We don’t yet have a complete picture of how deadly COVID-19 is, but an analysis of more than 70,000 confirmed and likely cases in China published late last month in JAMA indicated that the fatality rate for confirmed cases among 70-to-79-year-olds was about 3.5 times higher than the overall fatality rate, and the rate among those 80 and up was about 6.5 times higher than the overall rate.
When older people live alongside one another, their vulnerability to infectious diseases is compounded. Gershon said nursing homes can become a “soup cauldron” of infection and transmission. This often happens with skin diseases and influenza in long-term-care settings, and COVID-19 would be no different. This outbreak aside, each year an estimated 380,000 people living in American long-term-care facilities die of an infection, including staph infections and diarrheal diseases.
It doesn’t help that caregivers’ jobs require them to come into close contact with many residents, while helping them get dressed, bathe, eat, and use the toilet. Many home health aides, who visit their clients at home to assist with a similar array of tasks, do their jobs with less support and access to protective equipment than caregivers at live-in facilities; a 2010 study that Gershon co-authored found that fewer than half of home health aides surveyed said they would show up to care for a client during a pandemic. And whether they visit patients or tend to them in a nursing home, care workers are not only at risk of contracting COVID-19 themselves, but also of passing it on to those they care for; many young and otherwise healthy workers might exhibit only mild symptoms if infected, and thus might think they can keep on working.
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Gershon outlined some best practices for preventing the spread of disease in senior-living settings: rigorous and thorough hand-washing, the proper use of personal protective equipment (gloves, masks, gowns, and such), and “cleaning like mad—not just once a day at the end of the day, but several times during the day.” And if residents exhibit concerning symptoms, they should be isolated and monitored.
These measures are applicable in any communal environment, but deploying them in a long-term-care facility comes with a unique set of obstacles. Kevin O’Neil, the chief medical officer of Affinity Living Group, told me that implementing this sort of basic but crucial regimen can be particularly challenging in “memory care, in dementia-specific facilities, because people may not understand why it's important to wash hands and wear a mask and so forth."
O’Neil is currently guiding coronavirus-preparedness planning at Affinity’s 160 assisted-living facilities, which are located throughout the Southeast. “I still feel there’s no need to panic,” he told me when I asked him how worried he is. “At this point I don't think we need to fully disrupt our lives.” So far, Affinity has, among other things, educated staff about infection-control measures and put up signs encouraging prospective visitors not to enter if they have any potential symptoms themselves.