Many of our nursing home clients have inquired about Coronavirus and its potential impact on senior communities. At Tembo Health we utilized our expert specialty physician network to provide insights and explanations on the developing Coronavirus outbreak. Below we share background information, disease prevention measures, and how to respond to a positive case in a nursing home setting.
Wishing you the best of health,
Joseph S. Wallins, MD, MPH; Medical Director, Tembo Health
Anurag Gupta, MD, MBA, MMSc; Founder & CEO, Tembo Health
The outbreak of the Coronavirus disease of 2019 (COVID-19) at a King County nursing home in Washington State has led to dozens of infections and a number of deaths, and has made infection control and preventive measures of utmost importance. In addition, some states (e.g., Rhode Island) are announcing policies to limit the number of visitors to hospitals and healthcare facilities, including nursing homes [1]. Because older adults and those with chronic conditions are at higher risk, the effects of COVID-19 can be more severe. The Centers for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS) have provided guidance, recommendations, and additional resources for healthcare facilities, summarized below. Please see links at the bottom of the article for additional information and for updates on all topics covered.
Coronaviruses are a family of viruses, seven of which can infect humans. While they mostly cause the common cold, three Coronavirus strains can cause more serious symptoms, including Severe Acute Respiratory Syndrome (SARS) in 2002-2003, Middle Eastern Respiratory Syndrome (MERS) in 2012, and now, a strain called SARS-CoV-2 which causes the Coronavirus disease 2019 (COVID-19).
The Coronavirus appears to be most harmful to those who are elderly and those with preexisting conditions, such as cardiovascular disease, lung disease, or diabetes. The mortality rate from the Coronavirus is still not fully known. The World Health Organization estimates the overall mortality rate could be as high as 3.4%, and preliminary numbers from China suggest that for those ages 60 and older, the rate may be as high as 6% [2,3]. However, the actual mortality rate is likely significantly lower given the large number of patients with mild or no symptoms who are not tested. By comparison, the mortality rate for seniors last year from the flu was slightly under 1% of the over 3 million seniors affected [4].
The symptoms of COVID-19 are variable, and many patients may be asymptomatic. For patients who are symptomatic, initial symptoms may not be present for 2-7 days until after the initial infection, and often include a fever (temperature of greater than 100.4° F), chills, muscle aches, sore throat, and a cough [5].
Fevers often resolve after a couple of days, with most patients recovering without additional symptoms. For some patients, more significant symptoms develop over the next several days, including shortness of breath, a worsening cough, and in some cases, organ failure. About a quarter of severe cases may ultimately require critical care and hospitalization. Symptoms are worse in patients older than 60, and in those with pre-existing health conditions, such as cardiovascular disease, lung disease, and diabetes.
The virus is spread from person-to-person, mainly through respiratory droplets when someone who is infected coughs or sneezes [6]. These droplets can land in the mouths or noses of nearby individuals and cause infection. The estimated number of patients that each patient may infect is currently estimated at 2.2, but this number is highly dependent on preventive measures put in place [7]. Patients are thought to be most contagious when they are symptomatic, but even asymptomatic patients can be contagious. It is also possible to get the infection from surfaces or objects that have been infected; the virus can live on surfaces for up to 9 days.
A number of preventive actions can help prevent spread of the disease (adapted in part from the CDC and CMS):
If a resident develops a fever (temperature greater than 100.4° F) and symptoms of a respiratory disease, such as a cough or difficulty breathing, please reach out to your healthcare professional promptly. Direct the resident to wear a mask when traveling or around other individuals. Please follow the recommended preventive measures listed above.
Emergency legislation in Washington, D.C. to fight COVID-19 includes $490 Million for telemedicine services to be reimbursed through Medicare. This expands upon the current reimbursement program for rural areas.
During all seasons, telemedicine can reduce patients’ unnecessary exposure to bacteria and and viruses by eliminating visits to locations with high volumes of sick people, like doctors offices and emergency rooms. If you're interested in learning more or hearing best practices, feel free to contact our team at hello@tembo.health. We are available to discuss how we may be of assistance to your team, and how our services may improve your team’s ability to prevent and combat COVID-19.
Disclaimer: Please consult your facility medical director or local department of health for the most up to date recommendations on Coronavirus and other infectious disease protocols.
