Throughout the course of this unprecedented pandemic, from its initial outbreak to successive waves and mutations, one demographic has consistently borne the brunt of sickness and death: older individuals. This pattern has remained shockingly unwavering, with individuals over the age of 65 accounting for approximately three-quarters of all COVID-19 deaths since the beginning of the crisis. To illustrate this point, in 2020 older individuals constituted 75.4% of deaths, in 2021 they comprised 73%, in 2022 they accounted for 71%, and for the first half of this year, they made up 72% of deaths. This trend holds steady even as the total number of COVID-19 deaths has significantly decreased, largely due to vaccination and natural immunity, and despite the relaxing of safety measures such as mask-wearing, social distancing, and staying up to date on vaccinations. Could more lives be saved if we exercised a bit more caution?
The Los Angeles County Department of Public Health issued a warning last week, stating, “Although the number of ongoing outbreak investigations across Los Angeles County is at an all-time low, skilled nursing facilities still experience a disproportionately high number of outbreaks compared to other sectors. Given the vulnerability of skilled nursing facility residents due to advanced age and underlying health conditions, preventing the spread of COVID-19 remains of utmost importance.” Unfortunately, not everyone recognizes the gravity of the situation.
Outbreaks in nursing home facilities in Orange County reached 31 in December, decreased to five in June, and as of July, there have been three. “We seem to have reached a steady state with no substantial increase observed in recent months,” remarked Ellen Guevara, spokeswoman for the Orange County Health Care Agency. Data from 2023 through June from the California Department of Public Health supports this observation. Moreover, while outbreak investigations in L.A. County nursing homes peaked after Christmas 2021, with 94 in one week, the number has consistently remained under 10 for the past several months. However, it is concerning that half of the ongoing outbreak investigations are in skilled nursing facilities in L.A. County, a pattern seen in most areas.
Dr. John Swartzberg, a clinical professor emeritus at UC Berkeley School of Public Health, expressed disappointment at the high death rate in nursing homes, given the age and health status of the residents. He emphasizes the need for better protection of this population, stating, “Shortly after the pandemic began, we knew that this patient population was at exceptionally high risk for infection, severe disease, and death. Yet very few are taking effective measures to protect themselves, such as wearing masks, using personal protective equipment, and making prudent decisions. The relaxed guidelines from the Centers for Disease Control and California Department of Public Health may make sense for the general population, but not for the individuals in nursing homes.”
Another contributing factor is the waning interest in boosting immunity as time goes on. Statewide, only 21% of Californians have received the bivalent booster, indicating they are up to date on their COVID-19 vaccinations. Southern California has even lower rates, with just 20% in L.A. County, 19.7% in Orange County, 12.6% in Riverside County, and 11.4% in San Bernardino County. However, vaccination rates are better among the older age group, with 44% of Californians over age 65 being up to date on vaccinations.
There is a caveat when it comes to nursing facilities. Officials in L.A. County state that higher levels of vaccination have been achieved among skilled nursing facility residents. The vast majority of residents and staff have received the initial round of shots, with 89% of residents and 98% of staff members vaccinated. However, the first shots provide limited protection against current variants, and only 70% of residents and 48% of staff members have received the bivalent booster. Nonetheless, the proportion of COVID-19 deaths among residents in skilled nursing facilities has steadily declined since the introduction of vaccinations.
The fact that most COVID-19 deaths occur among the elderly is to be expected, according to Andrew Noymer, an epidemiologist and demographer at UC Irvine. While it is positive that deaths are decreasing, Noymer cautions that we need to remain vigilant. Unlike the flu, which typically subsides in the summer, COVID-19 has caused significant devastation during this season. “I hope that summer 2023 will return to normalcy, but I’m not necessarily optimistic,” he said. The true turning point will only be evident when we assess the overall mortality rates related to COVID-19.
Dr. Swartzberg believes that public health guidelines should have been more tailored to older individuals instead of following a one-size-fits-all approach. He recommends maintaining mask mandates in nursing homes for patients, staff, and visitors. He also urges all nursing home patients to be up to date with their immunizations since infection control measures in these facilities tend to be less stringent compared to hospitals.
To prevent infection when visiting skilled nursing facilities, Dr. Barbara Ferrer, director of the Los Angeles County Department of Public Health, advises family and friends to take protective measures. If potential visitors exhibit respiratory illness symptoms, they should wait until symptoms subside before visiting. Additionally, they can undergo a COVID-19 home test before their visit to ensure they are not infected. Vaccination provides another layer of protection. Ferrer emphasizes that while we may be in a less dangerous phase of the pandemic, it is crucial to continue implementing sensible precautions to minimize the risk of transmission, particularly for vulnerable residents in long-term care facilities.
Dr. Swartzberg concludes by stating that patients in nursing homes represent one of the most vulnerable groups in society, yet we fail to utilize the available tools to protect them. He suggests that a sociologist could provide insights into why this is the case.
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