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COVID-19 outbreaks in long-term care facilities demand our attention

Nearly half of Utah’s COVID-19 deaths have been among those in long-term care. These three suggestions will strengthen our effort to protect our community’s vulnerable population.

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A security guard walks with a health care worker testing patients for COVID-19 at Intermountain Healthcare’s Taylorsville Clinic in Taylorsville on Tuesday, April 28, 2020. Proactive testing in long-term care facilities will be critical to preventing more outbreaks.

Scott G Winterton, Deseret News

Whether it’s recovering from surgery or receiving specialized memory care for dementia, we all know and love somebody who depends on the dedicated facilities and staff in long-term care. As COVID-19 spreads, ironically, it is largely the hardworking, committed staff in long-term care who inadvertently expose our loved ones to COVID-19.  

Unaware they are even infected, they deliver essential, hands-on care to our frail elderly, resulting in more than 11,000 deaths in the U.S. and nearly half of Utah’s COVID-19 fatalities. If exposed, those living in long-term care are, by far, the most likely to die from COVID-19.  

The Utah Department of Public Health has an impressive outbreak response when COVID-19 is identified in a long-term care facility. Reacting to outbreaks is critical, but we must do more to adequately protect these vulnerable lives. Our dedicated public health officials and leaders are not the problem — their funding and size is. For decades, health care resources have been diverted away from the common, public good to hospitals and health systems.  

Today, health systems across the country have massive resources and human capital while the public health infrastructure is a shadow of its former self. Already, early in the course of this pandemic, nearly one-third of long-term care facilities in Utah have experienced outbreaks. We implore our elected officials to adequately fund the following three efforts to strengthen our public health response and protect those with no voice.

Guarantee adequate protective equipment and training in its use

Almost daily, we are hearing reports of long-term care staff putting their lives in jeopardy as they face shortages in personal protective gear and inexperience in its use, unknowingly exposing themselves to COVID-19. Hospitals are required to have respiratory protection programs well-equipped to protect their staff. Long-term care facilities are being exposed to all the risk of hospitals without the resources or training to protect themselves. Filling this gap in safety is an essential role for public health. We need trusted education and resources deployed in long-term care facilities across the state to protect the safety of our family members and staff.  

Provide transparent reporting to the public

Many long-term care facilities have made good-faith efforts to keep relatives informed when outbreaks occur; others have not or simply aren’t aware of an outbreak. The federal government recently mandated residents and relatives — but not the public — be alerted when residents and staff in nursing facilities test positive. The state’s coronavirus.utah.gov website reports testing data, hospitalization and death rates and demographics, but has no information on the impact of COVID-19 in long-term care. Families need all due information to help with decisions on whether to place their elderly loved ones in a nursing facility or remove them from one.  

Test broadly and proactively

We need to know not just who is sick but who is infected and not sick. Currently, Utah’s testing strategy in long-term care is reactive, testing broadly after a case is identified. Widespread, proactive prevalence testing of all residents and staff in long-term care facilities allows appropriate isolation of those affected to prevent outbreaks and informs targeted resource allocation. As Utah turns the “risk dial” from red to orange, any relaxation of current visitor restrictions in long-term care facilities stands to undo all the hard work already done to contain the spread of COVID-19. Testing permits a more calculated approach to resuming family visitation, a step desperately needed to prevent the adverse effects of isolation and loneliness in our loved ones. Anything else is just a guess, with potentially devastating consequences.     

Like many Utahns, we watch COVID-19 daily updates with hope, but also with trepidation as we hear reports of long-term care facility residents dying from COVID-19. We need a multi-pronged, proactive public health response that is not just reacting to crises. Ultimately, we are going to have to learn how to live with COVID-19, and we need to prepare for a sustained and intense effort to subdue upcoming waves of the disease.  

COVID-19’s march through long-term care facilities in Utah is silently feeding a new surge of illness yet to come. We cannot afford to let long-term care facilities be an afterthought in Utah’s response to the COVID-19 epidemic.

Michelle Hofmann, MD, MPH, MHCDS is a pediatrician at the University of Utah specializing in the care of children with complex health needs residing in long-term care settings.

Peter Weir, MD, MPH is a family medicine physician at the University of Utah who has focused his career on improving how health care is delivered.  

Their views are their own.