South Florida Sun-Sentinel (Sunday)
Joy, relief at one nursing home after vaccines
Health experts left guessing at reason for infection slump
WHEELING, W.Va. — The day had finally arrived.
After nearly a year in lockdown for the residents of Good Shepherd Nursing Home — eating meals in their rooms, playing bingo over their television sets and isolating themselves almost entirely from the outside world — their coronavirus vaccinations were finished and the hallways were slowly beginning to reawaken.
In a first, tentative glimpse at what the other side of the pandemic might look like, Betty Lou Leech, 97, arrived to the dining room early, a mask on her face, her hair freshly curled.
“I’m too excited to eat,” she said, sitting at her favorite table once again.
It has been a miserable year for U.S. nursing homes. More than 163,000 residents and employees of long-term care facilities have died from the coronavirus, about one-third of all virus deaths in the United States. Infections have swept through some 31,000 facilities and nearly all have had to shut down in some way.
For more than 1 million residents of nursing homes, the lockdowns themselves have been devastating. Cut off from family and largely confined to their rooms, many residents lost weight and saw ailments worsen. Some grew increasingly confused. Others sank into depression and despair.
West Virginia has emerged as one of the first states to finish giving two doses of vaccines to the thousands of people inside its nursing homes, so Good Shepherd, a 192-bed Catholic home in Wheeling, was among the first facilities in the country to begin tiptoeing back toward normalcy last week.
The first day back was full of ordinary moments: small talk over coffee, bidding wars at an afternoon
auction, a game of dice. But after a year of loss, loneliness and disruption, the very ordinariness of it all brought joy and relief.
In the dining room, which had been mostly empty since March, the tables were set with formal linens. Leech greeted friends and bantered with the dining room staff.
But amid the clinking of silverware and the soothing sound of jazz, the losses of the past year could be felt at each table where someone was missing.
Good Shepherd shut down in March, before the virus had been found in West Virginia. Residents went without visits with loved ones, outings to the movies, even fresh air.
“I felt really lost,” said Joseph Wilhelm, 89, a retired priest who said he had found it difficult to concentrate on prayer.
Twice, the nursing home tried loosening restrictions,
only to shut down again.
Sally Joseph, 85, grew tearful as she told of being separated from her children and grandchildren. At Christmas, she looked out the window and waved at her grandson, who visited in the parking lot. “This is the hardest thing,” she said. “But then when I get weepy and feeling sorry for myself, I think, ‘Everybody in the world is having the same problem as I am.’ ”
In November, an outbreak ripped through the third floor of Good Shepherd.
Five residents died. Among them was Michael Strada, an avid traveler who had visited 50 countries. John Strahl, who liked to fish and hunt. Marjorie Lekanidis, who delighted in spending time with her dog. Ann Martin, who loved her church, her granddaughters and going on car rides to nowhere in particular.
Fifteen others got sick in the outbreak, including
Leech. After recovering in the nursing home’s COVID19 ward, she was feeling better, she said, and eager to return to some version of normal life, however simple.
“Just seeing the people here,” she said, “is enough.”
On the menu for this first day back were cheeseburgers and potato soup, unveiled with a flourish of silver serving dishes.
Even with the vaccinations completed, everything has not gone back to normal. Residents are allowed to socialize again together, but they also are asked to continue wearing masks. They sit several feet apart. And most relatives and friends still cannot come to visit.
The continuing precautions offer insights into the complications of reopening, far beyond nursing homes. About 20% of people at Good Shepherd — mostly staff members and a few
residents — declined to be vaccinated, reflecting a hesitance that has emerged across the country. Cases in the surrounding county remain high. More research is needed to understand whether vaccinated people might still be able to transmit the virus.
So it was in a socially distanced maze of wheelchairs that a “penny auction” was held — the first in more than a year.
At one point, a bidding war broke out over a Snoopy stuffed animal that played the “Peanuts” theme song.
When Leech’s moment came, she spent all of her allotted cash — everyone got 10 pennies — on a giant tub of cheese puffs.
In the bustle of the day, there were moments of stillness.
In the lobby of a stainedglass chapel, Frank and Phyllis Ellis savored a quiet reunion.
Frank Ellis, 91, lives at the couple’s home in Wheeling, while Phyllis Ellis, 87, stays at Good Shepherd. As government rules have changed, the nursing home has begun to permit a small number of residents who seem most in need to have limited visits with their loved ones.
During 69 years of marriage, the Ellises said, they have never spent so much time apart as during the last year.
When their time together ends, she cannot leave with him, as she used to do for Christmas and other special occasions.
She longs for the comforts of home, for her children and grandchildren. He longs for her and even their marital spats.
“We were always fighting,” he said. “I miss that.”
By nightfall, there was just one activity left on the agenda: a game of bunco.
Pre-pandemic, the game had become an after-dinner tradition: Around 7 o’clock, residents gathered to roll dice and socialize. “We’d get a snack, ice cream or something, and we’d go to bed happy,” said Zita Husick, 95, who helped recruit players for the group.
For nearly a year, they could not play — the close quarters and intermingling were deemed too risky. By the time they were allowed to begin again, some members had grown too sick to join. Others had died.
Those who remained gathered in a circle around a table.
Around and around they went, clicking and tossing the dice. “We’re kind of rusty,” Husick said. The game lasted more than an hour, until finally, with the clatter of the dice, there were cries of “bunco.”
“OK, girls, it was really nice playing for a change,” said Leech, signaling the end of what had been one of their busiest days in a while.
One by one, they said their goodbyes and departed, up the elevator, back into their rooms.
NEW DELHI — When the coronavirus pandemic took hold in India, there were fears it would sink the fragile health system of the world’s second-most populous country. Infections climbed dramatically for months and at one point India looked like it might overtake the United States as the country with the highest case toll.
But infections began to plummet in September, and now the country is reporting about 11,000 new cases a day, compared to a peak of nearly 100,000, leaving experts perplexed.
They have suggested many possible explanations for the sudden drop — seen in almost every region — including that some areas of the country may have reached herd immunity or that Indians may have some preexisting protection from the virus.
The Indian government has also partly attributed the dip in cases to mask-wearing, which is mandatory in public in India. But experts have noted the decline is uniform even though mask compliance is flagging in some areas.
It’s more than an intriguing puzzle; determining what’s behind the drop could help authorities control the virus in the country, which has reported nearly 11 million cases and over 155,000 deaths. More than 2.4 million people have died worldwide.
“If we don’t know the reason, you could unknowingly be doing things that could lead to a flare-up,” said Dr. Shahid Jameel, who studies viruses at India’s Ashoka University.
India, like other countries, misses many infections, and
there are questions about how it’s counting virus deaths.
But the strain on the country’s hospitals has also declined in recent weeks, a further indication the virus’s spread is slowing. When recorded cases crossed 9 million in November, nearly 90% of all critical care beds with ventilators in New Delhi were reported full. Last Thursday, 16% of these beds were occupied.
That success can’t be attributed to vaccinations since India only began administering shots in January.
Among the possible explanations for the fall in cases is that some large areas have reached herd immunity — the threshold at which enough people have developed immunity to the virus, by falling sick
or being vaccinated, so that the spread begins to slacken, said Vineeta Bal, who studies immune systems at India’s National Institute of Immunology.
But experts have cautioned that even if herd immunity in some places is partially responsible for the decline, the population as a whole remains vulnerable — and must continue to take precautions.
This is especially true because new research suggests people who got sick with one form of the virus may be able to get infected again with a new version.
Bal, for instance, pointed to a recent survey in Manaus, Brazil, that estimated that over 75% of people there had antibodies for the virus in October — before cases surged again in January.
“The message is that a large proportion of the population remains vulnerable,” said Dr. Balram Bhargava, who heads India’s premier medical research body, the Indian Council of Medical Research.
But the survey offered other insight into why India’s infections might be falling. It showed that more people had been infected in India’s cities than in its villages, and that the virus was moving more slowly through the rural hinterland.
“Rural areas have lesser crowd density, people work in open spaces more and homes are much more ventilated,” said Dr. K. Srinath Reddy, president of the Public Health Foundation of India.
Another possibility is that many Indians are exposed to a variety of diseases throughout their lives — cholera, typhoid and tuberculosis, for instance, are prevalent — and this exposure can prime the body to mount a stronger, initial immune response to a new virus.
Despite the good news, scientists have identified several variants of the virus in India, including some that have been blamed for causing new infections in people who already had an earlier version of the virus. But they are still studying the public health implications.
Experts are considering if variants may be driving a surge in cases in the the southern state of Kerala, which had previously been hailed as a blueprint for tackling the virus.
Kerala now accounts for nearly half of India’s current
COVID-19 cases. Government-funded research has suggested that a more contagious version of the virus could be at play.
With the reasons behind India’s success unclear, experts are concerned that people will let down their guard. In many cities, markets are heaving, roads are crowded and restaurants nearly full.
“I feel that the worst of COVID is over,” said M. B. Ravikumar, an architect who was hospitalized last year and recovered. “And we can all breathe a sigh of relief.”
Maybe not yet, said Jishnu Das, a health economist at Georgetown University who advises the West Bengal state on handling the pandemic.
“We don’t know if this will come back after three to four months,” he warned.