It is the lead story in every newscast, news feed, and every other form of information sharing: the coronavirus, or COVID-19. (As the Centers for Disease Control and Prevention (CDC, a federal agency) explains, public health experts originally used the name “2019 novel coronavirus” to describe the phenomenon of a respiratory infection caused by a virus not previously observed in humans. International health officials then began using the term “coronavirus disease 2019,” or COVID-19.) [1] This disease poses a double threat for Las Vegas nursing home neglect.
Background on COVID-19
As suggested above, coronaviruses are not new discoveries or even new phenomena in humans. What is “special” about COVID-19 is that it appears to be a virus that has not existed previously in humans; many researchers believe that the virus “jumped” from a bat to humans. This is based on genetic sequencing of COVID-19 and comparisons with coronaviruses found in bats. This theory is supported by the fact that the cluster of early cases in Wuhan, China were traced to a market where exotic meats are sold, including bat meat. [2]
The world looked on with sympathy as China grappled with the disease’s rapid spread, but it seems that many officials hoped the disease would remain isolated in China. After initially trying to cover up the emergence of this public health threat, [3] Chinese officials moved quickly in the opposite direction to undertake major interventions to protect public health at the expense of individual liberties. [4] Despite those efforts, the disease leapt across borders and is now virtually a worldwide pathogen. Here is a list of the top locations with confirmed cases of COVID-19 as of March 8, 2020:
- China (80,734)
- South Korea (7,382)
- Italy (7,375)
- Iran (6,566)
- France (1,209)
- Japan (1,198)
- Germany (1,040)
- Spain (673)
- USA (545)
- TOTAL > 109,900 [5]
Researchers are working feverishly (truly, no pun intended) to learn about this disease so public health officials can fight it. The result has been a rush to publish emerging research papers, which comes at the cost of potentially propagating incorrect information about the disease. That said, there seems to be mounting evidence of a few facts about COVID-19. First, it is a respiratory illness with a symptomless incubation period of about 14 days. It appears to be highly contagious but not highly fatal for all groups. Young people and even children seem to experience the disease as a relatively minor illness or even without any symptoms, while the lethality of the disease seems to double for every ten years of age over age 50. [7]
That said, the “lethality” is currently being measured only by deaths per confirmed cases; while that seems like an appropriate metric, it is really rather crude from a public-health standpoint. Since there is also evidence that some people experience very minor symptoms (or none at all), there is good reason to question whether “confirmed cases” is a meaningful denominator; there may be many, many more cases of infection out there that are completely overlooked. But it also seems clear that, whatever the “true” mortality rate of the disease, it is a greater threat for older people than for the rest of the population. As a result, it poses a double threat for Las Vegas nursing home neglect.
The Nursing Home Conundrum
The epicenter of confirmed COVID-19 cases so far in the United States has been a nursing home outside of Seattle, Washington. A thoughtful review of the emergent research above makes this seem entirely predictable. Nursing homes are concentrations of older people in the age ranges where COVID-19 is thought to wreak the most havoc. They are also places that younger, healthier people visit to commune with their older, sicker relatives. If it is correct that COVID-19 is a disease with a long latency period, which can be transmitted by asymptomatic carriers, then it seems very likely that nursing homes will continue to become hotspots for outbreaks of this disease. Just one relative who is incautious with her handwashing, or who fails to cover his cough, can pass the disease to a vulnerable loved one; that loved one may carry the disease for up to two weeks before anyone realizes the threat, and then as patients become symptomatic there can be many illnesses or even nursing home deaths.
The spread of COVID-19 may be next to impossible under ideal circumstances, and regulatory investigations suggest that condition are far from ideal. More than three-fifths of nursing homes receive citations for improper hygiene practices during regulatory inspections. As we have noted in past blog posts, Las Vegas nursing home neglect is a major problem in our region that exposes seniors to risks of both intentional abuse and harm from inaction. Some 15 percent of Las Vegas valley residents are over the age of 65, and there are nearly 40 nursing homes. [8] Can we trust facilities that so often fail our aging loved ones to keep them safe during this new challenge?
Perversely, we may have to. Given the dynamics of this disease, the best way to protect our elderly relatives from COVID-19 may be to stay away. Nursing homes warn visitors to stay away if they have been ill, and nursing home staff do their best to press hand washing and screening questions on visiting relatives. [9] Indeed, keeping one’s distance may be the best way to avoid infecting an elderly, health-compromised relative. But that same distance creates a space for Las Vegas nursing home neglect to emerge and thrive, secure that the watchful eyes of loving relatives may be kept at bay.
[1] https://www.cdc.gov/coronavirus/2019-ncov/faq.html#basics
[2] https://www.cdc.gov/coronavirus/2019-ncov/summary.html#source-spread
[3] https://www.nytimes.com/2020/02/26/business/china-coronavirus-propaganda.html
[4] https://www.nytimes.com/2020/03/07/world/asia/china-coronavirus-cost.html
[5] https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html
[6] https://www.cdc.gov/coronavirus/2019-ncov/faq.html
[7] https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v1.full.pdf
[9] https://lasvegassun.com/news/2020/mar/08/as-fear-of-virus-spreads-care-home-puts-its-emphas