‘No More Visits’ Urges Nursing Home Industry in Wake of Virus

SAN FRANCISCO — Warning that the novel coronavirus poses an extreme risk to the nation’s elderly and infirm, nursing home industry leaders on Tuesday said they are recommending unprecedented action to curtail most social visits in the thousands of nursing homes and assisted living centers in the United States.

The recommendation comes with the support of the federal government following an outbreak of the virus in the region around Seattle. Five long-term care facilities have been hit with cases, including a facility in Kirkland, Wash., where 18 residents have died.

“The mortality rate is shocking,” said Mark Parkinson, president and chief executive officer of the American Health Care Association. He said that the death rate might well exceed the 15 percent that has been reported in China for people aged 80 and older.

The challenge of the virus “is one of the most significant, if not the most significant” issues the industry has ever faced, he said.

Officials said they are recommending that nursing home reception workers screen all visitors — family, staff, contractors and government workers — and that only essential visits be conducted.

“Do you need to be in-building to operate” the facility? said Dr. David Gifford, the health care association’s chief medical officer. As for family members, he said, “Our recommendation is they should not be visiting.”

Anyone who does visit, he said, should be screened carefully at reception and anyone who has signs of illness should be turned away.

The new guidance unfolded as another outbreak at a different nursing home in the state of Washington was developing. Nicole Francois, a spokeswoman with Issaquah Nursing & Rehabilitation Center, said one resident died over the weekend and seven others have tested positive for the virus — five residents and two staff members.

The facility, which announced last week that it was prohibiting visitors, was in the process of contacting everyone who has visited since early February.

The nursing home outbreak has been mainly isolated to the Seattle area so far, but experts in the field said that the outbreaks there are likely an early manifestation of the virus’s eventual spread among a particularly vulnerable part of the health care system.

A variety of factors make nursing homes especially at risk to an epidemic: older residents often have weakened immune systems; many facilities are poorly staffed and have lax infection prevention — partly because visitors are constantly coming and going — allowing germs to spread. On top of that, residents, who live in proximity, often move back and forth to hospitals when they become acutely ill, and that makes them potential carriers of infection.

In recent years, public health experts have intensified calls for an overhaul of a system that has long been linked to the spread of infection, but has been largely overlooked by policymakers.

The Covid-19 coronavirus appears to pose a significantly greater risk to the nursing-home population than a typical seasonal flu — although the two illnesses share some similarities and are often compared. Both can spread easily and attack the lungs.

With the flu, nursing homes vaccinate their staff and patients, but no vaccine exists for the novel coronavirus. When the flu hits a nursing home, patients are given prophylactic anti-viral medicine. No such prophylaxis exists for the new coronavirus. The death rate from the flu varies widely, depending on how strong the strain, but its potential lethality is sharply curbed by the built-in immunity created by vaccinations and some people’s immune defenses.

“None of those factors play into this. No herd immunity, no vaccine and no treatment,” said Dr. David Dosa, a geriatrician and expert in emergency preparedness medicine at Brown University.

“What is going to happen in each of these cases is the virus will get in, and presuming it’s not easily stopped once it gets in, everybody in the building will get it,” he said. “Then you’ll see mortality and morbidity rates that are very significant.”

That prospect has left Washington State officials scrambling to understand not only how to stop the spread in these facilities but how it appears to be jumping from one place to the next. Along with the outbreaks at the nursing homes in Kirkland and Issaquah, a staff member tested positive at Aegis Living Marymoor in Redmond, and one resident each were diagnosed at Ida Culver House Ravenna, a senior living complex in Seattle, and at Josephine Caring Community, which provides assisted living, in Stanwood, Wash.