The Ongoing Reality: Elderly in Nursing Homes Are Most at Risk for Covid-19

In an effort to stop the spread of Covid-19, Atria in Pacific Palisades does not allow visitors. A family member talks to a relative through an open window.

According to the L.A. County Public Health website, 2,143 people have died from Covid-19 in the county through May 26. Ninety-three percent of those who have died (1,993) had underlying conditions. Forty-seven percent of the people who died (1,007) were in nursing facilities.

In an April 27 daily briefing, director of the county Department of Public Health Barbara Ferrer said, “Early on in this pandemic, we were all unaware that COVID-19 could be spread by people who were infected but did not have any symptoms, and this unfortunately has resulted in the spread of the virus even where everybody has been doing their very best to implement infection-control measures with the information that we had at the time. So I apologize on behalf of all of us for not knowing enough at the start of this epidemic to take additional steps in our congregate living facilities to make sure we were doing everything possible to protect residents and staff.”

On April 28, county health officials announced that they would expand testing for COVID-19 to include all residents and staff at nursing homes, regardless of whether they showed any symptoms.

On May 14, in a Circling the News story (“Palisadian Is Desperate to Get Her Mother and Assisted Living Employees Tested for Covid-19”), a desperate resident wrote: “My mother is in an assisted living facility [in L.A. County] and found out today more of the caregivers have tested positive and six residents are ill. There have been two deaths, yet the director of the facility is telling me they cannot get anyone in to test the residents. I find this hard to believe. I thought when a facility had three or more people affected, that testing was going to be done by the county.”

Testing residents and staff in nursing homes had been the promise, but it had gone largely unfilled at that point.

On May 22, the L.A. Times reported: “A month after vowing to test all nursing home residents and staff for the novel coronavirus, Los Angeles County health officials have completed the effort in only about a third of homes and have dramatically scaled back testing plans.”

Instead of testing everyone, “testing only a small sample of residents in nursing homes that have not had an outbreak — is outlined in a letter county health officials sent to nursing homes last week, as the death toll continued to mount at facilities across the county.”

On May 26, the L.A. County Board of Supervisors voted to appoint an inspector general to oversee skilled nursing facilities. Supervisors Mark Ridley-Thomas and Kathryn Barger wrote in their motion that it is “critical that L.A. County learn the lessons of this crisis; identify the internal and external factors that have contributed to inadequate conditions within skilled nursing facilities; and provide oversight, accountability and resources as needed.”

According to a May 26 L.A. Daily News story (“As Coronavirus Deaths Climb, L.A. County Nursing Homes Will Get Watchdog”), about 1,085 people had died at institutional settings, most of them nursing homes. About 7,238 residents had become infected and 3,376 staff workers at the homes had been infected. In this story the percentage of people who have died at eldercare facilities was listed as 52 percent.

L. A. County Public Health Director Dr. Barbara Ferrer

Ferrer acknowledged that slowing the spread of the virus within nursing homes was hindered by medical unknowns early on. Up until early April, the department was unaware that asymptomatic people could spread the virus, so face masks were not required until that point.

Ferrer, who is not a medical doctor, is now being questioned about her decisions. Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine, and Dr. Noah Marco, chief medical officer at the Los Angeles Jewish Home, criticized Ferrer in a May 26 story in Capital & Main    (“Doctors Slam Public Health Agency for High COVID Toll at L.A. County Nursing Homes”).

“LAC DPH’s response to this novel coronavirus has not always been based on good science, not often based on what is practical, and, using Dr. Ferrer’s words, is just wrong,” Marco said. “Have they provided PPE [personal protective equipment] to facilities that needed it? No. Have they provided training on infection control to nursing home staff? No. Have they supplied additional staff? No. Have they provided testing in areas where testing would reduce the spread of the virus? No.”

Wasserman said, “When she made the public statement that they were wrong [about not testing all facilities], she said that we recently learned that asymptomatic cases were occurring. The world knew [about] asymptomatic [cases] since January. For her to make a statement in April makes no sense. Why would she not know about asymptomatic spread?”

Wasserman also questioned Ferrer’s most recent decision to test only a small percentage of those in nursing homes. “The 10 percent testing is not based on science, makes no sense medically, will miss hundreds of spreaders and will lead to hundreds more deaths in nursing homes.”


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