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Our war against the COVID-19 pandemic will likely end with an armistice. For health care workers on the front lines the cessation of hostilities will be welcome and come just in time.
But news from the front right now is that the war is not over. Here in Maryland and in other communities across the nation, courageous health care teams in hospitals and skilled nursing and rehabilitation centers are fighting to save lives. The care teams don’t like to be called warriors, but they are.
COVID-19 is a wicked and deadly virus, and unbelievably contagious. People of all ages with preexisting chronic conditions such as heart and lung disease, diabetes and other immune disorders are more at risk of hospitalization. And older people with such conditions are more likely to die from the virus.
One of the saddest storylines of this global pandemic is that it will perpetuate the narrative that people in this country go to hospitals to be saved, and to nursing homes to die.
I want people to know that their family, friends and neighbors who work in skilled nursing and rehabilitation centers are showing up every day and working in very challenging conditions to save lives. Truth is, many of the people who work in nursing homes have preexisting conditions themselves that put them at risk to die from the virus.
And people should know that those of us who work on behalf of the residents, patients, care teams and operators of nursing homes and the sector have been fighting since February to prepare them for this war, and behind the scenes we have been asking federal and state leaders to help us to prepare.
Our war against COVID-19 started as a defensive one. Here in Maryland before government orders, nursing homes worked to limit the visits of vendors and families, screen all visitors, review infectious disease protocols and to overcommunicate with workers, families, residents and patients.
Some nursing homes did better than others. But let’s be clear about a small but critical point: When we advised nursing homes to limit visits in advance of a government order, we were advising them to break the law, which limited such restrictions. But taking that step ahead of government orders was critical to slow the entry of COVID-19 into nursing homes.
In mid-March, about a month after the devastating tragedy of COVID-19 in nursing homes in Kirkland, Washington, the nursing home COVID-19 surge began here in Maryland. We had a single nursing home case on March 15, and a major outbreak in a single nursing home on March 29.
Today we estimate over 130 nursing home, assisted living and senior house centers in Maryland with at least a single worker, resident, or patient who is COVID-19 positive. Most COVID-19 cases in nursing homes in Maryland are not major outbreaks, and that is important to note. Centers prepared with observation and isolation units to separate COVID patients from others.
Given the nature of COVID-19, and who is most clinically at risk, it must be pointed out that the war of attrition we are now fighting in nursing homes and across all health care settings was inevitable. But it didn’t have to be this hard.
Absent massive national testing targeting health care workers and those clinically most at risk and government stay at home orders in January and February, we’ve been fighting this war with one hand tied behind our backs.
When we finally progress to the armistice of this fight, we will all examine and fix the long-term systemic government policies, the short-term government orders, the private sector response and health care lessons of the COVID-19 health pandemic which has been the economic world war of our generation.
Already there are questions and potential lessons to learn from.
The United States has arguably the best national intelligence capacity in the world, and most of our nation’s personal protective equipment is manufactured in China. So why didn’t we see the protective gear crunch coming?
What was and is the cause of our lack of testing? Even today in nursing homes in Maryland, adequate testing is still a problem.
COVID-19 has focused a bright light on the chronic underfunding of the part of Medicaid that pays for the majority of nursing home care in our country. If we spend wisely on Medicaid for nursing homes our system can avoid higher costs in hospitals and head off the torrent of patients before they reach our hospitals. It is clear in retrospect that not much thought was put into the planning of this war on the long-term care front.
COVID-19 has also shone a bright light on the health care disparities of people receiving and providing care, especially true in communities of color and economically disadvantaged communities. This a national shame.
Finally, our war to beat COVID-19 is coming at a huge economic cost. Given government spending and the lack of revenue from economic activity, government budgets coming out of this war will be in rough shape. Much more so than even with the 2008 Great Recession. This will be especially true for state government budgets.
And the bottom line is obvious: We must prepare better for the future.
Joseph DeMattos Jr. (jdemattos@hfam.org) is president of Health Facilities Association of Maryland, Maryland’s oldest and largest nationally affiliated association representing skilled nursing and rehabilitation centers in Maryland.