How to Avoid More COVID-19 Nursing Home Deaths

Policy discussions regarding COVID-19 in the U.S., and in other countries, are now moving away from a crisis pandemic stance and towards a return to more normal conditions in education, travel, business, and government. In the U.S. particularly this would mean that President Biden would not renew his national emergency declaration when it ends on March 1, 2022. This seems appropriate for most segments of society now that vaccines, boosters, and effective disease treatments are available, and natural immunity is developing. Though we still need to consider whether more can be done to protect the most vulnerable segments of our society at risk from COVID-19, and those hardest hit at the beginning of the pandemic: the elderly, and, especially, residents and staff in nursing homes. A targeted mix of mandates and incentives with culturally aware effective outreach is appropriate for this group.

The highest mortality during the pandemic has been concentrated among the elderly, and an exponential relationship between age and the infection fatality ratio of COVID-19 has been well established through research studies and data analysis. The close living arrangements within nursing homes exacerbated that tendency, resulting initially in very high mortality from COVID-19 in these settings. The vector of infection often came from staff. In the absence of vaccines, effective medical treatment, and natural immunity, various non-pharmaceutical interventions were imposed by governments on general society and nursing homes. The evidence of their effectiveness is modest and mixed, although they seemed to have temporary reduced COVID-19 deaths. But the price of these socially isolating interventions was high, increasing other causes of death in nursing homes, such as Alzheimer’s. With the availability of vaccines, and more recently boosters which have proven effective at reducing hospitalizations and deaths, it is essential to now focus on the elderly, nursing home residents, and their caregivers, to determine how to reduce these excessive deaths nationwide. Although there has been substantial progress, especially with reduced mortality in nursing homes, increases are still occurring, and vaccine hesitancy gaps remain among certain groups.