This summer brings a renewed sense of freedom as the country benefits from the widespread availability of vaccines as well as effective antiviral treatments that can prevent serious illness or hospitalization from COVID-19. Yet the emergence of new, highly contagious variants that spread and infect those who are vaccinated and boosted has led to high community transmission rates.
What does this mean for the estimated 1.3 million people residing in long-term care facilities, including nursing homes and assisted living facilities, who have been silently left behind? While a federal court order restored travelers the right to choose to mask up on planes, isolation was first shortened and then ended, residents of nursing homes across the United States live in much like they did in early 2020: they must wear masks in their assembly houses and are subject to “lockdown” when an employee or co-resident tests positive for COVID.
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To be fair, these public health measures aim to provide the highest level of protection to the most vulnerable segment of the population. It should be remembered that 80% of the deaths that occurred during the first months of the pandemic concerned people over the age of 65 and that residents of collective care establishments, such as retirement homes, remain the most exposed to the risk of serious complications and death from infection.
But case outcomes are no longer the same as in 2020. Thanks to vaccines, treatments, and decreasing virulence of circulating strains, most elderly patients are suffering from mild COVID-19 that does not require medical treatment. hospitalization. Their risk of death is very low, more than 10 times lower than in the pre-vaccination phase of the pandemic.
However, current national guidelines continue to endorse restrictions on care home residents regardless of their vaccination status or risk tolerance, particularly when cases arise in the facility. For example, residents may still be required to wear a mask in common areas of their nursing home when community transmission rates are high. They may need to self-quarantine in their room if one of the nursing home staff tests positive and worked at the facility while that person was potentially infectious.
In contrast, staff working in the facility can opt in or out of vaccination, choose whether or not to mask in the community, and freely visit family members and friends while returning daily to provide care. intimate to these same vulnerable patients. . All of these actions create a sense of isolation and inequality for nursing home residents.
As the landscape of COVID-19 has changed in the United States, we have failed to reconsider the costs associated with absolutist prevention strategies. As 90-year-olds assess their lost quality time with loved ones due to the pandemic, two years may account for a substantial portion of their remaining quality days. At this phase of the COVID-19 pandemic, what might residents be willing to risk to capitalize on the quality of their days and spend more time with family and friends?
The question of the willingness of EHPAD residents to accept certain health risks for the benefit of social gains remains largely absent from the medical literature, especially since the beginnings of vaccination. Many decisions are made on behalf of nursing home residents with well-meaning input from public health experts and family members. But often, experts and medical attorneys are more conservative than the patients they represent, prioritizing the patient’s well-being over their own preferences.
The time has come to recognize the diversity of risk tolerance of this elderly population and to restore their autonomy of choice. Now is the time for the Centers for Disease Control and Prevention to revise their recommendations and allow for local decision-making in nursing homes. Localities can work with nursing home residents’ councils (made up of elected residents who live in those facilities) to help determine whether to require universal resident and staff masking, mandatory testing for residents leaving care home grounds and frequency of COVID-19 testing.
Dr. KC Coffey is an assistant professor and Dr. Mary-Claire Roghmann is a professor — both of epidemiology and public health — at the University of Maryland School of Medicine.