A new, more-easily spread strain of the COVID virus has swept through a Colorado nursing home, apparently infecting almost everyone in the facility.
Scientists fear the new strain can spread twice as fast as the existing, dominant strain – even as cases in Arizona have set records.
The discovery of the new strain comes just as state officials are trying to speed up the slower-than-expected rollout of a new vaccine that provides 95% protection, with few side effects.
Nursing homes started vaccinating residents and staff last week and hope to finish administering the first of two doses this week or next. The first dose reduces infection rates by 50 to 60 %. A second dose three weeks later boosts protection to 95 %.
Other vaccines are on the way, but the new strain of the virus at the moment appears to be outrunning the lagging mass-vaccination campaign.
“News that the new strain of COVID-19 has been confirmed and connected with a Colorado nursing home indicates that our fight against this virus is far from over,” said CEO of the American Health Care Association and the National Center for Assisted Living. Some 38% of the deaths from COVID-19 in the US have been among nursing home and assisted living center residents and staff.
“This development comes at a time when long term care facilities are facing the worst outbreak since the spring,” said CEO Mark Parkinson. “Soaring community spread has resulted in a record-breaking number of cases and deaths in nursing homes—nearly 25,000 cases and 4,000 deaths per week. This is why long-term care residents and staff must be prioritized for critical resources, especially distribution of the COVID-19 vaccines. Given the asymptomatic and pre-symptomatic spread of the virus, coupled with the vulnerability of our populations, the vaccines will literally be a lifesaver for tens of thousands of long-term care residents. We need the full support of federal and state governments to win this war.”
Congress recently enacted a second, $900-billion pandemic stimulus bill, with some additional money for nursing homes and vaccines.
The bill provides $20 billion to buy more vaccine and $8 billion to help states distribute the shots, as well as $20 billion more for contact tracing. Nursing homes can also qualify for emergency loans, with many facing bankruptcy as a result of the pandemic. The loans would help hard-pressed nursing homes pay for mortgages, insurance and property taxes.
Scientists were alarmed at the recent emergency of a strain of SARS-CoV-2, which cases COVID-19. The strain was first detected in England and then South Africa. It has now cropped up all over the globe. Scientists isolated the strain after noting a rapid increase in the rate of spread of the virus in Great Britain.
Genetic analysis found a surprising cluster of 17 mutations that seemed to have surfaced all at once. Eight of those mutations took place in the gene that creates the spike protein on the surface of the virus that enables it to infect cells.
Scientists say the variant doesn’t appear more lethal, but does spread from person to person roughly 70% more easily. It’s unclear whether the rapid mutation in the spike protein will make the existing vaccines less effective against that variant, since they target the same spike protein. So far, vaccines have produced long-lasting immunity to all the known strains of the virus, but the mutation has unnerved some epidemiologists. Normally, key mutation occurs one or two at a time. The existing mutations affect nine of the 1270 amino acids that make up the spike protein.
So far, scientists can’t explain the sudden emergence of 17 related mutations all at once, according to a summary of the most recent research published in the Journal Science. One theory suggests the strain essentially underwent change through a lengthy bout of infection in a single, chronically infected patient who then infected someone else. One of the great challenges posed by the SARS-CoV-2 virus has been its ability to infect people without causing symptoms, who can still pass it along. Moreover, some evidence suggests that a single person can be infected by the virus more than once, giving the virus and the immune system more opportunities to interact and adapt.
Equally worrisome, some very preliminary information suggests the new variant might more readily infect children than the current, dominant strain. Up until now, children younger than 12 have proved less likely to get infected – and less likely to spread the virus along when they do get infected.
But nursing homes and assisted living facilities have remained the tragic heart of the pandemic even as cases have risen, fallen and risen once again.
People older than 65 in Arizona have so far accounted for 13% of known cases, but 74% of deaths.
Unlike most states, Arizona has not consistently reported cases and deaths in individual nursing homes and assisted living facilities to a national database. In aggregate, more than 1,400 long-term care facilities, rehab facilities, assisted living facilities and “others” have reported infections in Arizona.
Nationally, 29,000 nursing homes and long-term care facilities have reported COVID cases. More than 927,000 residents and employees have been infected and more than 117,000 have died – 35% of the cases nationally.
The New York Times maintains a national database of nursing home deaths, but Arizona isn’t included because the state doesn’t report deaths by facility. Among the states that do report such deaths, the share of nursing home deaths varies widely. In New Hampshire, nursing homes account for 81% of deaths, compared to just 19% in Nevada. Overall, the death rate in nursing homes is about seven times higher than the 2% national average for cases with a positive test.
An investigation by the Arizona Republic found that many of the state’s nursing homes either didn’t have enough protective equipment or in some cases required workers to keep working even when they had symptoms of COVID-19.
State health inspectors found widespread violations of infection protocalls during the pandemic. Federal inspectors cited nearly half of the state’s 145 nursing homes for errors that could spread the virus, including wearing masks improperly, neglecting to sanitize their hands and not keeping residents six feet apart.
Other studies have found no consistent relationship between the spread of COVID and a history of citations. The infection rate in nursing homes mostly reflects the infection rate in the surrounding community, according to those studies.
The pandemic has cast tragic light on long-running problems in the industry, which despite the high costs of such care frequently run on the margins of profitability. Nursing home staffers are generally poorly paid and often offered only part-time work, which has the effect of reducing the benefit costs for the workforce. As a result, many nursing home staffers don’t have health insurance and work in multiple facilities. That provided the perfect setup for having workers spread the infection through multiple facilities before they know they’re infected.
One recent survey found that 56% of assisted living providers say they won’t make it through another year financially, given the extra costs of coping with the pandemic. Some 86% of nursing homes have a profit margin of less than 3% and more than half are currently operating at a loss.
The nursing home industry has been pleading for relief for months, lacking money for the necessary protective gear and money to pay higher staff salaries to cope with shortages and the impact of quarantines. Some 61% of the nursing homes responding to the industry survey said they have had to hire additional staff and 90% have required overtime.
“The gravity of the situation we are facing with this deadly virus cannot be overstated,” said Scott Tittle, executive director of the National Center for Assisted Living. “Congress provided minimal funding that could be available for long-term care residents and caregivers. Hundreds of facilities are in danger of closing their doors permanently and uprooting the frail seniors they care for. Congress must do more in the new year by directing specific aid to long-term care. We owe it to our nation’s seniors and our healthcare heroes.”
Some studies have found that the financial pressures on nursing homes even before the pandemic set them up for the rapid spread of the virus.
For instance, a study in Canada found that nursing homes with single-resident rooms had half the death rate as more crowded nursing homes with two or more people per room, according to the study published in JAMA Internal Medicine. The survey of about 1,400 nursing homes found a death rate of 1.3% in single occupancy homes compared to 2.7% in more crowded homes. For those residents who contracted the virus, 28% died. The virus was just as likely to show up in the less-crowded nursing homes, but spread much faster in crowded conditions.
Another study found that for-profit nursing homes in Canada had higher infection and death rates – but that likely reflects the higher percentage of double, triple or quadruple room occupancy.
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