The Young, the Old, and COVID-19

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As COVID-19 infection, hospitalization, and mortality rates head downward, pediatric SARS-CoV-2 rates rise, and nursing homes can again become disaster zones. And remember: Winter is coming.

Some of the numbers do look encouraging. Overall, COVID-19 infection, hospitalization, and mortality rates are declining as of October 6, according to the Centers for Disease Control and Prevention (CDC). But, to coin a phrase, winter is coming. With winter comes the holidays and indoor celebrations. While COVID-19’s infection rates head in the right direction, with the current 7-day moving average at 95,448 cases, down 11.6% from the previous 7-day moving average (107,953), we still have a way to go to reach that 10,000 per day infection rate, that Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases, told CNN Sunday, should be our goal. Fauci said: “I would like to see it well below 10,000 and even much lower than that. But when you’re at 95,000, that’s still a situation where you have a high degree of dynamic circulation of virus.”

COVID-19 will be with us always, as more and more medical experts conclude that it’s endemic, a point that Kevin Kavanagh, MD, a member of Infection Control Today®’s (ICT®’s) Editorial Advisory Board (EAB), has been making for well over a year. And herd immunity doesn’t seem likely either, what with a constantly mutating virus, something that Kavanagh asserted back in April 2020.

Some groups seem particularly vulnerable: the very young and the very old. There were 148,222 pediatric COVID-19 for the week ending October 7, according to the American Academy of Pediatrics, which means that children now represent nearly a quarter of reported COVID-19 cases.

“The number of new child COVID cases remains exceptionally high,” the AAP states in a press release. Over 750,000 child pediatric COVID-19 cases have been added in the last 4 weeks.

There’s still this caveat: “At this time, it appears that severe illness due to COVID-19 is uncommon among children,” the AAP states. “However, there is an urgent need to collect more data on longer-term impacts of the pandemic on children, including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects.”

Kavanagh said told ICT® in January that “one of the things that’s really frustrated me with this epidemic and pandemic is that people are totally focused on dying…. But in actuality, the disabilities are much, much more concerning because that is even affecting the young people.”

Meanwhile, problems persist at nursing homes, which have been losing staff at an alarming rate, partly because of vaccine mandates. The COVID-19 pandemic exposed serious and systemic gaps in nursing homes and other long-term care facilities that had been festering for decades. As Linda Spaulding, RN-BC, CIC, CHEC, CHOP, and a member of ICT®’s EAB, told ICT® recently: “The time to hold nursing homes accountable is not the time when everything’s falling apart, and they don’t know what to do, and there’s nobody there to guide them.”

Spaulding has offered some guidance. In an article in the July/August 2020 issue of ICT®, Spaulding gave some pointers on how infection prevention and control at nursing homes can be improved in a cost-effective manner.

There’s a bill before the Senate called the Nursing Home Improvement and Accountability Act of 2021 that would require a fulltime infection preventionist on staff at every nursing home, something that the Association for Professionals in Infection Control and Epidemiology (APIC) has long argued for.

Which begs the question: Where’s the money going to come from? Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), says that “the proposal to institute permanent minimum staffing requirements without a permanent funding source would be incredibly challenging for long-term care providers. Providers will not be able to meet staffing requirements if we can’t find people to fill the open positions. There must be a comprehensive approach to staffing beyond just numbers.”

Now, nursing homes find themselves with a choice, and it’s not a good one.

David Grabowski, PhD, a health policy expert at Harvard, tells Axios this morning, that “we have this terrible tradeoff right in a lot of parts of the country where we can either have staff working who aren't vaccinated and put our older adults at risk, or we can be short-staffed and that also puts older adults at risk.” Grabowski added that “we’ve not valued older adults or the people who care for them for a long time and this is what happens when you have a pandemic like this hit.”

Data released last Friday by the U.S. Bureau of Labor Statistics underscore that health care in general is losing workers, and nursing homes are being particularly hit hard. The data state that “job losses occurred in nursing and residential care facilities (-38,000) and hospitals (-8,000), while ambulatory health care services added jobs (+28,000). Employment in health care is down by 524,000 since February 2020, with nursing and residential care facilities accounting for about four-fifths of the loss.”

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