Three settings share common features that make them particularly vulnerable to the coronavirus, says a 40-year veteran of long-term and post-acute care.
What do cruise ships, prisons, and nursing homes have in common? Turns out they have many commonalities, which makes them all highly vulnerable to COVID-19, writes Philip D Sloane, MD, MPH, in the Journal of the American Medical Directors Association.
“I was not surprised that some of the earliest signs of COVID-19 outside of China were outbreaks on cruise ships,” write Sloane, who recounts his 30-day stint as a “trip physician” on a 500-passenger cruise ship during a respiratory virus outbreak. By the same token, he writes, no one should be surprised that nursing homes and prisons soon followed cruise ships as deadly hotspots for COVID-19.
These 3 seemingly disparate settings share many commonalities, according to Sloane, who spent over 40 years working in long-term care and post-acute settings. All feature a densely-populated congregate setting, a central kitchen that serves meals to large gatherings, regularly scheduled large group activities, and large numbers of staff who “have extensive contact with the residents and work under demanding conditions for modest pay.”
Each setting also has medical resources that compete with non-medical priorities, and health care regulations “that, while extensive, could not possibly have fully prepared them for COVID-19.” In each setting, writes Sloane, “the conditions that prevent disease dissemination are nearly impossible to achieve.”
Rather than blaming the settings, however, Sloane suggests that support and help would have been a better response to their COVID-19 outbreaks. He highlights 4 issues that need “priority attention” in nursing homes, the setting he knows best. Those issues include physical plant limitations, chronic staffing problems, poor infection control, and limited health care capacity. But Sloane is not hopeful that change is imminent.
“Given the societal ageism that has been exposed by the COVID-19 pandemic, and the persistent economic problems that will follow the pandemic for the foreseeable future, I would not bet money on major changes occurring in the long-term care system in the near future,” Sloane concludes. “But I would be thrilled to lose that wager.”