The outbreak of COVID-19 in long-term care facilities in Hamilton County and throughout Tennessee is stressing the health care systems tasked with providing for those most vulnerable to the deadly virus.
Sixteen nursing homes or assisted living communities in Hamilton County, housing more than 1,600 people, have 294 active cases among residents and 207 cases among staff, according to data published Nov. 25 by the state department of health.
The severity of the outbreak in long-term care facilities can be seen more clearly when comparing it to the outbreak in the wider community, which is dealing with unprecedented levels of spread.
On Thursday, Hamilton County had seven active cases per 1,000 residents. Yet, in Hamilton County's long-term care facilities, using the same calculation from last week's data, there are 183 active cases per 1,000 residents.
On Thursday, Hamilton County leaders repeated a call to the public to help staff clinical and non-clinical positions at local hospitals and long-term care facilities.
Across a 10-county region of Southeast Tennessee with 34 facilities housing 2,895 residents — including facilities in Bradley, Coffee, Franklin, Grundy, Hamilton, Marion, McMinn, Meigs, Rhea and Sequatchie counties — there were 717 active COVID-19 cases as of Nov. 25, according to the state department of health. There have been 72 resident deaths in these facilities and more than 530 staff members are sick with the virus.
Dr. Victor Legner, associate professor of medicine at the University of Vanderbilt Medical Center, said the residents of these facilities have weaker immune systems and more underlying health issues than the general population. The needs of such residents, such as having medications delivered or needing help using the bathroom, can complicate isolating those who are sick.
"One of the worst statistics that no one really talks about is that if you live in a facility, whether it's assisted living or a skilled nursing facility, and you end up with coronavirus, you have about a 30% mortality rate," Legner said. "The majority of the deaths are occurring in the facilities, and it's because of the frailty of the people."
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According to the state, 45% or 43 of the 95 residents of the Soddy Daisy Healthcare Center are infected with COVID-19. The Soddy-Daisy facility had the highest rate of infected residents in Hamilton County, while Standifer Place is the facility with the highest number of infected residents in the county, with 77.
In the opening months of the pandemic, long-term care facilities implemented strict visitation policies to protect seniors, who are especially vulnerable to serious COVID-19 illness and death.
Outbreaks still occurred. Life Care, the Cleveland-based operation and the nation's largest privately-owned nursing home chain, drew national attention in March as deaths soared at a Seattle location where few precautions were taken. A Life Care location reported more than a dozen deaths at its facility in Athens, Tennessee, in May.
The nearby Ridgewood Manor Health and Rehab in Dalton, Georgia, reported 46 resident and 21 staff infections, along with seven deaths, in August.
In mid-September, Tennessee state officials praised its strict efforts to stop the spread. Dr. Lisa Piercey, Tennessee health commissioner, said at the time the measures "saved dozens, if not hundreds, of lives." The state then allowed facilities that had gone at least 14 days with no new COVID-19 cases among residents or staff members to offer outdoor or limited indoor visitation with residents starting Oct. 1.
Kristina Wick, assistant professor at the University of Tennessee at Chattanooga and member of the state's long-term care task force, said the opportunity for visitors is particularly important for residents. The shutdown brought many negative emotional consequences for the elderly, such as increased loneliness, depression, isolation and cognitive decline.
"One of the major problems with this is that people have not been able to have visitors or have not been able to really get out of their facilities for visitation at all. And the social isolation has really taken its toll," Wick said.
But case rates and deaths are spiking. In the past month, cases and deaths among facility residents across Tennessee increased by 39% and 35%, respectively, according to data from the state health department. This tracks with national trends that saw a spike in confirmed cases and deaths since October.
According to the most recent data published by the state, 1,276 residents have died from the virus since the start of the pandemic.
On Tuesday, a group advising the U.S. Centers for Disease Control and Prevention suggested the first round of available COVID-19 vaccines go to residents and employees of long-term care facilities, as well as health care workers on the front lines. The decision was applauded by the American Health Care Association and National Center for Assisted Living, an advocacy group representing more than 14,000 nursing homes and assisted living communities.
Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement that state governors should implement this recommendation into their vaccination plans.
The first doses of the Pfizer vaccine, which was reported to be 95% effective during clinical trials, are expected to arrive in Tennessee in mid-December. Between 40,000 and 50,000 people will be fully vaccinated with the two-dose vaccine. Long-term care facility residents are listed as a critical population in need of the vaccine in Tennessee's first draft of its vaccine distribution plan.
Legner said the best strategy to protect residents of long-term care facilities until a vaccine is available is controlling the virus in the surrounding area. The higher the level of spread, the greater the chance the virus has of getting into a nursing home. Only three of Tennessee's 95 counties have control of the virus enough to not be considered in the "red zone" for spread, according to the state.
Hamilton County shattered multiple records for the local outbreak on Wednesday including hospitalizations, active cases, new infections and people in the intensive care unit. Active cases climbed even higher, to 2,628, when new data was reported Thursday.
"We are the ones bringing it into the facility," Legner said. "It's not my grandma who is 85 years old and in the facility who's bringing it in, right? Someone is bringing it into the facility. So it's really us as a community. We have to come together and say we're going to limit the spread and we're going to do everything we can to protect our vulnerable adults and put them at the forefront of our thoughts."