For America's battered long-term care residents and staff, who account for roughly 40 percent of all U.S. coronavirus deaths — or some 87,000 victims — the upcoming winter could bring with it much more disease and death.
As temperatures drop, “nothing is certain” about what will happen in nursing homes, assisted living and other such facilities, says Justin Lessler, an associate professor of epidemiology at the John Hopkins Bloomberg School of Public Health. “But there's a big chance we will see a resurgence of COVID case numbers.”
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It appears to already be happening. As COVID cases in the general U.S. population surged in late September, nursing homes quickly followed suit, reporting a 3 percent uptick in cases, according to a new report by the American Health Care Association and National Center for Assisted Living. The report ties the increase to the broader community spread, concluding that “nursing homes in the U.S. could see a third spike."
But more cases aren't the industry's only worry. There's concern that an expected new surge will be met with continued shortages of personal protective equipment (PPE), testing and staff, which have been lacking in many long-term care facilities. Then there are other winter health hazards, including the annual flu and seasonal affective disorder, which, like COVID, affect long-term care residents at disproportionate rates. The drop in temperatures will also force many facilities to halt outdoor visits, which have been crucial in combating social isolation and loneliness among residents over the summer.
All these factors could create “a disastrous scenario” for residents and staff in long-term care facilities, says Bill Sweeney, AARP's senior vice president of government affairs. “This virus is completely out of control,” he says, noting that the U.S. recently hit its highest daily case count since the pandemic began. “The idea that winter weather, a flu season and continued infection control deficiencies could make what we saw in the spring, in terms of long-term care deaths, just a prologue is an unimaginable nightmare."
Many long-term care facility operators are implementing strategies to help with those challenges, applying lessons of the last seven months, which has seen more than 20,000 long-term care facilities experience COVID cases. Nearly 530,000 residents and staff have been affected nationwide. But Heather Smith, lead psychologist in the long-term care units at the Milwaukee Veterans Affairs Medical Center, says that “everyone's anticipating things to get harder before they get better."
"I feel like we're treading water,” she says.
COVID may thrive in the cold
The main reason COVID cases are predicted to spike in winter is because the cold changes how humans interact. “We know that the weather will force people inside,” says Lessler, “and we know the virus transmits more efficiently when people are in close quarters and the way air moves inside may also contribute to transmission."
As COVID spreads in communities, the virus gets into long-term care facilities, often through staff who work at multiple facilities to make ends meet. And changes in human behavior inside the facilities can increase spread. “Residents won't be able to go into outdoor areas as much, they won't be able to keep the windows open to keep air circulating well,” says Lessler, “and those things could aid transmission when the virus gets in."
While we can anticipate how humans will likely behave come winter, we can't do the same for COVID. “We don't know whether the virus itself will gain any benefit from the colder weather,” says Lessler.
If coronavirus does benefit from winter weather — like the flu, which moves through cold dry air more easily — the threat of transmission intensifies. The way our breathing changes in winter, and how our respiratory tissues respond to the cold, could also aid the virus. Such changes would be keenly felt in long-term care, which generally includes older adults with underlying conditions who are at increased risk of infection and severe illness from COVID-19.
All of which makes infection control measures — washing hands, using PPE properly, screening, testing, social distancing, limiting contact, having a COVID response plan and others — more important as winter approaches. Many facilities are proactively sourcing supplies themselves, rather than relying on government help, which has often been slow to arrive, especially for facilities that are not nursing homes.
In Iowa, Glen Lewis, executive director at Edgewater in West Des Moines, is stockpiling testing kits that can be run through the rapid testing machine his facility got last summer. Only 150 kits accompanied the machine, enough for about two weeks’ worth of staff tests. “So there was a little bit of a hiccup through that process,” he says. “But do I feel that we have the resources now? I do. Absolutely ... It's to our benefit not to be in the middle of winter, when case counts and positivity rates may go up, and you can't get them."
Aegis Living, an assisted living and memory care provider operating 32 facilities in Washington, California and Nevada, has stocked seven months’ worth of PPE, according to founder and CEO Dwayne J. Clark. “We're looking at [the pandemic] as though it's going to run through to next summer,” he says. “That has to be our mentality."