Update on the Corona Virus for Long-Term Care Facilities

As of 3/29/20, the World and Health Organization has released their findings indicating 103,321 Americans have already acquired the Corona Virus.  That’s actually less than 1 in a thousand Americans. Though every death from this is very sad, the death rate remains relatively low at about 1% as well.  But if we assume the virus will continue to increase at its current rate (which it shouldn’t due to current quarantine measures) 1.5% of all Americans will be affected within a year.  Unfortunately some epidemiological models indicate a much worse picture, with as much as 95% of Americans eventually being affected.  Other models show that, provided current national quarantine measures stay in effect till about June of 2020, it can peak around October of 2020, with only 0.25 % of Americans being affected.  No one is sure when it will be over, but it seems prudent to keep observing these measures at least until June of 2020.
For long term care facilities, places of high risk of spread of the disease and high risk patients (category 2 per the CDC ), what can be done to reduce the risk of spread?
  • Implement remote care as much as possible
  • Implement virtual socialization, supporting the education of residents with I-pads, I-phones or PCs
  • Restrict visits to only essential personnel, limiting these visitors to two at a time while maintaining a distance of 6 feet if possible
  • If testing is available, anyone meeting criteria in the facility including patients should be tested
  • Discourage community outings; consider deliveries as much as possible
Who should be screened at Long term care facilities:
  • All permitted visitors/personnel for respiratory or other symptoms potentially indicating the Corona virus (especially fever AND cough or shortness of breath)
  • All permitted visitors/personnel for recent travel to an affected geographic area or high-risk setting prior to entering the facilities
  • Some places also screen all permitted visitors/personnel for any prolonged contact with people known to have the Corona virus, or who have traveled to high-risk areas
What happens if they meet your screening criteria? 
This may be state by state, but consider the following: LTCHs should consider screened out visitors/personnel to post-pone further vists/work for at least 14 days until they are symptom free at a minimum, and/or tested negative for COVID-19.  If a LTCH resident is screened positive with your criteria, instruct the resident to wear a mask if tolerable, and place them in a single room for further assessment and/or COVID-19 testing.  Health care workers should provide care to residents with suspected or confirmed Corona virus using droplet and contact precautions.
Of those in long term care, who should get tested for the Corona virus?
This is state by state.  But consider: those with clinical features of fever AND lower respiratory symptoms (including lower respiratory symptoms including cough and or shortness of breath).  Those at higher risk for poor outcomes might include older adults and those with chronic medical conditions and/or an immuno-compromised state (e.g. diabetes, heart disease, under immuno-suppressants, chronic lung disease, chronic kidney disease).
Please see the CDC’s report on preparing for COVID-19: Long-term Care Facilities, Nursing Homes.

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