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Coronavirus Poses Special Risks For Nursing Homes

The novel coronavirus outbreak at Life Care Center nursing home in Kirkland, Washington, which has killed 13 residents and left others seriously ill as of Sunday, highlights the risk that such facilities face from the virus.


As of Saturday, 70 of the 180 staff members at Life Care Center were reportedly out sick with symptoms resembling COVID-19, the disease caused by the coronavirus.

The nursing home-focused outbreak of the coronavirus comes as nursing homes and assisted living facilities are already struggling with infections. Such places are sometimes poorly staffed and don't control infections properly, leading to resident hospitalization or death, The New York Times reports.

“We have to prepare for the inevitability that there are going to be facilities like the one in Washington where you’re going to have the virus ... move rapidly through nursing homes and assisted living facilities,” Brown University geriatrician David Dosa told the NYT.

A large majority of U.S. nursing homes — 75% — have been cited for not controlling (or monitoring) infections during the last three years, USA Today reports, citing federal inspection data. Not all of the citations were serious, but many were, including ones for facilities trying to cover up infection outbreaks.

Inspection reports show that many errors are fairly simple, and thus theoretically easy to correct, such as workers not washing their hands between patients, or not bothering with masks, gloves or gowns in situations where they are called for, such as visiting a patient in isolation, Kaiser Health News.

Even though it is a top-rated nursing home by the government — five stars — Life Care Center had previously been cited for a lapse in infection control.

The potential damage from infections in nursing homes is quite large. Over 4 million Americans reside in nursing homes or skilled nursing facilities each year, according to the U.S. Centers for Disease Control and Prevention, and almost 1 million live in assisted living facilities.

The problem of serious infection in these facilities isn't precisely known, though it is estimated to be extensive. Between 1 million and 3 million serious infections occur annually in the facilities, the CDC says, including antibiotic-resistant staph infection, urinary tract infections and diseases marked by diarrhea.

Since the coronavirus outbreak in the United States is still evolving, its impact on nursing homes or any other kind of congregate care is unknown. 

The problem is compounded by the fact that the elderly are proving to be particularly vulnerable to COVID-19. In China (as of Feb. 11), the fatality rate for the disease for people over 80 is 14.8%, and for those 70 to 79 years old it is 8%, compared with a 2.3% fatality rate overall, the Chinese CDC reports.

Another consideration for senior housing, especially skilled nursing facilities that employ a significant number of healthcare workers, is protecting those workers from the disease. Healthcare–associated transmission is a major problem, the U.S. CDC reports.

To deal with that problem, the U.S. CDC further recommends that healthcare workers use personal protective equipment such as gowns, gloves and either an N95 respirator plus a face shield, goggles or a powered, air-purifying respirator. How practical that would be for skilled nursing facilities, the agency does not address.