Coronavirus: The nursing home dilemma

They'll have to vaccinate staff to get federal funds.

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By Amelia Nierenberg

Writer, Briefings

Nursing homes at a crossroads

On Wednesday, President Biden said that all nursing home employees must be vaccinated by Sept. 30. Any facilities that don't comply will not receive federal Medicare or Medicaid funds.

The practical effect of the mandate, nursing homes operators said, is that workers will have to be vaccinated or lose their jobs. Only about 60 percent of the nation's nearly 1.5 million nursing home employees are vaccinated, far below the industry's goal of having 75 percent vaccinated by the end of June.

Some administrators are thrilled. "It's great," said Marita Smith, who runs a nursing home in Seattle. She called the new policy a "pretty big deal" that would "flush out health care professionals who shouldn't be in health care." If individuals don't want to be vaccinated, she said, they put nursing home residents at risk and need to go.

But some prominent officials in the industry argue that the move will exacerbate staffing shortages, which they say could pose a bigger threat than having unvaccinated staff.

"We will lose tens of thousands, maybe hundred thousands, of workers," said Mark Parkinson, president and chief executive of the American Health Care Association, the main nursing home industry group.

The blanket mandate means unvaccinated workers cannot simply take another nursing home job, but they can apply for jobs at hospitals or assisted living facilities. Parkinson's group wants a mandate that will eventually apply across all health care settings, so that nursing home employees recognize that there is nowhere else to go.

More than 80 percent of nursing home residents nationwide are vaccinated, but they now face another frightening surge. Of the 625,000 Covid deaths in the U.S. to date, nearly one-fifth — 133,700 — have been nursing home residents, according to the C.D.C.

As we reported yesterday, a C.D.C. study found that effectiveness of the Pfizer and Moderna vaccines at preventing infections among nursing home residents dropped to 53 percent from about 75 percent after the rise of the Delta variant.

Last week, there were 354 deaths of nursing home residents with Covid-19, the highest figure since mid-March.

Plastic barriers: worse than nothing?

Clear barriers have sprung up at restaurants, nail salons and school classrooms since the pandemic began. But most of the time, they do little to stop the spread of the coronavirus, my colleague Tara Parker-Pope reports.

Scientists who study aerosols, air flow and ventilation say the barriers often don't help. They probably give people a false sense of security. And sometimes, they can even make things worse.

That's not intuitive, and there are some situations in which the clear barriers might be protective. For instance, they can stop big droplets ejected during coughs and sneezes, which is why they're used for buffets and salad bars.

But Covid-19 spreads largely through much smaller aerosol particles. And although the research is limited, scientists have found that rows of clear plastic shields can impede normal air flow and ventilation.

That can create "dead zones," where viral aerosol particles can build up and become highly concentrated.

A study published in June showed that desk screens used in classrooms were associated with an increased risk of coronavirus infection.

"One way to think about plastic barriers is that they are good for blocking things like spitballs but ineffective for things like cigarette smoke," said Linsey Marr, a professor of civil and environmental engineering at Virginia Tech and one of the world's leading experts on viral transmission.

"The smoke simply drifts around them, so they will give the person on the other side a little more time before being exposed to the smoke," she continued. "Meanwhile, people on the same side with the smoker will be exposed to more smoke, since the barriers trap it on that side until it has a chance to mix throughout the space."

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