December 21, 2021
The Covid epidemic is ramping up again. Cases were up 21 percent over the past week, according to the NY Times. Even more important, so were hospitalizations and deaths: hospitalizations rose by 16 percent; and more than 1200 people are dying of Covid daily, which is not as bad as the peak levels of over 3000 in the winter of 2021 but represents a 9 percent increase over the course of a week. It’s dramatically more than this past July, when the count was around 250 deaths per day. 75 percent of all Covid deaths have been in those over 65. two-pronged strategy: keep the virus out by testing staff on a regular basis and bolster the residents’ defenses in case Omicron sneaks in by making sure everyone has received a booster. This strikes me as an excellent approach. I propose a few modifications. Keeping the virus out: this is critical. Long-term care institutions are relatively closed communities. That means the virus can get inside one of two ways: either a resident goes out, say to visit family or to go shopping, and brings the virus back, or a staff member contracts the virus and spreads it within the LTC facility. The first route is best dealt with by requiring that residents wear masks when they go out and that they be tested before re-entering the facility if they have been indoors with a group of people. The second route is the most common means of spread since staff members often live with families, take public transportation, and live in areas with high prevalence of Covid. Addressing the risk of staff inadvertently carrying the virus with them when they come to work requires regular testing. The Times article proposes a rapid test before each shift, which is probably optimal given that an aide, for example, might test negative one day because she has a very low viral load but test positive the next day after the virus has had a chance to replicate further. That’s a lot of testing. During the earlier peak, public health authorities established guidelines that called for the frequency of surveillance to reflect how widespread Covid is in the surrounding community. Weighing the inconvenience and cost of frequent testing against the benefit of vigilance in the face of an organism that multiplies with extraordinary speed, a reasonable balance might be twice weekly testing. The lesson we should have learned from our earlier experience is that waiting is a very bad idea—if we wait to institute the revised policy until the first case of Omicron appears in the nursing home, we will be too late. The time to start is now.