents not getting visitors,” Chicotel said.
On Saturday, Weismann and other grassroots activists will be marching at 1 p.m. at Arcadia Community Regional Park, while socially distanced, to honor those who have died in long-term care facilities since the March 13 visitation ban and those who are still isolated inside. They will also be calling for formal recognition of an essential caregiver designation in public health policy for public health emergencies.
The “honor walk” in Arcadia is part of a series of coordinated events happening across 17 states in commemoration of the anniversary of the ban.
As vaccinations continue and the pandemic retreats, more social interaction is planned at many senior communities.
At Emerald Court, a senior assisted living facility in Anaheim, more than 90% of residents and 75% of staff have been vaccinated. Its two dining rooms reopened at 50% capacity on Monday, Executive Director Patricia Gustin.
“We want to do it as conservatively and safely as possible,” she said.
More residents will be able to meet for prayer groups and attend in-person Mass, and activities such as bingo and Wii bowling are back on. Gustin said Emerald Court administrators hope next month they can reopen their bistro, where family and friends can join residents to eat and socialize outdoors.
“They can actually have conversations at the same table,” Gustin said, “and they’re not feeling so lonely.”
Lunch on Monday was a welcome reunion for friends Wendy Green, 81, and Alice Tillman, 92.
“We really were in a lockdown and our meals were delivered to our rooms,” Tillman said.
During the pandemic, Tilllman was able to go outside daily to take her little dog out, but Green said she felt like she’d been locked in her apartment for a year.
“It was very nice to finally feel like you’re part of the human race again. You really do feel isolated and lonely all the time,” Green said.
Wildomar resident Nancy Andrzejczak is days away from being able to mingle with also-vaccinated people, and she said she just can’t wait.
“My best friend and I have not spent any time together besides on the phone” since last March, said Andrzejczak, 72. “I reach my twoweek post-shot (status) not this weekend, but next weekend. So we’re planning to go out to lunch and celebrate seeing each other again. A small thing, but a happy thing.”