Thread by @kavitapmd

Nursing Homes and Covid-19- the state affairs- thank you @JonLemire for taking time to discuss this topic @MSNBC @WayTooEarly a long 🧵 that I start with a picture from a NH in rural Michigan: yep, thats right- 14 staff out with covid-19 infections.

2/ A series of Graphs with situation today: data from @CDCgov illustrating cases by vaccine status-

clear decoupling among those w/ boosters vs not boosted

cases of vax but not boosted quite close to unvax-this is unadj data but reflective of highest efficacy of 3rd dose in NH

3/Next up-cases-data lag by about a week, but state data which maps to experience in many states-note Michigan data below followed by national trend-note low case counts this past year=vaccine.vaccine.vaccine

4/ Nursing Home Hospitalizations- also on the rise-harder to get granular data on % of hospitalizations from Nursing Home residents, but it is a growing share. Equally growing-->pressure to ACCEPT covid+ pts to NH but lack of hosp capacity/staff has forced hands of many states

5/Nursing Home Deaths-always the last to rise, but trends are NOT good, appear to be rising above #s seen in delta surge. Controversy exists over deaths to date in nursing homes (largely undercounted): detroitnews.com/story/news/pol…

6/Now on to even more bad news- cases and deaths amongst staff- almost 2500 deaths- this is probably the most under-reported statistic- also a couple of weeks old so actual # is higher. Majority of staff are female, over 50 and black.

7/ More on Deaths amongst Staff from CDC: below are unadjusted rates, but useful to see the uptick in trends- again, after lower rates earlier in year as part of delta surge. Some of these deaths are still delta to be sure.

8/why are hcw esp in nursing homes refusing the vaccine? not for the reasons you might think-top reason is:
1⃣vaccine cynicism- initially vax were rolled out too quickly, not enough data but now that viewpoint has morphed to sentiment they dont work/e.g see breakthrough rates

9/ More disturbing news: according to a survey profiled in this excellent @19thnews article in JULY 2021, only 1 in 4 nursing homes thought they can survive in a year (which is in about 6 months): 19thnews.org/2021/07/nursin…

10/ but lets go beyond statistics and maps:

I used to work inside of nursing homes/stopped bc I got pretty frustrated/easier to feel I could make a difference in the hospital/clinic setting

here is a glimpse of what it is like to be a nursing home resident now from @Altarum :

11/ here is what women who work in nursing homes tell me:
1⃣ they are so short staffed, they are just trying to make sure residents can get to the bathroom/get 3 meals
2⃣ average pay $14.82/hr -->not enough to pay bills
3⃣ they lack infection control/fear getting sick

12/

and why so many nursing home residents still unboosted? majority of nursing homes have less than 50 beds, are small esp rural ones and lack pharmacy infrastructure to vax/ large retail pharm either not able to come in like they did earlier in pandemic or simply not enough

13/
America has always had a problem with how our we treat our elderly (average age of resident: 85 yrs). we dont want to think about:

who will help turn us in bed to avoid bedsores

clean us after we urinate or defecate

who will feed us when we cant feed ourselves

Fin/
so what can we do?

for starters, pass #BuildBackBetter which has significant funding for $1 billion in workforce/infection control improvements. So lets actually start there