The Washington PostDemocracy Dies in Darkness

The Health 202: Nursing homes repeatedly fell short on preventing infections. That's deadly under covid-19

with Paulina Firozi

Nursing homes were already doing a poor job of preventing infections, even before the coronavirus pandemic. Now the virus is tearing through many of them.

A new government report finds that nearly half of all nursing homes repeatedly fell short in meeting federal standards to prevent infections between 2013 and 2017. More than 8 in 10 of the centers didn’t meet all the standards in at least one year during that time frame.

Those findings, detailed in a Government Accountability Office report released yesterday, further illuminate the dire threat the novel coronavirus poses in these homes, where the oldest Americans most vulnerable to serious cases also live in close proximity and share caregivers who can easily pass infections around. 

Between one-third and one-half of coronavirus deaths nationwide have occurred among residents of long-term care facilities. In some states, nursing home residents account for 60 to 70 percent of the virus death toll. And in Canada, it’s 81 percent

More than 1 in 6 nursing homes in the United States have reported covid-19 cases among residents or staff. New York Gov. Andrew Cuomo (D) has described nursing homes as “a feeding frenzy for this virus.”

The federal investigators found that over the past few years, nursing homes frequently fell short on preventive measures.

The measures include regularly using proper hand hygiene or isolating sick residents and using masks and other protective equipment around them. California had the most offenders, with 60 percent of nursing homes in the state found to be falling short of federal guidelines in 2017.

Almost all the deficiencies were classified as not severe, meaning residents weren’t harmed by the oversight. But these types of preventive measures become crucial in a pandemic situation, the GAO noted. 

Sen. Ron Wyden (D-Ore.), who requested the report, said it shows nursing homes “were unprepared to face a pandemic” — and blamed the Trump administration for not doing more to correct longstanding breaches of safety protocol.

“Too many seniors and their families have suffered as a result of this pandemic, and there need to be big changes in the way nursing homes care for seniors,” Wyden said in a statement.

The precise figure of nursing homes deaths from covid-19 isn’t known because of serious deficiencies in reporting cases and deaths. 

The Trump administration is now trying to correct that. The Centers for Medicare and Medicaid Services required nursing homes to report virus death data by Sunday, and the agency plans to release it next week.

“Federal officials said they will collect the data weekly and publish it online, along with the names of nursing homes, by the end of May,” my colleague Maria Sacchetti reported. “The data will offer a first look at the impact in such states as Texas and Virginia that have declined to identify nursing homes with covid-19 infections.”

“It’s going to be ugly,” Brian Lee, executive director of Families for Better Care, a national watchdog group for nursing homes and assisted-living facilities, told Maria. “The lid is about to blow off.”

Andy Slavitt, former CMS administrator, had some thoughts about the elderly:

The move follows troubling reports of equipment and staff shortages in some facilities, a lack of transparency for patients and their family members, and steep death tolls. In one New Jersey nursing home, bodies piled up. In Maryland, nursing home workers struggled to obtain sufficient protective equipment and managers played down the severity of the coronavirus outbreak.

Vice President Pence and members of the coronavirus task force also told governors last week they should ensure all nursing home residents and staff are tested for the virus.

“We really believe that all 1 million nursing home residents need to be tested within the next two weeks as well as the staff,” task force coordinator Deborah Birx told the governors, according to the Associated Press.

Some governors have come under fire for their nursing home policies and the high covid-19 death toll in these facilities.

Cuomo, along with the governors of California and New Jersey, required nursing homes to admit residents who tested positive for the coronavirus, raising safety concerns among residents and staff members. The approach was in contrast to policies in Connecticut and Massachusetts, which designated certain facilities for covid-19 patients alone.

The covid-19 nursing home spread was particularly acute in New York, accounting for one-fifth of all nursing home deaths nationwide. Cuomo initially appeared to shrug off his policy — saying “it’s virtually impossible” to keep the virus out of nursing homes — but this month revised it, saying hospitals can’t release patients into nursing homes unless they test negative for the virus.

New York Gov. Andrew M. Cuomo announced regulations May 10 to protect nursing home residents, saying the state had opened facilities to treat covid-19 patients. (Video: Reuters)

Cuomo again addressed the criticisms yesterday, appearing to blame the policy on President Trump.

“Anyone who wants to ask why the state did that with covid patients in nursing homes, it’s because the state followed President Trump’s CDC guidance,” Cuomo said. “So they should ask President Trump.”

Ahh, oof and ouch

AHH: A major Centers for Disease Control and Prevention study will attempt to gain insight into how many people are infected with the coronavirus. 

The study plans to assess the prevalence of the virus in 25 metropolitan areas. It aims to test 325,000 people by fall 2021 and will “build on an antibody study that has been underway in six of those cities since March,” Chelsea Janes reports. “… Starting in June, this vast new antibody study will test samples from 1,000 blood donors each month for 12 months in the 25 metro areas.”

That comes after a new Columbia University study projected 36,000 fewer Americans would have died if states had imposed social distancing measures earlier in the pandemic.  If policymakers had closed down the country by March 1, the study concludes, 83 percent or the “vast majority” of U.S. deaths would not have occurred.

CDC spokeswoman Kristen Nordlund confirmed plans for the antibody study to The Post but didn’t provide any further details. 

Antibody testing can determine whether someone ever had the virus, and in some cases when. It can help epidemiologists figure out if individuals were infected even if they never reported a positive test or experienced symptoms. 

“If, after 15 months, we still see that less than 10 percent or so of the population has been infected, we’ll know we better have a vaccine because natural infection rates have not created herd immunity,” Busch said. “And that immunity won’t be enough to preclude another significant outbreak if society returns to the way we used to live.”

OOF: Health workers are still reporting shortages of critical protective equipment. 

A Washington Post-Ipsos poll found two-thirds of front-line health-care workers cited insufficient supplies of N95 masks, which filter out 95 percent of airborne particles, into early May. More than 40 percent also said they experienced shortages of less protective masks; 36 percent said they didn’t have enough hand sanitizer. 

About 80 percent said they wore one mask for an entire shift. More than 7 in 10 said they wore the same mask more than once. 

“The dire shortage of personal protective equipment for health-care workers emerged in March as one of the earliest signals of the country’s lack of preparation for the coronavirus pandemic,” Lenny Bernstein and Alauna Safarpour report. “Nurses and others have said they were forced to put their own health at risk caring for highly infectious patients because they lacked adequate supplies.”

The latest poll “may provide the clearest nationwide measure to date of the shortages during those weeks, when the virus surged through parts of the country, overwhelming some hospitals in New York City and placing others across the nation under tremendous strain.” 

OUCH: Some corners of the Internet offer a window into the brewing resistance to a potential coronavirus vaccine. 

“Some of the same online activists who have clamored to resume economic activity, echoing President Trump’s call to ‘liberate’ their states from sweeping restrictions, are now aligning themselves with a cause on the political fringe — preemptively forswearing a vaccine,” Isaac Stanley-Becker reports. “To further their baseless claims about the dangers of vaccines and to portray the scientific process as reckless, they have seized on the brisk pace promised for the project, which the Trump administration has branded ‘Operation Warp Speed.’ ”

Medical experts worry members of this anti-vaccine movement, while representing the views of a small minority of Americans, can contribute to misinformation or otherwise undermine future vaccine distribution efforts. 

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, described concern that the project’s name has fueled misunderstanding that hastened efforts that could mean safety or efficacy will be sacrificed. 

“People don’t understand that, because when they hear ‘Operation Warp Speed,’ they think, ‘Oh, my God, they’re jumping over all these steps and they’re going to put as at risk,’  ” Fauci told The Post.

Congress on coronavirus

The federal watchdog who reported hospital shortages of tests and protective equipment will testify before a House panel next week. 

Christi A. Grimm, the principal deputy inspector general for the Department of Health and Human Services, issued a report documenting “severe shortages” of supplies in late March. She described the frustration hospitals were feeling about the way government officials were addressing the shortages.

“Grimm’s appearance before the Oversight and Reform Committee, chaired by Rep. Carolyn B. Maloney (D-N.Y.), stands to be a high-profile moment of public scrutiny of the Trump administration by the Democratic-controlled House, which has struggled to secure Trump administration witnesses for oversight hearings,” Mike DeBonis reports. “… According to a draft notice of the hearing, Grimm is expected to brief the panel about her office’s work related to the coronavirus pandemic.”

HHS spokeswoman Melissa Rumley said Grimm’s appearance would not be focused on her previous findings on hospital experiences. 

The Trump administration's response

Moncef Slaoui, the scientist leading the administration’s vaccine efforts, has spent the last several days trying to rid himself of stocks that tie him to pharmaceutical interests.

Slaoui, a venture capitalist and a former longtime executive at GlaxoSmithKline, recently sat on the board of Moderna, one of the companies working on developing a coronavirus vaccine. He has resigned from the board now that he's leading “Operation Warp Speed,” Trump's effort to quickly produce a vaccine.

“Just days into his job, the extent of Dr. Slaoui’s financial interests in drug companies has begun to emerge: The value of his stock holdings in Moderna jumped nearly $2.4 million, to $12.4 million when the company released preliminary, partial data from an early phase of its candidate vaccine trial that helped send the markets soaring on Monday,” the New York Times reports.

Slaoui sold his shares this week. The administration said he would donate the increased value to cancer research.

“But the Moderna stock is just one piece of his pharmaceutical portfolio, much of which is not public,” Sheila Kaplan, Matthew Goldstein and Alexandra Stevenson write.. “And some ethics and financial securities experts have voiced concerns about the arrangement Dr. Slaoui struck with the administration.”

The United States has resisted the idea of government-run isolation facilities, even as other nations have seen some success with the strategy. 

In Hong Kong, for example — where officials recently announced that weeks passed with zero new locally transmitted cases — anyone known to have been exposed was sent to such a facility for two weeks. In South Korea, where the response has been hailed as a global model, individuals with moderate symptoms went to isolation centers, too.

“But even as centralized, out-of-home quarantine and isolation appeared helpful in breaking the chain of transmission in other countries, the United States has remained largely resistant to isolating people in government-run centers away from their homes,” Chelsea Janes reports. “And in places where voluntary isolation facilities are available, local officials are finding fewer people taking advantage of them than expected. It’s a reflection, experts said, of cost and conflicting priorities, of cultural norms and mistrust of government.” 

“We just don’t have enough civic trust, in many different ways, to make that something people are going to let happen with confidence,” Michael Fine, former director of the Rhode Island Department of Health, told The Post. “You can see that in people on the right, you can see that from the perspective of people of color, and others.”

Conservative groups are recruiting “pro-Trump” doctors that will go on TV to push for reopening. 

These doctors will call for reopening the nation without waiting to meet standards proposed by public health experts, including the CDC, the Associated Press’s Michael Biesecker and Jason Dearen report

“The plan was discussed in a May 11 conference call with a senior staffer for the Trump reelection campaign organized by CNP Action, an affiliate of the GOP-aligned Council for National Policy,” they write. “… CNP Action is part of the Save Our Country Coalition, an alliance of conservative think tanks and political committees formed in late April to end state lockdowns implemented in response to the pandemic. Other members of the coalition include the FreedomWorks Foundation, the American Legislative Exchange Council and Tea Party Patriots.”

About a sixth of the nation relies most on the president for information about the pandemic. 

New data from the Pew Research Center found 16 percent said they rely on Trump and the White House coronavirus task force the most for information about the coronavirus pandemic.

That’s compared with a quarter who said they relied on national news media the most, and 18 percent who cited public health professionals as a go-to source. 

“Unsurprisingly, there were wide partisan differences among those groups,” Philip Bump writes. “Two-thirds of those who said they rely most on the national news media identified as Democrats or Democratic-leaning independents — meaning about 17 percent of all respondents were Democrats/leaners who rely most on the national media. More than 9 in 10 of those who rely most on information from Trump and the White House were Republicans or Republican-leaning independents, meaning about 15 percent of all respondents were Republicans/leaners who rely most on the president’s team for information.”

Coronavirus latest

Here are a few more stories to catch up on this morning: 

More on the administration’s response: 
  • Guidance from the CDC for the reopening of houses of worship has been put on pause amid disagreement between the agency and the White House on the road map’s details, Lena H. Sun, Josh Dawsey and Michelle Boorstein report.
In the states: 
  • Churches in Minnesota announced they will resume in-person worship services next week, in defiance of the governor’s current executive order, Samantha Pell writes for The Post’s live blog.
  • Experts warn that several places in the South — including Dallas, Houston, Southeast Florida’s Gold Coast and the state of Alabama — are at risk of a second wave of coronavirus infections in the next month as they’ve quickly reopened their economies, Joel Achenbach, Rachel Weiner, Karin Brulliard and Isaac Stanley-Becker report.
  • As New York City experiences a sharp drop in coronavirus patients, hospitals shift into the next phase of its coronavirus fight. “Hospital executives and doctors, wary about what comes next as the city looks to ease out of its near lockdown, are asking whether this is a lull before a new wave of cases or a less chaotic slog,” the New York Times’s Sheri Fink reports. “At hospitals, staff members are preparing for both possibilities.”
Part of a new normal: 
  • Maura Judkis writes about how face masks have “changed the landscape of human expression at a time when people are looking to one another anxiously for signs of fellowship, hope and danger.”

Sugar rush

Olympic pole vaulter Sandi Morris decided to build her own pole vaulting setup after the coronavirus pandemic prompted her training space to close. (Video: Sandi Morris)