Since 1976, I have been a medical professional in Virginia Beach, having completed an internal medicine and pulmonary fellowship. Since 2004, I have been the medical director for long-term-care facilities and a hospice organization, practicing medicine to ensure the well-being of our aging population.
Unfortunately, this population is the most vulnerable to, and the most at risk for fatal outcomes from, the COVID-19 disease caused by the coronavirus.
Statistics show that COVID-19 outbreaks have had very different results at several nursing homes, based on the protective measures put in place. Some facilities have seen almost half of residents and staff contract the virus, and some have had death rates as high as 30%-40% among those who have contracted it. Exact death rates are unclear, as many people are still dealing with the virus and its repercussions.
Sadly, news articles are popping up daily highlighting that the large majority of COVID-19 deaths are from long-term-care facilities.
Throughout my 44-year career, too often I have seen that leadership and decision making regarding medical issues do not come from medical professionals, but rather from administrators, lawyers, and corporate or political leaders who worry too much about current regulations, lawsuits, bottom lines, and appearances and not enough about the well-being of the patients and the medical providers who care for them.
Regrettably, the medical system we have today requires balancing financial, legal, and political risks with the health of patients and long-term residents.
Tragically, during times of crisis, this mindset results in responses that are too little, too slow and too antiquated to be effective, resulting in lost lives.
The data from Canterbury Nursing Home, outside of Richmond, showed that 50% of positive cases were without any symptoms. I suspect the same is true outside of the nursing home.
It is reported that 80% of individuals who get this disease will recover without any difficulty or without requiring hospitalization, but will still be carriers of the disease and an unwitting vector to infect others. In fact, research showed 70% of those admitted to the hospital do not have a fever.
With the onslaught of this indiscriminate, unforgiving, and devastating viral disease, family nurse practitioner Christina Holloway and I have determined that we do not have the luxury of time for a graduated response with ineffective actions.
Medical providers need to speak up and take a more active role in making decisions based on understanding of how this virus is transmitted and how it kills once an infection occurs. The decisions being made daily by leadership must focus on stopping the spread of the disease, preventing infection, and clearly separating those who have it and who have potentially been exposed to this virus.
Decisions should be informed primarily by medical, disease, and crisis-management professionals and should be open to innovative, out-of-the-box ideas such as the one devised by nurse Holloway, calling on community support to make masks from recycled fabrics for employees to wear while in our nursing homes to protect the patients.
We began a face-mask campaign, which has since developed into a nationwide project. This campaign had two goals: to create washable cloth masks to allow for a sanitary reuse of our limited supply of surgical masks and to get their use not only approved, but mandated for all staff and medical providers in long-term-care facilities.
We accomplished the goals due to the strong support and steadfast leadership from state Sen. Jen Kiggans, and the supporting efforts of Helene Molnar, our nursing home CEO. We have since made face shields, and, with the generosity of CHKD Thrift Stores, procured bathrobes to use as protective garments that can be laundered and reused for our staff’s protection when we exhaust our current supply of personal protective equipment.
We all need to be vigilant and protect each other by wearing masks and learning about infection control in public and in our homes. The U.S. Centers for Disease Control and the Virginia Department of Health are good resources.
We do not yet know the overall fatality rate of this virus, but if it is you or one of your loved ones the effect is the same as if it is 100%.
While we have seen many attempts at innovative ideas to stop the spread, sometimes innovation not informed by medical professionals can have unintended consequences. A perfect example is supporting our local restaurants. Even with drive-by meal pick-up, we still have risk of transmitting this virus.
Medical personnel in some places are conducting drive-by testing in full hazmat suits; why aren’t our take-out personnel required to wear face masks, face shields, and goggles? Let’s prevent drive-by infections!
Even innovative ideas from hospitals can have unintended consequences.
Unfortunately, long-term-care facilities are being challenged by ill-informed decisions that gloss over the health risks of patients and their caregivers. With the daily increase of COVID-19 cases, hospitals have the potential of rapidly running out of beds to house the ill. The hospital’s response to this problem may be to discharge patients believed to be free from COVID-19, and send them to rehab and long-term-care facilities for continued care.
While this seems like a logical response to aid struggling hospitals, this decision puts our long-term-care residents, staff and care providers at significant risk for contracting this virus.
Based on testing data, approximately 30% of the negative PCR COVID-19 viral tests have shown positive on follow-up testing. If these statistics are accurate for discharged hospital patients, then it is not a matter of if, but when an infected individual is admitted into a long-term-care facility. Just like the wildfires through California hotspots, a coronavirus-infected patient can cause devastation, as the virus rolls through the facility.
The people who might suffer are our parents, grandparents, brothers and sisters, as well as veterans and first responders who have dedicated their lives to protecting others. Now they need our protection. Better to quarantine patients who are presumed to be free of COVID-19 for a minimum of two weeks, in a separate facility, than to release them directly into the public or admit them to long-term-care facilities.
This could be done several ways. Empty hotels could be contracted to house quarantined patients. We could set up medical units staffed by displaced medical personnel from medical offices that have closed or from hospitals that have furloughed personnel or reduced their hours. Local hospitals could support the effort from their reserve funds; so could cities and counties from their emergency funds.
If the hospitals still insist on sending patients to long-term-care facilities, then at least place isolation trailers in the facilities’ parking lots in which to keep the patients separated. Long-term-care facilities are not set up to be isolation units, nor are they designed to handle infections that can become aerosolized with nebulizer treatments, as does COVID-19.
As our politicians begin to re-open the economy, everyone needs to consider himself as a vector for the disease and to wear a mask whenever out in public — not to keep from getting the disease, but to lessen the chances of spreading it if you are an asymptomatic carrier.
I am pleading with you, my fellow medical providers, to speak up. I am pleading for our community members to call your General Assembly members as well as your city or county management team and encourage them to seriously consider some of these suggestions to protect our elderly.
With your help, we can make a difference and save more lives.