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Outcomes: 1. Articulate the risk, benefits, and outcomes of compassionate care visits during restricted visitation in nursing homes as they pertain to psychological, social, and spiritual domains of care. 2. Explore potential approaches to improve care for people living with serious illness in nursing homes while balancing risk/benefit and equitable access to resources for safety precautions during restricted visitation. During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services announced strict guidance for compassionate care visitation (CCV) in nursing homes (NHs) to protect residents and facilities from outbreak yet permit residents' visitors at the end of life. As a result, seriously ill NH residents, not imminently dying, experienced enormously high rates of social and physical isolation, and staff were left to interpret guidance and manage who could and could not have CCV. This qualitative descriptive study intended to illustrate NH staffs' understanding, use, and perception of risk around CCVs for residents experiencing serious illness during the COVID-19 pandemic. We conducted semi-structured interviews and analyzed data using directed content analysis to assess staffs' definition of CCVs, their facilities' use of CCVs, and staffs' perceptions of the risks and benefits of CCVs. Participants (N=24) included licensed and unlicensed nursing staff (eg, RN, LPN, CNA), social workers, and activities directors;were mostly female (88%) and White (79%);and had more than 3 years of experience working in NHs (79%). Results indicate the definition and use of CCVs simultaneously expanded over time supported by three themes: visits for those imminently dying, visits to support psychosocial needs, and visits to alleviate family concern. Throughout the themes, we found: 1) the benefits of CCVs-improved physical and emotional well-being-outweighed the risk of COVID-19 transmission and 2) the risks of CCVs were perceived as minimal when adequate safety precautions (e.g., screening, personal protective equipment, and vaccination) were available and used as risk mitigation strategies. The findings highlight the need to consider the physical and psychosocial consequences of social isolation of NH residents while expediently assessing the risk/benefit profile of CCVs and viral transmission and ensuring equitable access to safety precautions in NHs during public health crises.Copyright © 2023
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This article considers current contemporaneous practical issues of delirium care in nursing homes with reference to a hypothetical case study B.M. I introduce the diagnosis and management of delirium-superim-posed-on-dementia (DSD), being relatively common in patients in advanced phases of illness of many nursing home residents. General principles are discussed, although this article applies mainly to higher income countries. There is inevitably much palliative and end-of-life care in nursing homes, necessitating rigorous advance care planning. Nursing home residents are especially prone to acquiring infections. Urinary tract infections (UTIs) are traditionally the most commonly treat-ed infection among nursing home residents and, indeed, the accurate diagnosis of a UTI poses significant and distinctive challenges in the nursing home setting. There is no denying, however, that recently the global coronavirus (SARS-CoV-2) pandemic has posed an existential threat to both staff and residents of nursing homes. Resident-focused factors are striking. Psychotropic drugs are the most frequently prescribed medications in European nursing homes, but medication errors in nursing homes in general are relatively prevalent. Contributing factors to a high burden from pain for residents include residents belief set that age-related pain is inevitable, as well as un-der-recognition of pain and inappropriate pain assessment by clini-cians. Dehydration is associated with frailty, poor cognition, falls, de-lirium, disability, and mortality. Issues relating to the environment also matter. It is also impossible to ignore the organisational constraints on the provision of high quality care. Faced with widespread staffing short-ages, and many economies in financial distress, one partial solution is to retain current staff longer in nursing homes. Research on nursing home staffing has expanded beyond just staffing levels to include mul-tiple other staffing issues of concern.Copyright © by Societa Italiana di Gerontologia e Geriatria (SIGG).
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Background: SARS-CoV-2 has emerged as a novel pathogen of community-acquired pneumonia (CAP). Aims and objectives: We aimed to compare characteristics, clinical outcomes and pneumococcal identification in patients with COVID-19 vs non-COVID-19 CAP. Method(s): EGNATIA is an ongoing, prospective study of adults >=19yo hospitalized with clinical and radiographicallyconfirmed CAP in Greece. The primary objective is to estimate the proportion of CAP due to pneumococcal serotypes included in 13-valent pneumococcal conjugate vaccine (PCV13). Pneumococcus was identified using serotype-specific urinary antigen detection assays (UAD 1/2), BinaxNow and conventional cultures. Testing for SARS-CoV-2 was performed as per national guidelines. Result(s): We compared 202 patients with COVID-19 pneumonia during Apr2020-Mar2021 vs 1033 patients with nonCOVID-19 CAP during Nov2017-Oct2020. Patients with COVID-19 were younger (median age 68.8 vs 75.8 years) and had fewer comorbidities (67.8% with >=1 underlying condition vs 79.2%) than non-COVID-19 patients. Patients with COVID-19 less frequently reported past pneumonia episodes (0.5% vs 7.7%) but were more frequently nursing home residents (13.9% vs 6%). Patients with COVID-19 had less severe pneumonia presentation (CURB 65 3-5 6.4% vs 30.5%;PSI IV-V 41.1% vs 55.2%) but required mechanical ventilation more frequently (7.4% vs 1.9%) and had a longer hospital stay (mean 17.4 vs 9.6 days). In-hospital mortality was similar between the 2 groups (7.9% in COVID-19 vs 8.9% in non-COVID-19). Pneumococcus was identified less frequently in patients with COVID-19 vs non-COVID-19 CAP (4% vs 11.1%). Conclusion(s): Significant differences were identified in patients with COVID-19 vs non-COVID-19 CAP.
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Background. Data on COVID-19 related nursing home infections and mortality accumulated at a rapid pace;yet little is known about the impact of nursing homes' response to COVID-19 on resident clinical, functional, and psychosocial outcomes. Methods. We examined aggregated Minimum Data Set (MDS) assessments to describe resident outcomes using an interrupted times series methodology for three timeframes: pre-COVID (1/2019 to 2/2020), pandemic (3/2020-12/2021), and vaccination (1/2021-6/2021). Data included 307,558 federally mandated resident MDS assessments from 60,846 resident in 489 nursing homes in a Mid-Western state. We calculated MDS based quality measures (QM) using definitions available from Centers for Medicare and Medicaid Services. Each QM-based outcome was fit to a logistic regression model using the method of generalized estimating equations. Results. None of the QMs displayed a statistically significant trend pre-COVID. The prevalence of excessive weight loss and ADL decline increased sharply during the pandemic and reversed that trend with vaccination. Pressure ulcers among high-risk residents followed a similar trend, although pandemic and vaccination-related regression parameters for thatQMwere only marginally significant (p = .08). Pain worsened during the pandemic and vaccination period approaching significance (p=.07). Antipsychotic medication use worsened in the pandemic (p< .001) and did not improve in the vaccination period. Other QMs including any fall, fall with major injury, and incontinence did not exhibit statistically significant change in trend. Prevalence Profiles Circles: Observed proportions, Dashed Line: Model expected value, Solid Lines: 95% confidence limits for expected values Conclusion. We noted significant changes in QMs for antipsychotic use, ADL loss, andweight loss, with the latter two improving in the vaccination period. Isolation, disease outbreaks, and staffing issues in facilities could have affected theseQMs. Data variability may have limited our ability to detect other changes. Antipsychotics may have increased with the need to reduce wandering and other behaviors common in the nursing home population;behaviors high risk for spreading COVID-19. Why antipsychotic use did not improve during the vaccination period is less clear. Data beyond June of 2021 may help clarify the pattern of antipsychotic use. (Figure Presented).
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Background: Implementation of evidence-based training into real world practice in nursing home settings is a major challenge. Digital approaches provide real potential to addressing the barriers, particularly over the difficult period of the COVID-19 pandemic. Method(s): iWHELD is a first-of-its-kind digital programme evolving the principles of the WHELD intervention combining person centred care, social interaction, and antipsychotic review, combining virtual coaching with a digital resource for nursing homes. The intervention utilising a Dementia Champion model supported by live virtual coaching set within a digital resource hub and peer networking platform was compared to usual care in a 16-week randomised control cluster study of 741 people with dementia across 149 nursing homes in the UK. The initial outcomes evaluated are the use of antipsychotic drugs and neuropsychiatric symptoms (using the Neuropsychiatric Inventory NH). Result(s): 36/72 (53%) of nursing homes allocated to the active treatment arm engaged successfully with the digital intervention, with 563 residents completing the treatment period. The average age of residents was 84.5 years, 71% were female, and there were no significant differences between treatment arms. There was a significant reduction in antipsychotic use in the digital iWHELD treatment group from 49% to 31% compared to no change in the group receiving usual care (p = 0.046). Initial analysis of neuropsychiatric symptoms indicates a non-significant improvement in the intervention group compared to those receiving usual care. Conclusion(s): The current RCT using an online programme with live virtual coaching delivered through a Dementia Champion achieved better than 50% engagement, which compares favourably with previous studies of digital interventions in other therapeutic areas. The intervention also achieved significant reductions in antipsychotic use without any worsening of neuropsychiatric symptoms, and provides an important potential approach to safely reducing the rise in antipsychotic use in nursing home residents with dementia that has become a major challenge during the COVID-19 pandemic. Copyright © 2022 the Alzheimer's Association.
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Background: The effects of isolation and loneliness have been exacerbated by the COVID-19 pandemic. While assistive technology offers potential benefits for long-term care residents, there is limited evidence on technology adoption in complex care environments in LTC. The voices of older persons, family members and staff perspectives are not adequately included in implementation science literature. The poster report the adoption of Tochie, a smart audio device that allows family members to remotely record and schedule messages, such as daily reminders or comforting audio recordings, to send to their loved ones in LTC care homes during the time of COVID lockdown. Method(s): We applied qualitative descriptive design with interview and focus group methods. A total of 25 people in LTC participated in the study, including residents, family members, and care staff from two long-term care homes in British Columbia, Canada. Each resident was given a device to use with their family member for a four-week intervention period. The research team checked in with family members and staff weekly via telephone and email to provide support and gather feedback. Pre- and post-intervention focus groups and interviews were held via Zoom and phone correspondence to learn about participants' experiences using Tochie. Thematic analysis was performed to identify themes. Result(s): Four common themes were identified to describe the experience of using Tochie in LTC: (a) fostering emotional connection (b) connecting in creative and personalized ways (c) considering contextual considerations in LTC (d) lessons learned for future developments. Conclusion(s): The COVID-19 pandemic has provided us an opportunity to redefine and reconstruct what it means to "keep in touch" with loved ones in care settings. In our study, residents, families and staff highlighted the ways in which Tochie has enabled and expanded possibilities for family connection. Our findings offer pragmatic insights into challenges and possibilities for future product development and implementation. Copyright © 2022 the Alzheimer's Association.
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Background: While the UK's Royal College of General Practitioners developed guidance concerning the delivery of essential services during the COVID pandemic, no such guidance was available in Australia and little is known about the experiences or approaches taken by general practitioners (GPs) for the delivery of care in Australia. Aims/Objectives: To describe GPs' experiences and approaches to delivering essential clinical services (ECS) during COVID lockdowns. Method(s): A survey of GPs who had practiced during lockdowns in Melbourne and Sydney. Questions focused on changes made to care delivery including what services were continued: (1) regardless of outbreak scale, (2) if capacity allowed, or (3) postponed. Finding(s): Of 274 completed surveys, 95% of participants reported increased use of telehealth for diagnosis, investigation, and management of clinical conditions, and 97% for follow-up. Time-sensitive services such as provision of care for symptoms consistent with cancer or those with immediate health impact (e.g., immunisations, prolia injections) were generally continued even if requiring face-to face delivery. Consultations involving screening or health assessments or those necessitating face-to-face care but not clinically urgent (e.g., low risk cervical cancer screening and IUD insertions), were more likely to be postponed, as were visits to homebound and nursing home patients. Implications: The almost universal uptake of telehealth by GPs supported continuity of service provision during lockdown. Australian GPs acted autonomously to triage and provide ECS face to face through the lockdowns. To optimise future preparedness, local guidance for safe delivery of ECS must be developed considering contextual factors relevant to the Australian primary healthcare system.
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The proceedings contain 79 papers. The topics discussed include: vertebral fractures increase the risk of subsequent vertebral fractures: results from a large German health insurance dataset;analysis of bone architecture using fractal-based TX-Analyzer in adult patients with osteogenesis imperfecta;bone health in nursing home residents in Germany - do we care enough?;types of therapeutic errors in the management of osteoporosis: results of an experimental study;cysteine-rich angiogenic inducer 61 as a tool to efficiently enrich myeloid angiogenic cells from peripheral blood;response of bone tissue to ostarine treatment and/or treadmill exercise in a healthy adult rat model;influence of the cell aggregation technique on the differentiation of human articular chondrocytes in microtissues;changes in dispensing of anti-osteoporotic drugs during COVID-19 pandemic;and loss of adipogenic dickkopf-1 increases trabecular and cortical bone mass by promoting bone formation in male mice.
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Most patients hospitalized for COVID-19 are aged over 70 years old, and half of those who die are over 83 years old. Older patients do not always present with typical symptoms (fever, cough and dyspnoea) but sometimes are and remain asymptomatic (contact screening), or have aspecific presentations (altered general condition, falls, delirium, unusual fatigue). Rectal swab, which minimizes exposition risk, appears useful in long-term care patients with diarrhea. Older age is associated with worse prognosis, but the analysis should be refined by means of prognostic indexes that account for the heterogeneous health, functional, and cognitive status of the elderly population. Gathering elderly patients’ wishes and assessing their remaining life expectancy allows to anticipate care decisions according to the level of tension in the health system.
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In adults, COVID-19 infection increases the risk of thrombotic events. Hospitals worldwide reported a poorer prognosis for patients who did not receive venous thromboembolism (VTE) prophylaxis, in comparison to those who did. This finding instigated UK hospitals to form their own local policies on VTE prophylaxis in COVID-19 positive patients, to prevent death and complications secondary to clot formation. Due to older age, multiple co-morbidities, decreased mobility and increased frailty, nursing home residents with confirmed COVID-19 have an increased thrombotic risk. Therefore, a primary thromboprophylactic (TP) strategy was formulated (see figure 1) and applied to COVID-19 positive residents in Islington nursing homes. This included the prescribing of apixaban 2.5 mg twice daily if there were no contraindications. The guideline included a risk versus benefit assessment tool, prescribing advice and monitoring recommendations. It was also stated that the prescribing of apixaban for this indication would be considered as off-label use. The guideline was amended following the role out of the COVID-19 vaccination programme with the addition of 'residents who have been doubly vaccinated and become COVID positive but are asymptomatic will not require VTE prophylaxis as the vaccines have demonstrated some protection against severe illness from COVID-19'. The aim of this service evaluation is to review the implementation of this thromboprophylactic strategy. This included the number of residents prescribed TP, the incidence of bleeding or thrombotic complications, as well as number of deaths relating to COVID-19. Data were retrospectively collected from six nursing homes between November 2020 and April 2021 from GP electronic medical records (EMIS). Fifty-one residents tested positive for COVID-19 during this time. Six deceased residents were eliminated from the audit as their electronic records were not available to determine thromboprophylactic status. Additionally, two residents were excluded as they were admitted to hospital and 12 residents were already in receipt of anticoagulation. The 12 residents who were already prescribed anticoagulation prior to their positive COVID test were on anticoagulation for the treatment of AF. From these 12 residents, three died with COVID-19 reported on their death certificates. Of the 31 residents included, there were 12 males and 19 [SZ4] females and the median age was 79 years (range: 46-101). All residents had at least one co-morbidity which would increase their VTE risk. Twenty-three (74%) residents were prescribed TP in line with the guidelines. Of these, three died from COVID-19. The remaining eight residents were not prescribed TP. Of these eight, two died from COVID-19. The most common reasons for not prescribing thromboprophylaxis included residents on end-of-life care, high bleeding risk or lack of locum GP awareness of the guidelines. There were no reported bleeding events in residents prescribed TP. There were no thrombotic events in residents prescribed TP. The accuracy of the cause of death recorded for the deceased residents was limited, due to the absence of postmortem examinations. The numbers of residents included in this audit was too small to provide statistical relevance. Apixaban may be a safe option for residents in nursing homes who are COVID-19 positive and are considered to have a high risk of thrombosis..
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Background COVID-19 has had a disproportionate impact on nursing home residents with significantly higher mortality rates compared to the general population. Less attention however has been paid to COVID- 19 induced morbidity in this cohort. Our study aims to examine how nursing home (NH) residents who survived a COVID-19 infection, have been affected in terms of their cognitive, mood and functional outcomes as compared to residents that did not contract the virus. Method We performed an observational retrospective cohort study of the records of 452 residents in NHs affected by COVID-19 in Ireland from February 2020 to February 2021. We extracted data from the scheduled monthly assessments of the Barthel Index (BI), the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS) performed on residents of these NHs. We compared data from residents who had contracted COVID-19 (cases) to those that had not (controls);at 6, 3 and 1 month prior to a positive COVID-19 PCR test, to ensure comparability of control group, and again at 1, 3 and 6 months after the infection using a Students-T test for normally distributed data. Results We noted a significant deterioration in MMSE, BI and GDS scores in residents who had contracted COVID-19 as outlined in the table. While there was recovery in BI and GDS in the months following the index infection, the MMSE score in COVID-19 affected residents remained significantly adversely affected at 6 months. Conclusion Our study demonstrates the significant impact of COVID-19 infection on the physical, functional, cognitive and mental health of nursing home residents. The patient cohort displayed significant resilience in recovering from the physical and psychological consequences of the disease. The failure of cognitive function to improve over the period of observation may represent the development of 'Long COVID' in these patients. The development of this condition in nursing home residents has been poorly studied, is likely under reported and requires further exploration.
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Background. Background. Understanding the viral load and potential infectivity of individuals in nursing homes (NH) with repeat positive SARS-CoV-2 tests ≥ 90 days after initial infection has important implications for safety related to transmission in this high-risk setting. Methods. Methods. We collected epidemiologic data by reviewing records of a convenience sample of NH residents and staff with respiratory specimens who had positive SARS-CoV-2 rRT-PCR test results from July 2020 through March 2021 and had a SARS-CoV-2 infection diagnosed ≥ 90 days prior. No fully vaccinated individuals were included. Each contributed one repeat positive specimen ≥ 90 days after initial, which was sent to CDC and retested using rRT-PCR. Specimens were assessed for replication-competent virus in cell culture if Cycle threshold (Ct) < 34 and sequenced if Ct < 30. Using Ct values as a proxy for viral RNA load, specimens were categorized as high (Ct < 30) or low (if Ct ≥ 30 or rRT-PCR negative at retesting). Continuous variables were compared using Wilcoxon signed-rank tests. Proportions were compared using Chi-squared or Fisher's exact tests. Results. Results. Of 64 unvaccinated individuals with specimens from 61 unique NHs, 14 (22%) were sent for culture and sequencing. Ten of 64 (16%) had a high viral RNA load, of which four (6%) were culture positive and none were known variants of interest or concern (Figure 1). Median days to repeat positive test result were 122 (Interquartile range (IQR): 103-229) and 201 (IQR: 139-254), respectively, for high versus low viral load specimens (p=0.13). More individuals with high viral loads (5/10, 50%) reported COVID-19 symptoms than with a low viral load (1/27, 4%, p=0.003). Most individuals (46/58, 79%) were tested following known or suspected exposures, with no significant differences between high and low viral load (p=0.18). Conclusion. In this study, nearly 1 in 6 NH residents and staff with repeat positive tests after 90 days demonstrated high viral RNA loads and viable virus, indicating possible infectivity. While individuals with high RNA viral load may be more likely to be symptomatic, distinguishing asymptomatic individuals who have high viral loads may be difficult with timing since initial infection, other test results, or exposure history alone.
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Background. As of May 2, 2021, U.S. nursing homes (NHs) have reported >651,000 COVID-19 cases and >132,000 deaths to CDC's National Healthcare Safety Network. Since U.S. COVID-19 vaccination coverage is increasing, we investigate the role of vaccination in controlling future COVID-19 outbreaks. Methods. We developed a stochastic, compartmental model of SARS-CoV-2 transmission in a theoretical 100-bed NH with a staff of 99 healthcare personnel (HCP) in a community of 20,000 people. We modeled admission and discharge of residents (parameterized with Centers for Medicare & Medicaid Services data), assuming the following: temporary replacement of HCP when tested positive;daily visits to NH residents;isolation of COVID-19 positive residents;personal protective equipment (PPE) use by HCP;and symptom-based testing of residents and staff plus weekly asymptomatic testing of HCP and facility-wide outbreak testing once a COVID-19 case is identified. We systematically varied coverage of an mRNA vaccine among residents and HCP, and in the community. Simulations also varied PPE adherence, defined as the percentage of time in the facility that HCP properly used recommended PPE (25%, 50% or 75% of the time). Infection was initialized in the community with 40 infectious cases, and initial infection in the NH was allowed after 14 days of vaccine dose 1. Simulations were run for 6 months after dose 2 in the NH. Results were summarized over 1000 simulations. Results. At 60% community coverage, expected cumulative symptomatic resident cases over 6 months were ≤5, due to low importation of COVID-19 infection from the community, with further reduction at higher coverage among HCP (Figure 1). Uncertainty bounds narrowed as NH resident coverage or PPE adherence increased. Results were similar if testing of staff and residents stopped. Probability of an outbreak within 4 weeks of dose 2 remained below 5% with high community coverage (Figure 2). An outbreak is defined as an occurrence of 2 or more cases within 4 weeks of dose 2. Probability of no outbreak was calculated by counting how many simulations out of a total of 1000 simulations had ≤1 symptomatic case in NH residents or HCP within 4 weeks after dose 2 was administered in the nursing home. The first vaccine dose in residents and HCP was assumed to be given on day 1, and the second dose 28 days later. A probability value and its 90%-confidence interval (CI) at a given community and HCP coverage was calculated by pooling model outputs for 9 sets (3 PPE adherence values X 3 resident coverage levels) of model simulations. Simulations were performed assuming no asymptomatic testing or facility-wide outbreak testing. Conclusion. Results suggest that increasing community vaccination coverage leads to fewer infections in NH residents. Testing asymptomatic residents and staff may have limited value when vaccination coverage is high. High adherence to recommended PPE may increase the likelihood that future COVID-19 outbreaks can be contained.
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The proceedings contain 1654 papers. The topics discussed include: mucosal cytokine profiles in children with COVID-19;the relationship between chlorhexidine skin concentration and multidrug-resistant organism (MDRO) colonization in ICU patients;space time trends of community onset staphylococcus aureus infections in children living in southeastern United States: 2002-2016;stopping hospital infections with environmental services (SHINE): a cluster-randomized trial of intensive monitoring methods for terminal room cleaning on rates of multidrug-resistant organisms (MDROs) in the intensive care unit;the PROTECT trial: a cluster randomized clinical trial of universal decolonization with chlorhexidine and nasal povidone iodine versus standard of care for prevention of infections and hospital readmissions among nursing home residents;staphylococcus aureus in a single blood culture bottle: should we be concerned?;and electronic surveillance criteria for non-ventilator HAP: empiric testing and chart review at veterans affairs facilities.
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Purpose of Study During the COVID-19 pandemic, the State of Louisiana implemented a quarantine to decrease the risk of infection. This situation led to a decrease in social interaction which is a risk factor for anxiety and depression, among the elderly population confined in residences. The objective was to determine whether being quarantined while living in a residential community would negatively affect the mental health of the elderly. Methods Used A short longitudinal assessment and analysis to assess anxiety and depression. Data was initially collected, then at 6 weeks, and 12 weeks during the quarantine. We used the Geriatric Depression Scale (GDS) and Geriatric Anxiety Inventory (GAI) as these screening tools are designed for the elderly, to assess the incidence and severity during the quarantine. Summary of Results 57 residents of a Continuous Care Retirement Community (CCRC) in the New Orleans metropolitan area, stratified as nursing home residents, assisted living, and independent living of a 37 (80%) of the 46 patients were females, with a mean age of 86.1 (SD 9.1) years old;25 (54.3%) were nursing home residents, 13 (28.3%) were in assisted living, and 8 (17.4%) were in an independent living community. 16 (34.8%) patients were diagnosed with depression before taking the survey, and five (10.9%) had previously diagnosed anxiety. Anxiety scores decreased significantly from baseline (average 4.35 vs. 3.28, p-value =0.045) at 6 weeks but did not change from time 0 to week 12 or week 6 to week 12. Depression, scores did not change significantly between the time periods. Conclusions Our data indicate a trend toward an increase in depression and anxiety during periods of pandemic quarantine isolation. Because the elderly are particularly susceptible to loneliness and resulting depression assessing these indicators may help mitigate the economic burden and cognitive decline resulting from the complications of depression and anxiety in the elderly population residing in community centers during periods of unanticipated extended quarantine isolation.
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Introduction: During the COVID-19 pandemic in 2020, patients with heart failure (HF) accounted for a large fraction of COVID-19 mortality. In addition, studies suggested that lockdowns and other restrictions may have increased mortality in this population, even among those without COVID-19. The purpose of this study is to provide an overarching measure of excess mortality for HF patients during 2020 in contrast to other Medicare enrollees age 65+ without HF, including those living in the community and in nursing homes. Methods: We used 100% fee-for-service Medicare Parts A and B between January 1, 2019 and December 31, 2020. Using International Classification of Diseases (ICD) 10 codes in the preceding year, we created 4 cohorts: 1) HF;2) non-HF, 3) HF living in the community;4) HF living in the nursing homes. We calculated excess deaths in 2020 by comparing 2020 observed mortality to corresponding rates in 2019 for each of the four groups;adjusted for age, sex and region. Results: In 2020, excess mortality was lower for patients with HF (1.13), compared to patients without HF (1.21;difference -0.08 for HF, p <0.001). Among Black, Hispanic and Asian patients, excess mortality was higher overall, but still lower for with HF compared to those without HF (Figure 1). Patients with HF living in nursing homes also experienced overall higher excess mortality, but nursing home residents with HF also experienced less excess mortality (1.24) than nursing home residents without HF (1.39, p <0.001). Conclusions: Mortality rates rose for all elderly groups during 2020, but HF patients' excess mortality rose by less than those without HF, including among populations with known high burdens of COVID-19. Additional work is needed to understand the mechanism driving this, but restricted dietary options and improved medication compliance during lockdown may be playing a role.
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What was thought to be a short-term disease process, isolated to East Asia, has continued, with forecasts of subsequent "waves" mimicking three separate waves of the 1918 Spanish flu.106 Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, has recently warned Congress that COVID-19 cases could ultimately reach 100,000 per day.107 Further, it could be a year or more before an effective vaccine has been created, tested, proven safe, and ready for administration to the world's population.108 Or it could be never, as is the case with the Human Immunodeficiency virus, Zika virus, Hepatitis C Virus, tuberculosis, malaria, West Nile, and others.109 Developing natural immunity through exposure to an active disease is the best type of immunity because it can sometimes provide life-long immunity.110 However, according to the Chief of the World Health Organization ("WHO"), Tedros Ghebreyesus, allowing a dangerous virus, like COVID-19, which is not fully understood to progress unchecked, is simply unethical.111 Therefore, herd immunity is not a feasible option to combat COVID-19.