COVID-19: Staff and Survey Team Members – Food for Thought

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

These are indeed very strange times that we live in.  All our lives are on the line during this pandemic, especially individuals in congregate living communities and workers in those communities.  In the past few days, I’ve read two (2) articles that were almost heart-stopping for me.   I offer these articles and a paper for your consideration.

After Times investigation, Newsom says nursing home inspectors will be tested for coronavirus from the July 24, 2020 LA Times.  “California Gov. Gavin Newsom announced Friday that the state will start an aggressive COVID-19 testing regime for its health employees who inspect nursing homes.  The announcement came hours after publication of an L.A. Times investigation that found since the beginning of the pandemic, the state health department had been sending inspectors from nursing home to nursing home without testing them for the deadly virus, which means they could be spreading it.”  My curiosity tweaked, I kept reading and stopped when I saw these 2 statements: “Eight registered nurses working as inspectors for the California Department of Public Health — all of whom spoke on condition of anonymity for fear of retaliation — told Times reporters they weren’t being tested. One said she came down with a bad cough and tested positive for COVID-19 soon after visiting more than a dozen nursing homes in two days; Most of the inspectors interviewed also said they have not been provided with properly fitting personal protective equipment. One inspector said she refuses to spend more than a few minutes in a nursing home’s “red zone,” the quarantine wing reserved for COVID-positive residents, because every time she exhales wearing her ill-fitting masks, her glasses fog up.” 

I read James Berklan’s (McKnight’s Long-Term Care News) July 26, 2020 Eliminating staff ‘cross-traffic’ could have cut nursing home COVID-19 deaths by 44 percent, researchers find.  If you have not seen this, it’s worth your time and consideration.  By now, you are probably aware of what happened in King County Washington earlier this year – where COVID-19 became part of our everyday pandemic lives in this country. COVID-19 in a Long-Term Care Facility — King County, Washington was published in the March 18, 2020 and March 27, 2020 editions of Morbidity and Mortality Weekly Report (MMWR).  In this report: “Information received from the survey and on-site visits identified factors that likely contributed to the vulnerability of these facilities, including 1) staff members who worked while symptomatic; 2) staff members who worked in more than one facility; 3) inadequate familiarity and adherence to standard, droplet, and contact precautions and eye protection recommendations; 4) challenges to implementing infection control practices including inadequate supplies of PPE and other items (e.g., alcohol-based hand sanitizer); 5) delayed recognition of cases because of low index of suspicion, limited testing availability, and difficulty identifying persons with COVID-19 based on signs and symptoms alone.”   Jim Berklan’s piece provides information regarding Nursing Home Staff Networks and COVID-19.  This was a study/paper done by UCLA Anderson School of Management and the Yale School of Management.   “In this paper, we perform the first large-scale analysis of nursing home connections via shared staff using device-level geolocation data from 30 million smartphones, and find that 7 percent of smartphones appearing in a nursing home also appeared in at least one other facility—even after visitor restrictions were imposed. We construct network measures of nursing home connectedness and estimate that nursing homes have, on average, connections with 15 other facilities.”

The 22-page abstract goes on with these observations and conclusions (bolding and italics added by me):

  • Results suggest that eliminating staff linkages between nursing homes could reduce COVID-19 infections in nursing homes by 44 percent.
  • The practice of employing nursing home workers across multiple care facilities may play an important role in the spread of COVID-19.
  • In principle, if a congregate setting were completely closed to the outside, infection could not enter. A key challenge in isolating nursing homes derives from their reliance on staff who live in the community. A study by the State of New York (New York State Department of Health, 2020) concluded, largely based on the timing of infections, that through no fault of their own, nursing home workers were likely the main source of SARS-CoV-2 transmission in nursing homes.
  • These results provide evidence of the magnitude of the benefits that would derive from compensating nursing home workers to work at only one home and limiting cross-traffic across homes. While some nursing homes and other long-term care facilities have undertaken actions to create a “staff bubble”, this is still not a component of extant regulation (Sudo, 2020; Rodricks, 2020). Absent such regulation, allocation of PPE, testing, and other preventative measures should be targeted thoughtfully, recognizing the current potential for cross-transmission across homes. While the nursing home population is particularly fragile, this research has implications for cross-linkages amongst other congregate settings such as assisted living homes, prisons, or large workplace facilities such as food-processing plants.

We can do better!  We need to increase testing – appropriate testing – for staff in congregate living communities.  Each of us needs to wear masks in the overall communities we live in when we cannot socially distance and in public places.  We must be cognizant that our behavior affects others around us.