Nursing homes deal with new reality

SALISBURY — Administrators of Northwest Corner nursing homes said they are responding cautiously to updated state and federal COVID-19 infection prevention and control guidance, released last week, relaxing protocols for masking, vaccination, Personal Protective Equipment (PPE), quarantine and testing protocols in areas where community transmission rates of the coronavirus are low.

The announcement was made in a 2-hour video call on Thursday, Oct. 6, between the Connecticut Department of Public Health (DPH) and nursing homes statewide. Discussion centered on the Centers for Disease Control and Prevention’s (CDC) newly released guidance.

The changes come at a time when Litchfield County’s community transmission rate is high, response to the reformulated bivalent boosters is low, flu season is approaching, and nursing homes are seeing a resurgence in infections among staff and residents.

In the last month at the Geer Village Senior Community in North Canaan, two residents in assisted living and two staff tested positive for the coronavirus, according to CEO Kevin O’Connell. They have since recovered.

“All had minor symptoms. Nobody really got horribly ill, although some people came down with real hard flu-like symptoms,” said O’Connell.

At Salisbury’s Noble Horizons Senior Community, Administrator Bill Pond reported on Friday, Oct. 7, that two nursing home residents tested positive for COVID-19 in as many days but exhibited no signs of illness.

“Both are asymptomatic, and I think that is what we are starting to see with these positive results,” said Pond.

Referring to last week’s call with DPH, “We went over new strategies for once the community transmission rate goes down below substantial, and when we can start to adjust to getting back to a more normal environment,” said Pond. But for now, he added, it’s “status quo” at Noble.

“From where we sit, we have gotten through this pandemic in pretty good shape, and, personally, I don’t see us making any dramatic changes in the very near future.”

Neither does Geer’s O’Connell.

“It’s a lot to digest. We are not doing anything different at this point until I can fully understand it all,” particularly how CDC guidance aligns with state and local regulations, said O’Connell.

The disease has been ‘steadily declining’

The CDC noted that the updates were made to reflect the high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools.

Its data is not based on Connecticut’s state COVID-19 positivity rate, which is trending upward. The rate was 9.55% on Thursday, Oct. 6, compared to 4.77% on April 6.

“There is a lot of virus, including the omicron subvariants BA.4 and BA.5, circulating out there, so I expect we’ll see a lot of viral transmission heading into fall and winter, although COVID-19, the disease, has been steadily declining,” said Sharon epidemiologist Dr. James Shepherd, an associate professor of medicine at Yale School of Medicine.

The rate of hospital admissions and seriously sick people has “slowly and steadily” been declining, said the infectious disease physician, “which is the data that most guidelines are based on, and not the virus, which is spreading.”

“Although the risk of COVID-19 and severe illness is starting to come down, the risks are still there for older people in nursing homes and significantly immunocompromised individuals who are on immunosuppressants because they’ve had organ transplants or blood cancer,” said Shepherd.

Some of the key changes

Under the CDC’s new guidance, that agency is no longer routinely recommending quarantine for patients, or work restriction for health-care personnel for asymptomatic individuals following COVID-19 exposures. It will continue to emphasize monitoring for symptoms, series of three tests, continued use of masking for 10 days following exposure and prompt isolation or work restriction if symptoms develop or testing is positive for COVID-19 infection.

Also, the CDC is no longer recommending asymptomatic screening testing of nursing home personnel who have not had a recognized exposure, although screening testing remains recommended for new admissions to nursing homes when community transmission levels are high.

The revised guidelines also recommend the use of PPE when community transmissions are high, and the CDC is no longer routinely recommending quarantine for patients, or work restriction for health-care personnel, for asymptomatic individuals following COVID-19 exposure.

‘The public has voted

with their feet’

Both Geer and Noble are in the process of rolling out the reformulated vaccination boosters, as well as flu shots, to residents and staff, according to administrators.

While the boosters are not mandated, Pond said he is strongly encouraging Noble employees to roll up their sleeves and get the jab.

In late August, the U.S. Food and Drug Administration (FDA) authorized the use of the new COVID-19 vaccine boosters, known as bivalent boosters, which target both the original strain and the new omicron variants.

The bivalent boosters, one by Moderna and one by Pfizer, are authorized for use by individuals 12 and older who have already received the initial COVID-19 vaccine series and one or more boosters.

The CDC has recommended that all adults get a bivalent booster at least two months after they complete their primary vaccine series.

So far, said Shepherd, demand for the new boosters has been lethargic.

Poll results announced Sept. 30 by the nonprofit Kaiser Family Foundation found that two in five fully vaccinated adults are not sure if the updated booster dose is recommended for them, and one in five adults said they have heard “nothing at all” about the new booster doses.

“Remember, the COVID booster is not free anymore, unlike the flu shot,” noted the physician.

“The numbers are very low. The public has voted with their feet. They’re saying, ‘Nah, we’re done. We know that you are trying to scare us about COVID-19, but we think we already know what is happening and are not that bothered by it anymore, so we don’t care.’ I think they made the argument because of what they are seeing around them.

“And, honestly, I think they are probably right,” said Shepherd. “The nursing home population would be the only groups that might have significant benefit from the booster. COVID-19 is becoming a much milder illness and right now it’s near what it would be for the seasonal flu.”

Noble Horizon’s Pond said he views the ramping down of CDC guidance as long-awaited relief.

“We are rounding the beginning of the end in this whole thing,” he said of the COVID-19 pandemic.