Trends in community infections from the novel coronavirus appear to run on par with cases among nursing home staff and residents, per a recent report from the Centers for Disease Control and Prevention (CDC).
This finding underscores the need to monitor local virus spread and prevent exposure to facilities, especially among staff potentially infected by family and others, and isolating newly admitted residents with unknown COVID-19 status.
The federal health agency documented summer-time high case numbers among nursing home residents at 11.5 cases per 1,000 resident-weeks, a measure of occupied beds on weekly reporting of data. The incidence dipped to 6.3 cases/1,000 resident-weeks in the early fall, only to see a surge in late November at 23.2 cases/1,000 resident-weeks. The incidence among nursing home staff nearly matched those figures at 10.9 per 1,000 resident-weeks in June and July, dropping to 6.3 in September and spiking to 21.3 during the week of Nov. 22.
“Rates of COVID-19 in the surrounding communities followed similar trends,” reads the report released Friday. “Increases in community rates might be associated with increases in nursing home COVID-19 incidence, and nursing home mitigation strategies need to include a comprehensive plan to monitor local SARS-CoV-2 transmission and minimize high-risk exposures within facilities.”
The findings stemmed from data reported from late May to November 2020, as part of the CDC’s National Healthcare Safety Network (NHSN), which includes COVID-19 surveillance in nursing homes. CMS-certified facilities were federally mandated to report the data, including the number of occupied beds and confirmed cases among residents and staff.
The CDC said some facilities made mistakes in reporting the data, like entering cumulative case counts each week instead of new confirmed cases, though the federal health agency accounted for these errors in its report released Friday.
The CDC then superimposed the data, 572,135 cases from some 15,300 nursing homes, on regions across the U.S. designated by the Department of Health and Human Services (HHS).
Of note, reported coronavirus cases among nursing home residents and staff were split about down the middle at 51.8% to 48.2%, respectively.
Outside of the nursing home setting, the CDC said case rates across the HHS-designated regions nationwide ranged from 17-67 cases per 100,000 people in May, increasing to over 178 per 100,000 in the summer-time July peak across the South. These rates fell nationwide in August and September, only to pick up again in October, topping 615 cases per 100,000 in late November across the Midwest.
Generally speaking, estimates list long-term care facilities as responsible for about 40% of the country’s total COVID-19 deaths; residents of nursing homes are at heightened risk for poor outcomes from SARS-CoV-2 infection due to old age and underlying conditions. These facilities were therefore recommended to receive the highest priority in the initial phases of vaccination, alongside front-line medical workers.
“Increased COVID-19 incidence in communities with nursing homes increases the risk for introduction of SARS-CoV-2 by staff members,” the CDC report continues.
The CDC highlighted Minnesota in particular. At least 34% of “high-risk exposures” among health care staffers came from household contacts and others in their social circles in the state, highlighting the gaps in mask use and social distancing. To confront this issue, the agency advised teaching staff about potential for community exposure, consistently adhering to CDC guidance, ensuring enough supplies of PPE (personal protective equipment), routine testing for staff and isolating new residents where COVID-19 status is unknown.
These steps can lower the risk of bringing the deadly virus into nursing homes, especially in communities where virus transmission is on the rise, the CDC says.
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