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Vigilance Needs to Continue in Protecting Older Persons from the Covid-19 Pandemic

Alan S. Gutterman

Best-Selling Author

发布日期: 2021年10月22日

Vaccines have been available for almost a year and have been widely embraced among older persons.?The result has been a dramatic drop in death and suffering among the group that was most adversely impacted by the pandemic.?However, the untimely deaths of Colin Powell and other vulnerable persons even after being fully vaccinated are a sobering reminder that vigilance needs to continue.?In this adapted excerpt from “Covid-19 and Older Persons”, available from the Ageism Project (www.ageismproject.org), I provide a reminder of the timeline of the Covid-19 pandemic in relation to older persons and the challenges that remain before, since we cannot forget.?

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The first US case of Covid-19 was confirmed at a Kirkland, Washington nursing home in late February 2020 and in the year that followed nursing homes and assisted-living facilities suffered through more than 1.1 million cases among their residents and staff members and more than 129,000 deaths.[1]?In fact, The New York Times reported that 5% of all cases and more than a third of the Covid-19-related deaths in the US during that year were linked to nursing homes, including both residents and staff, even though less than 0.5% of the country’s population lived in them.[2]?The number of cases and deaths continued to climb as the pandemic surged into its second year and data from the Public Policy Institute and the Kaiser Family Foundation indicated that by the end of July 2021 there had been about 1,468,000 cases across 35,000 facilities, nearly one out of every 10 nursing home residents in the US had died from Covid-19 and the death toll among the residents and staff members of nursing homes and other long-term care facilities around the US had reached 186,000 (31% of the total for the country).[3]?Beyond nursing homes, the toll that the pandemic took on all persons aged 65 or older has been sobering: as of September 2020, eight out of ten Covid-19-related deaths in the US had been in that age group and 94% of the deaths in Europe, on average across all of the European countries, were among people over the age of 60 during the periods that the outbreak was most severe.[4]

The development and testing process for the Covid-19 vaccine was criticized for underrepresentation of members of the groups that had suffered most from the outbreak, including older adults and members of racial and ethnic minorities[5]; however, once it was rolled out in December 2020 it was enthusiastically welcomed and accepted by older Americans: by mid- October 2021 about 96% of people aged 65 and older has gotten at least one dose of the vaccine, and 84% of the group was fully vaccinated.[6]?Many nursing home administrators breathed a sigh of relief as they began to see a “precipitous drop in cases among residents and staff—an absolutely straight-line decline”.[7]?By the end of June 2021, government data showed that with 80% of nursing home residents vaccinated the number of cases in those homes had fallen to a low of 322, welcome news after the devastating toll of death and serious illness that the pandemic had taken in nursing homes since the beginning of 2020[8]; however, by mid-July 2021 they had doubled to more than 700 cases as “breakthrough” infections among fully vaccinated residents became more common, most frequently in facilities where unvaccinated staff were testing positive and likely bringing the virus into the facilities from the communities in which they lived (many of which had overall low vaccination rates).?The Centers for Disease Control and Prevention (“CDC”) announced that it was monitoring the impact of the delta variant of the virus on nursing homes to see if “additional measures are needed” including “testing, quarantine, visitation, use of PPE and source control”, and some nursing homes reintroduced measures taken during the worst days of the pandemic including imposing limitations on visitors.[9]

The situation in nursing homes thrust the industry into the broader political and societal debate about vaccine mandates.?According to an article in The New York Times, government data indicated that only about 60% of nursing home staff members were vaccinated as of the end of July 2021, and some states reported an even lower rate, with less than half inoculated.[10]?Due to the rising case numbers, LeadingAge, which represents about 2,000 nonprofit nursing homes, joined nearly 90 other groups in supporting mandates for nursing home workers; however, opinions remain split among key players in the industry even as major medical organizations have endorsed mandates among health care workers and more hospitals are requiring their employees to show proof of vaccination.?For example, as of the end of July 2021, the American Health Care Association, the nursing home industry’s main trade group, rejected mandates in favor of continuing efforts to educate workers.?Others have argued that it is more than just a matter of education, but that there also needed to be respect for the personal concerns of nursing home workers, mainly women of color including Black women that are rightly skeptical of the new vaccines due to historical misuse of research in their communities.

Another worry is that requiring vaccines would cause nursing home workers to leave their jobs and/or make it difficult for nursing homes to recruit new workers, a critical issue in an industry that is already understaffed and continuously disrupted by rapid turnover among personnel.?All of this comes amid pre-existing anxiety across the country about the safety of nursing homes in light of the number of Covid-19-related death that has caused families everywhere to rethink nursing home care and seek other solutions for providing care to their elderly members.[11]

Regulatory approval of booster shots of the Covid-19 vaccine in September 2021 was driven, in large part, by the perceived need to continue shoring up protection of older persons.?When boosters became available, data from the CDC indicated that 6.7 million of the first 10.7 million Americans to receive them were older adults, as might be expected; however, as of mid-October 2021 only about 1 in 7, roughly 15%, of Americans aged 65 and older had received a booster dose.[12]?Nursing homes and assisted living facilities moved quickly to roll out the booster shots to their residents[13] and public health experts were proactively encouraging older adults to get their booster shots and continued to prod family members and others within the general population to get fully vaccinated in order to reduce the risks to older persons, even those who are fully vaccinated, and persons of all ages with conditions that have suppressed their own body’s immune response.?While it was true that the death rate among persons with breakthrough cases was quite low, estimated to be .004%, 85% of those who did die were aged 65 and older.?One challenge for the use and efficacy of the booster doses is the above-described hesitancy among a significant number of workers in nursing homes to take the vaccine, which obviously creates risks for residents.?As noted, nursing homes are reluctant to impose mandates on their workers, fearing that workers will quit and the already difficult staffing shortages in those facilities will be exacerbated.

About the Author

This Work was written by Alan S. Gutterman, whose prolific output of practical guidance and tools for legal and financial professionals, managers, entrepreneurs and investors has made him one of the best-selling individual authors in the global legal publishing marketplace.? Alan launched and leads the Ageism Project, which is a California nonprofit public benefit corporation with tax exempt status under section 501(c)(3) of the Internal Revenue Code dedicated to advancing awareness of the challenges and opportunities associated with increased longevity; combatting and eliminating prejudice against older persons and age discrimination in all its forms; defending the human and civil rights of older persons secured by law, with particular attention to the rights of members of vulnerable groups; and promoting and advancing the interests of older persons in society as a whole through education and efforts to enhance intergenerational solidarity.?The Project engages in high-quality, independent research with the goal of providing innovative, practical recommendations for policymakers, businesses and civil society on addressing ageism and improving the lives of older persons.

For more information about Alan and his activities, please contact him directly at [email protected], follow him on LinkedIn, subscribe to his newsletter and visit his website at alangutterman.com.?Many of Alan’s research papers and other publications are also available through SSRN and ResearchGate.?

Notes?

[1] J. Silver-Greenberg and R. Gebeloff, “To Lift Ratings, Nursing Homes Shroud Neglect”, The New York Times (March 14, 2021), 1.?Reports from several states including Indiana and New York have raised concerns that deaths in nursing homes may have been significantly underreported, perhaps by as much as one in ten deaths in those facilities during the period, which means that the total number of deaths will eventually be much higher, particularly if similar reporting issues are discovered in other states.