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 Helping Nursing Homes Navigate Coronavirus

Helping Nursing Homes Navigate Coronavirus

March 6, 2020

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

Background

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.

What is the Coronavirus i.e., COVID-19?

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).

How serious is the Coronavirus?

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].

What to look for at your long term care facility?

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.

How is COVID-19 spread?

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.

How do I prevent the spread of COVID-19 at my nursing home?

A number of preventive actions can help prevent spread of the disease (adapted in part from the CDC and CMS):

  • Good hygiene practices are the greatest defense against the spread of the Coronavirus. To this end, patients, employees, and family members should be reminded to:
  • Wash hands often, with soap and water, for at least 20 seconds
  • Stay home when sick
  • Cover your cough or sneeze with a tissue, and then throw out the tissue
  • Keep hands away from one’s face
  • Regularly disinfect common spaces, including surfaces like cafeteria tables and door knobs
  • Minimize unnecessary contact.
  • Avoid self-serve buffets at meals
  • Restrict visitors who may have been exposed, including those who have travelled internationally within the last two weeks to restricted countries, are sick, or who have sick contacts (for an updated list of restricted countries, please see CDC guidelines here)
  • Residents displaying respiratory symptoms should wear a mask
  • All staff with symptoms of a respiratory infection should stop work, put on a facemask, and go home
  • Facemasks are only recommended for people who are already showing symptoms of COVID-19 to help prevent spread, or by health care workers and people taking care of those who are sick
  • Regular facemasks do not prevent healthy individuals from contracting the disease
  • Healthcare workers treating patients suspected of respiratory illness need to wear specialized protective masks (e.g., N95 mask) with additional respiratory droplet precautionary safeguards
  • Keep informed.
  • Monitor the CDC website for the latest in information and resources and sign up for alerts from the CDC.[8]
  • CMS has announced the suspension of most survey activities, aside from surveys focused on infection control and abuse [9,10]
  • Contact local department of health authorities with questions
  • Assess your nursing facility using the CDC’s infection control self-assessment worksheet

How to identify residents who might have COVID-19?

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.

What should I do if a patient is suspected to have COVID-19?

  • Alert your local health department for all concerns of exposure to disease
  • If appropriate, arrange for your patient to be tested
  • There are no current antiviral treatments for COVID-19, and all treatment is directed at managing and improving symptoms, as you would the flu
  • Acetaminophen or Ibuprofen for fevers and muscle aches (if appropriate)
  • Dextromethorphan or guaifenesin for cough and mucous (if appropriate)
  • Additional medications at the discretion of your medical director
  • Fluids to prevent dehydration, which is more likely to occur with fevers
  • Rest and sleep are critical for the immune system to combat the disease
  • If the illness appears to be worsening, such as difficulty with breathing, seek immediate medical attention
  • Prevent cross-infections
  • Use a mask for all close or same room interaction with others for those infected
  • Patients with confirmed COVID-19 should remain under isolation precautions at home until the risk of transmission is deemed to be low by healthcare providers or local health departments

Telemedicine as a tool for infection control and treatment.

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.

Sources

  1. RI.gov press release, March 5, 2020
  2. WHO Remarks, March 3, 2020
  3. China CDC Weekly, 2020, 2(8): 113-122
  4. CDC Seasonal Influenza, 2018-19
  5. New England Journal of Medicine (NEJM, Guan 2020)
  6. WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
  7. New England Journal of Medicine (NEJM, Fauci 2020)
  8. Centers for Disease Control and Prevention (CDC)
  9. CMS Suspension of Survey Activities, March 4, 2020
  10. Centers for Medicare and Medicaid Services (CMS)

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