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The coronavirus pandemic is not over
Letters to the Editor • Opinion
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Vera Leip, 88, is vaccinated in December at the John Knox Village retirement community in Pompano Beach, Fla. (Joe Raedle/Getty Images)

Federal health officials on Wednesday substantially relaxed the government’s guidelines for family and friends to see nursing home residents in person, saying that vaccinations and a slowing of coronavirus infections in the facilities warrant restoring indoor visits in most situations.

The nursing home guidance, the first federal advice on the subject since September, says “outdoor visitation is preferred,” even when a nursing home resident and family or friends are fully vaccinated against the novel coronavirus.

But acknowledging that weather or a resident’s poor health might make an outdoor visit impractical, the recommendations encourage nursing homes to permit indoor visits “at all times and for all residents,” regardless of whether people have been vaccinated, except in a few circumstances.

Federal officials say the exceptions include when a resident has not been fully immunized against the virus and lives at a home in which fewer than 70 percent of fellow residents are fully vaccinated and when the nursing home is in a community with high rates of local infections — more than 10 percent of tests being positive. Visitors are also discouraged from seeing residents who have covid-19, the illness caused by the novel coronavirus, or are in quarantine after having been exposed to the virus.

The eight pages of guidance from the Centers for Medicare and Medicaid Services mark the most recent sign that the Biden administration regards drastic restrictions on life as beginning to slide into the past tense, even as the president and his aides urge Americans to continue public health precautions for the foreseeable future.

The guidance comes two days after the Centers for Disease Control and Prevention issued separate advice, sketching the outlines of what activities are considered safe for fully vaccinated Americans. Monday’s guidance gave such people greater freedom to socialize and engage in some aspects of normal daily living. It said people two weeks past their final shot may visit indoors with unvaccinated members of a single household at low risk of severe disease, without wearing masks or keeping their distance.

The two federal announcements are not outright edicts for the country. They are recommendations, rooted in the best available information about the state of the pandemic and a far-from-complete body of research pointing to what makes sense — all juxtaposed against Americans’ profound weariness with a constricted way of living that is reaching its first anniversary.

Even as appointments to get shots remain in short supply in much of the country, 62.5 million people in the United States have received at least one dose of a vaccine. Vaccines authorized by the government for emergency use, developed by Pfizer-BioNTech and Moderna, require two shots. A third more recently authorized vaccine, created by Johnson & Johnson, is a single shot. In all three cases, immunity after vaccination takes about two weeks to develop.

About 3.7 million vaccine doses have been administered to nursing home residents and staff, according to CMS, which did not specify the number of individuals who received the shots.

According to the American Health Care Association, which represents 14,000 nursing homes and other long-term care facilities, about 1.3 million people live in U.S. nursing homes. Nearly 1 million more live in assisted-living facilities, which are not covered by the recommendations.

Mark Parkinson, the association’s president, called the recommendation that nursing home residents can see loved ones in person “welcome news that we fully support. . . . [T]hanks to the vaccines, we cannot wait to safely open our doors.”

Parkinson urged the CDC to continue giving vaccine priority to nursing home residents and staff “to help facilitate these reunifications,” making sure shots are easy to obtain for new residents, and for those who hesitated at first but have chosen to be vaccinated now.

Katie Smith Sloan, president of LeadingAge, an association of nonprofit providers of aging services, said, “This is the right thing to do,” given the progress in vaccinating nursing home residents and staff.

“There is no substitute for an in-person visit, even in nursing homes that have gone to extraordinary lengths to support residents and find creative ways to keep them connected with loved ones throughout the pandemic,” Sloan said.

The nursing home guidance, issued by CMS in coordination with the CDC, acknowledges the pandemic’s harrowing impact on some of the nation’s oldest and frailest people, who make up nursing home populations.

“We acknowledge the toll that separation and isolation has taken,” the document says. “We also acknowledge that there is no substitute for physical contact, such as the warm embrace between a resident and their loved one.”

For those reasons, the guidance says, a fully vaccinated nursing home resident “can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after.”

Those visitors, the guidance says, should maintain a safe distance from a nursing home’s other residents and staff.

The recommendations say “compassionate care visits,” including when a resident is nearing death, should be allowed at all times. They should be permitted even when a resident is unvaccinated, the facility has a covid-19 outbreak, or a community has high infection rates.

Wednesday’s guidance marks the fourth time that CMS, the agency within the Department of Health and Human Services that oversees Medicare and Medicaid, has issued pandemic recommendations for nursing homes. The facilities have been intense breeding grounds for covid-19 among staff and residents, who live in close quarters. In late November, the pandemic crossed a milestone, having killed 100,000 workers and residents in U.S. long-term care facilities, according to an analysis by the Kaiser Family Foundation, a health-policy research group.

The first CMS nursing home guidance, almost a year ago to the day, restricted all visitors and nonessential health workers, except for compassionate care visits, which were to be held in a single, designated room. A May update urged caution in reopening nursing facilities, saying they should relax restrictions more slowly than the communities around them, with visits allowed only if a facility had no new cases of covid-19 for four weeks.

The latest guidance says visits can still occur during a covid-19 outbreak at a nursing home, as long as the virus’s spread appears to be contained to one area. If tests show no new cases elsewhere in the facility, visits may still take place in the other areas, the recommendations say.

Still, federal officials said in their advice they were “emphasizing the importance of maintaining infection prevention practices, given the continued risk of covid-19 transmission.”

The American Health Care Association announced last week that covid-19 cases among its member facilities had declined 82 percent since late December to early February.

Coronavirus: What you need to know

Where do things stand? See the latest covid numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people.

The state of public health: Conservative and libertarian forces have defanged much of the nation’s public health system through legislation and litigation as the world staggers into the fourth year of covid.

Grief and the pandemic: A Washington Post reporter covered the coronavirus — and then endured the death of her mother from covid-19. She offers a window into grief and resilience.

Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

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