COVID-19 Spread in Michigan Nursing Homes Despite Pandemic Preparations

Michigan nursing homes had reported 2637 residents infected with coronavirus 2019 (COVID-19) as of April 27, despite a new study finding that almost all the facilities had developed pandemic preparedness policies since last surveyed.

The study, by Lona Mody, MD, MSc, Geriatrics Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbour Healthcare System, and colleagues, published in the Journal of American Geriatric Society on April 24—3 days before the state released new statistics—described the findings as a substantial improvement in preparedness.

The previous survey was conducted in 2007, when just over half of the 280 nursing homes that responded reported having a pandemic preparedness policy. The new survey indicated that nearly all (98%) of the 130 responding nursing homes have policies in place.

The researchers attribute the H1N1 influenza pandemic of 2009, 2 years after the previous survey, as one factor for the increased number of facilities with policies found in the 2020 survey.

"Our results show that Michigan nursing homes may be better prepared for pandemics now than in 2007," Mody and colleagues wrote. "In 2020, nursing homes were able to make policy and procedure changes within one week in response to urgent guidance from the Centers for Medicare & Medicaid Services (CMS) and CDC."

The 2020 survey indicates that 94% of respondents have a designated staff person(s) responsible for preparedness, compared to 80% of 2007 respondents. The researchers also found a greater proportion of nursing homes willing to accept hospital overflow non-pandemic patients (82% vs 53% in 2007) or discharge patients to open up availability of acute care beds (18% vs 9% in 2007).

In addition, nursing homes in 2020 are more likely to have expedited communications with area hospitals (62% vs 49% in 2007) and with public health officials (86% vs 56% in 2007).

The increased open communication between nursing homes and acute care hospitals and public health suggest, Mody and colleagues wrote, "better integration within the healthcare system."

The high number of nursing home residents who were reported to have COVID-19 after the study publication, however, suggests that the preparation, albeit improved, was insufficient to confront the challenge of the SARS-CoV-2 pandemic and the particularly high risk of the elderly residents.

The Health Care Association of Michigan was reported by the ABC network affiliate in Detroit, WXYZ, on April 27 as indicating that staffing issues were confounding efforts to provide appropriate care.

“The virus has lead to staffing issues as workers have had to be quarantined," the news report indicated, adding "the fact that some carriers of the virus are asymptomatic creates challenges, but that workers do their jobs out of love for their patients."

The contribution of asymptomatic carriers of SARS-CoV-2 to the high number of nursing home patients becoming infected has also been reported by Contagion.

Mody spoke to the particularly high risk of these residents.

“This virus unfortunately is very contagious, the disease it causes has incredibly poor outcomes in older adults with comorbidities, and nursing homes are communal settings with shared spaces and resource limitations,” Mody said in a statement. “This creates a perfect storm of sorts."