LEON KRAYBILL | Special to LNP | LancasterOnline
We worked desperately to keep COVID-19 out of our community and our nursing facility. That was unsuccessful.
We hoped for medications that slow or stop COVID-19 disease. They have not yet been found.
We long for a vaccine that will prevent this disease. It likely will not be ready for months.
COVID-19 has not gone away in our community or our nursing homes. Whenever people gather for voting, demonstrations or shopping, there is greater risk of infection.
So, in long-term care, we gather and sharpen the clinical tools that we have. If we cannot completely eradicate risk to our residents, we try to minimize it. At the moment, we have three main tools: first, to prevent exposure to COVID-19; second, to prevent infection if exposed; and finally, to limit the spread of infection once it occurs.
This op-ed examines the first tool. Subsequent columns will address the second and third tools.
If we are not exposed to COVID-19, then we cannot become infected or pass it on to someone else. This is a basic scientific principle, but it is hard to implement.
COVID-19 is spread primarily through close interaction (less than 6-10 feet) with someone who is infected. This is the underlying reason for social distancing.
Distance does matter. Research shows that staying at least 3 feet away from others decreases the infection risk from 13% to 3%. At 6 feet, the risk falls to 1.5%. At 10 feet, the risk decreases to 1.25%.
Nursing home care cannot be given at a 6-foot distance, so we must find other ways to decrease risk.
We limit the exposure to staff members and movement throughout the building. We restrict outside providers and vendors. We discontinue communal meals and activities. We ask residents to stay in their rooms or distance from others. We significantly decrease family visits. The inevitable consequence is social isolation that is emotionally devastating for many people. It is a terrible choice between prioritizing emotional health versus illness and death.
We actively prevent employees with symptoms of illness from entering the building. We screen staff members before and after work, asking about exposure and symptoms. We check temperatures coming and going. Anyone with symptoms during work is promptly sent home.
Unfortunately, screening will not prevent transmission of COVID-19. Studies show that one-third of COVID-19 infected individuals will have no symptoms at all. Even when the individual does show symptoms, studies reveal that 40% of transmission occurs before these symptoms are evident.
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Nursing homes have taken drastic steps to limit the spread of infection, but what is in the community will inevitably come to nursing homes.
The risk of nursing home COVID-19 clearly correlates with the rate of community infection. Nursing homes are not isolated environments that just happen to be located in our county. Rather they are living examples of the people in our community. The staff come and go every day from their families, neighborhoods and grocery stores.
Most healthy, younger individuals who acquire COVID-19 will recover without long-term harm. Many frail nursing home residents who become infected will die.
I saw this personally in my nursing home, where 60% of infected individuals died. Nursing home residents and people with chronic illness pay the life-and-death price of societal decisions that do not limit the spread of COVID-19.
COVID-19 places a horrendous toll on our society that goes beyond physical health. Consequences include social isolation, depression, loss of employment and financial disruption. Prioritizing one of these areas can harm other areas. Our individual opinions are influenced by where we feel the most pain.
The best solutions will occur as we listen to each other, make the choices that harm the fewest individuals and show willingness to compromise.
Nursing home residents would be safer and die less often if our community stayed quarantined longer, but that is not feasible indefinitely. As we reopen, I plead with our community to take all the steps we can to limit COVID-19 from entering our nursing homes.
I am convinced that use of social distancing and cloth masks decrease the risk of COVID-19 spread in our community, and thus decrease the risk of infection to my nursing home residents.
If you favor longer community quarantine due to the infectious nature of COVID-19, you likely already support widespread use of cloth masks and distancing.
If you worry about the financial impact of societal quarantine and favor opening sooner, you should be even more supportive of cloth masks and social distancing. The greatest risk to sustained reopening is a resurgence of COVID-19. Cloth masks and distancing clearly help to prevent that resurgence and accomplish the goal of reopening.
Protecting our nursing home residents is a team effort that includes residents, families, nursing home staff, hospitals, community members and county leaders. Will you join our team?
Leon Kraybill, M.D., is the chief of Penn Medicine Lancaster General Health’s geriatric division and post-acute care, and medical director at Luther Acres in Lititz.
LEON KRAYBILL | Special to LNP | LancasterOnline