NEJM
on
SNFs

April 24, 2020 -- Here in the venerable NEJM is Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. It posits:

"Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility."
This should frighten anyone who goes or whose loved one goes into such a facility.

The facts are perhaps worse than the article describes. In the SNF where I work, we use infection-control strategies for all our residents, not only the symptomatic ones. Yet upwards of 70% in my unit (my unit is the Covid unit; this is not facility-wide) tested positive for the virus last week. The previous week it had been 10-20%.

When a worker has symptoms or tests positive, he/she stops coming to work. (So far, I am negative, thankfully.) But when a resident tests positive, what can we do? Sending them home is not an option (as I have discussed in an earlier blog posting, "sitting ducks".) SNF residents with their numerous comorbidities comprise by far the most vulnerable demographic.

My facility is doing everything the NEJM article recommends:

  • Restricting visitors and nonessential personnel from entering the building
  • Universal use of face masks by all staff
  • Strict screening of staff
Beyond these, we do frequent hand-washing, use full PPE, and wipe with bleach our instruments between patients. Even so, nearly all the residents of my unit have caught the bug. In close quarters, it is indomitable.

We are at the limit of what's possible. Yet the near-term outlook is poor.

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