The Shame of Infection


Michael Gill

In relation to Covid-19 and the management of senior living communities, my mantra is: “There is no shame in getting coronavirus in a building; the only shame is in not handling it well when you do.” This bears keeping in mind because although as of mid-November, Central Texas does not have a significant spike in coronavirus, the rest of the country is experiencing an unprecedented level of infection. The pandemic is now in a third wave. The regular flu season brought about by cold weather months creates an ideal breeding environment for contagious diseases. It seems a given both that the coming four months will see a further traumatic surge in infection transmission and that this surge will eventually engulf Central Texas as well.

So what is to be done? Or, more importantly, what can we realistically expect over the coming winter months for our loved ones on Senior Housing? This essay will discuss what is ideal, what is realistic, what we can expect, and what we are currently doing.

It is impossible for management to control the infection entering any Senior Living building, with two exceptions. First is the “Bubble Strategy,” in which you move all caregivers into the building and allow no one to come and go. The second strategy is the “Perfect Testing Strategy,” where everyone entering the building takes an accurate test yielding immediate results. Unfortunately, neither of these “ideal” strategies is realistically implementable. In addition, the Bubble Strategy eliminates any family contact, which is particularly undesirable.

The infection vector for any Senior Living community is easily identifiable: its staff. A Senior Housing’s team is made up of widely disbursed members of the broader community, with children, spouses or romantic partners, outside interest and hobbies, occasional second jobs, and ordinary activities such as shopping and socializing. Whenever there is “community spread” of Covid-19, Senior Living staff are as vulnerable to catching the infection as anyone.

Knowing this, management at Senior Living communities have “realistic” strategies to train their staff to minimize their risk of infection. There are infection control seminars. There are documents outlining places and activities to avoid, which staff members are asked to agree to and sign. There are pledges to wear masks even outside the community and not to come to work if sick. There is an emotional plea to staff to remember that failure to follow these strategies is catastrophic, resulting in deaths. But even if staff were perfectly able to follow all the directives, they are still vulnerable to catching coronavirus. Their children may bring it home from school or their spouse from their workplace. Let’s face it; we are in a pandemic because the virus is highly contagious, widespread, and inscrutable. Individuals can, through sensible precaution, significantly reduce the chance of becoming infected. Still, it is virtually impossible to eliminate all risk, and simple luck plays a part. The coronavirus will eventually make an appearance at almost every Senior Living building at some point in the pandemic, at least among staff but possibly among residents as well. Thus my assertion that there is no shame in getting the virus in a Senior Living building.

And we can expect the coming cold weather months, the period just before the vaccine comes online, will be the single most dangerous period in the entire pandemic.

Senior Living management has now had eight months of pandemic experience to prepare for an outbreak among their residents. In many cases, the same management has experience with a prior outbreak. Once the virus is in the building, the containment strategy is to identify those infected as early as possible, contain the infection, and safely reopen. (See my previous blog for more details: What Happens When a Community Gets COVID ) To summarize, the containment strategy is as follows:

  1. Identification of suspected cases and immediate testing
  2. Full PPE for all staff
  3. Isolation of residents testing positive
  4. Contact tracing
  5. Separate staffing for Covid-positive residents in isolation
  6. Meals delivered, and activities stopped for all residents
  7. Visitation stopped except for essential services
  8. Ongoing testing of all residents
  9. Reopening 14 days after last identified positive test

We have not mentioned the new risk of incoming infection from visiting relatives. In August, two types of visitation were allowed in Texas: outdoor visits six feet apart and indoor visits on either side of a plexiglass barrier. In October, an expanded visitation policy began where two family members were allowed to visit their loved one in their room, with the ability to actually hug.

It remains to be seen how risky visitation policies will turn out to be. Given how high the risk is of infecting a loved one, the hope is that family visits won’t be a significant infection vector. Undoubtedly, however, even families will inadvertently bring Covid into a building. Hopefully, visiting family members will be diligent in taking the appropriate precautions and safety measures to help keep themselves and their senior loved ones safe during this time.

As ever, feel free to call Texas Senior Living Locators at (512) 630-7133 for help with your Senior Living needs.

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