Infection Control Problems Persist in Nursing Homes During COVID


The new analysis draws on self-reported data from nursing homes collected by the federal government over four weeks from late August to late September. While some states fared much worse than others, all 50 states and the District of Columbia had one or more nursing homes that reported inadequate PPE supply, staff shortages, staff infections and resident cases. Forty-seven states reported at least one COVID-19 death among residents.

The analysis found that more than 28,000 residents tested positive for COVID-19 during the four-week reporting period, and more than 5,200 residents died, showing that the virus is still raging in nursing homes. More than 84,000 long-term care residents and staff have died since January, and more than 500,000 residents and staff have contracted the disease, according to the Kaiser Family Foundation’s tally, accounting for roughly 40 percent of the national death toll. Long-term care providers include assisted living, adult day care centers and more, while AARP’s new analysis features just nursing home data.

“This is a nationwide crisis, and no state is doing a good job,” says Bill Sweeney, AARP’s senior vice president of government affairs, adding that the results of AARP’s analysis are “profoundly disappointing.”

“While the pandemic has been unexpected to all of us, basic infection control should have been going on in nursing homes for a long time,” he says. “These are places where people are vulnerable to infection, whether it’s COVID or something else, so for these facilities to still not have basic PPE, even now, with a deadly virus in the air, is outrageous and unacceptable.”

Staff infections nearly match resident infections

For months, providing adequate PPE and developing plans to mitigate staffing shortages have been “core principles” set out by the Centers for Disease Control and Prevention (CDC), for COVID-19 infection control in nursing homes, which generally house older adults with underlying conditions who are at increased risk of infection and severe illness from the disease. PPE stops the transfer of infectious droplets through the air, while adequate staffing ratios mean better care and less person-to-person contact.

Yet in 18 states, more than 30 percent of all nursing homes reported PPE shortages, and in 26 states and the District of Columbia, more than 30 percent of nursing homes are experiencing staff shortages. N95 respirators were the most in-demand PPE item across the country, with 11 percent of all nursing homes reporting shortages. And nursing home aides (certified nursing assistants, nurse aides, medication aides and medication technicians) were the most in-demand staff, with 27 percent of all nursing homes reporting shortages.


Source Article

How coronavirus’s genetic code can help control outbreaks

Scroll to continue arrow-down

The six British patients seemed to have little in common besides this: Each was dealing with kidney failure, and each had tested positive for the coronavirus.

They were among scores of virus-stricken people showing up at Addenbrooke’s Hospital in Cambridge in the early weeks of April. Had they lived in the United States instead of the United Kingdom, the link that allowed the contagion to spread among them might have slipped by unnoticed.

But the U.K. had done something in the early days of the pandemic that the United States and many other nations had not. It funded a national push to repeatedly decode the coronavirus genome as it made its way across the country. The process reveals tiny, otherwise invisible changes in the virus’s genetic code, leaving a fingerprint that gives scientists valuable glimpses into how the disease is spreading. It’s a cutting-edge technique that was not widely available in prior global pandemics but that researchers believe can help hasten the end of this one.

[The code: How genetic science helped expose a secret coronavirus outbreak]

Experts cite this practice, known as “genomic epidemiology,” as one more tool the United States has failed to fully employ in the fight against the virus. Though it first sequenced the 3 billion-base-pair human genome 20 years ago and spends more on basic biomedical research than almost any other nation, the United States has yet to muster the kind of well funded and comprehensive national effort that could produce a more precise accounting of how covid-19 is infiltrating communities around the country.

In the case of the six British patients, sequencing revealed they had been infected by almost identical sub-strains of SARS-CoV-2, the virus that causes covid-19. Epidemiologists soon determined that all six had visited the same outpatient dialysis clinic on the same day of the week. Many had ridden in the same small transport van that regularly brought patients for treatment from across the surrounding area.

Officials promptly put in place new safety measures, including mandatory masks and intense cleaning of the van and the chairs at the dialysis clinic.

“And, you know, we’ve had no further cases,” said Estée Török, an infectious-disease expert at the University of Cambridge who helped decipher the outbreak. Studying the virus’s genome “helps to highlight cryptic or hidden transmission. That’s the real power of it — you can detect outbreaks and act while they’re happening.”

Image without caption
Image without caption
Image without caption

Estée Török, an infectious-disease expert at the University of Cambridge, and her colleagues have sequenced and catalogued thousands of viral genomes since the spring. (Photos by Anastasia Taylor-Lind for The Washington Post)

Already, the United Kingdom has sequenced at least 72,529 coronavirus genomes, nearly as many as the rest of the world combined. By contrast, U.S. labs have produced less than half as many sequences as their British counterparts, based on data from the GISAID Initiative, a global database of coronavirus genomes. That’s despite the fact that the United States is battling an epidemic that’s massively larger.

Pubs Shut In Liverpool As UK Tightens Virus Control Measures

British Prime Minister Boris Johnson on Monday ordered pubs in Liverpool to shut as part of a new strategy to tackle a surge in coronavirus cases, as staff at three field hospitals across the country were told to prepare for a wave of admissions.

The northwest English city is the first to be placed at “very high risk” under a new three-tiered system designed to bring order to what has become a complex web of local restrictions.

Johnson addressed the nation to explain the decision, saying the latest figures “are flashing at us like dashboard warnings in a passenger jet and we must act now”.

Police patrolled on horseback in Liverpool Saturday as people stayed out late partying Police patrolled on horseback in Liverpool Saturday as people stayed out late partying Photo: AFP / Lindsey Parnaby

He earlier told MPs that he could not allow Covid-19 to “let rip” and risk the death toll — the highest in Europe at almost 43,000 — spiralling even higher.

“This is not how we want to live our lives,” the Conservative leader, who himself was hospitalised with coronavirus in April, told the House of Commons.

“But this is the narrow path we have to tread between the social and economic trauma of a full lockdown and the massive human and economic cost of an uncontained epidemic.”

Prime Minister Boris Johnson has been heavily criticised for his government's response to the outbreak Prime Minister Boris Johnson has been heavily criticised for his government’s response to the outbreak Photo: AFP / Daniel LEAL-OLIVAS

Inter-household mixing will be banned indoors and in private gardens while pubs, bars, gyms, betting shops and casinos will close from Wednesday in Liverpool, which has a population of about 1.5 million.

People will be advised not to travel in and out of these areas.

Johnson said businesses forced to close would be supported under a new government programme to fund two-thirds of an employee’s monthly wages, as well as extra support for local contact tracing and enforcement.

Almost 14,000 new coronavirus cases were reported across the UK on Monday Almost 14,000 new coronavirus cases were reported across the UK on Monday Photo: AFP / Paul ELLIS

Other areas of England will be classed either as “medium”, in which current nationwide rules limiting social gatherings to six will apply, or “high”, where different households are banned from mixing indoors.

Whole swathes of northern England already facing local restrictions will automatically enter the “high” risk tier.

Earlier, the state-run National Health Service (NHS) announced that three field hospitals across northern England, in Manchester, Sunderland and Harrogate, would be mobilised to accept new patients.

They are among a string of temporary hospitals, named after nursing pioneer Florence Nightingale, put up by the military in conference centres and stadia coronavirus as swept across the UK earlier this year.

A street sign advises members of the public to "Maintain Social Distance" in Liverpool A street sign advises members of the public to “Maintain Social Distance” in Liverpool Photo: AFP / Paul ELLIS

Testing for hospital staff is also being stepped up in high-risk areas, as health officials warned infection rates were rising across the country and in all age ranges, not just the young.

Almost 14,000 new coronavirus cases were reported across the UK on Monday, with 50 further deaths.

Some U.S. doctors flee to New Zealand where the outbreak is under control and science is respected

Prime Minister Jacinda Ardern speaks to media at a press conference ahead of a nationwide lockdown at Parliament on March 25, 2020 in Wellington, New Zealand.

Hagen Hopkins | Getty Images

Dr. Judy Melinek knew it was time to make a change when she started fear for her health and safety.

While working as acting chief forensic pathologist for Alameda County in California, she read early reports about a virus in Wuhan, China. By June, after repeatedly sounding the alarm about the need for health workers to have sufficient personal protective equipment, she’d had enough. She also hoped for temperature checks, social distancing and masks, but she noticed that not all of the staff in her office were taking these steps.

And then an email appeared offering her the opportunity to relocate to New Zealand, a country that has reported less than 2,000 coronavirus cases and 25 deaths, drawing widespread praise from around the world for its science-led response. Melinek jumped at the opportunity. 

After a period of quarantine, she’s now living and working in Wellington City, New Zealand. She’s been impressed so far. “There’s a lot more respect for the government and for science here,” she said. 

Melinek is part of a wave of U.S. doctors plotting a move to New Zealand. A spokesperson for Global Medical Staffing, a recruitment group that helps doctors find short and long-term positions around the world, noted that inquiries have increased about relocating to New Zealand from the U.S. as more physician jobs have been affected during the pandemic. In addition, more physicians currently employed in New Zealand who already located are choosing to extend their contracts “because of fewer reported cases of Covid-19,” meaning that there’s a slight dip in open roles. 

Melinek has been open about her decision on social media, and has subsequently heard from half dozen of her peers considering doing the same. She expects the number to keep rising as the pandemic continues. “America will suffer an exodus of professionals to other countries that have responded better, with economies that have recovered faster,” she said. 

In the the United States, where the federal government has largely left the response for the pandemic up to the states, more than 213,000 people have died from the virus. Across the country, some states have largely reopened, despite recent surges in cases. An outbreak that tore throughout the White House has spread to at least 37 people, including President Donald Trump, according to a website tracking the infections. 

New Zealand, by contrast, recently declared victory over the virus after eradicating community spread for the second time. 

In addition, many public health workers and scientists based in the United States say they have faced online harassment and threats while sharing guidance to the public about measures to keep them safe, including masks and social distancing. New Zealand’s Prime Minister Jacinda Ardern has repeatedly praised scientists, and offered empathy to the public at the most trying times, including during the early lockdown. 

New Zealand

Gilead Sciences resumes control of remdesivir distribution

Mannequins with face masks and designer clothing fill a window at a Diane Von Furstenberg store in New York City on September 8, 2020. Photo by John Angelillo/UPI | License Photo