Although it was unusual in these circumstances, her initial response was right. She’d been kept in the dark for weeks about conditions at her sister’s facility. According to the letter, only one case had been identified and the employee was immediately removed from the facility. Carla requested anonymity because she was concerned about her sister being mistreated. However, the relief quickly turned to fear as she learned how infections can spread quickly through facilities. Three days after receiving the letter, her fear was compounded by a call from Carla: Her sister, 89, had just been diagnosed with the disease. This was the first case among Carroll County’s residents. One case was deemed an outbreak by the state’s health department in April, prompting testing at the facility. After that, the number of cases among employees and residents began to rise. In a matter of weeks, the number of cases jumped from 2 in April to 29. Two weeks after the initial positive test, cases rose to 45 by May 9. They have remained there ever since. Coronavirus is a deadly virus that infects nursing homes like a bomb. It’s almost impossible to get rid of the virus once it has infected your facility. Long-term care facilities are a breeding ground for viruses. They have a lot of shared space, workers and visitors, and they can be a home to elderly people and those with weakened immune systems. The care required in these facilities requires close contact, just as it does in other settings. This includes feeding, assisting with invasive devices and helping with daily activities. Although the Carroll County case surge is not unusual, it is the most severe outbreak to be linked to one county. Carla discovered that her sister had a positive re-test, which was a warning sign to staff and family that the outbreak could be spreading throughout the facility. Carla said that her sister is not showing traditional symptoms but is becoming weaker. Carla’s sister is one of more than 16,000 Mississippians who live in long-term care facilities. Carla has not seen her sister for more than two years and fears that the dementia, which made long-term care the only option, will completely take over by the time she can see her again. They have been close throughout their nearly one-year stay at the home. Their two-decade-old age difference has made it difficult for them to be close. Carla told Carla, holding back tears. She said that she was afraid that she wouldn’t know who she was after all the events. “She doesn’t understand why I can’t come. The staff explain the virus to her, but she asks them 15 minutes later why my sister isn’t coming. “Vaiden Community Living Center is one of the 211 in the state, but only has 60 beds. Rachel Ethridge, spokesperson from Community Eldercare Services which runs Carroll County’s nursing facility and 18 others in the state, stated that most of the cases at the facility were among staff. 23 of them have recovered and are back to work. Ethridge stated Wednesday that 12 residents have now recovered, even though some are still awaiting retests. According to MSDH records, eight residents who were positive for COVID-19 died since then. The virus has now been confirmed in at least three quarters of the residents in the nursing home. More than a tenth of long-term residents in the state have been diagnosed by COVID-19. Although it is not clear how many cases remain, nearly 20% of people who have contracted the disease in a facility (332) have died. This is four times the rate of death for the general population. Even though residents of long-term nursing homes, rehabilitation centers, and homes for people with developmental disabilities, only 13 percent of COVID-19 cases in Mississippi have been reported, they account for more than half of all deaths. Long-term care residents accounted for 65 percent of all the deaths in May and one-third since the outbreak. Long-term care residents account for around 11 percent of all deaths and about one-third of all cases nationally. Some nursing homes are doing worse than others. Although it is not clear why, Thomas Dobbs, the State Health Officer, stated Friday that new targeted testing was helping to identify unknown epidemics. He also said, “In places where really good infection control practices are in place, a lot more times we’ll see zero cases.” Mississippi was slower than other states to experience nursing home spread. Because of the rapid spread of these diseases in these settings, the state started counting outbreaks in April. There were 28 long-term care cases in 24 counties. This was only 2% of all cases. In late April, the state health department started releasing information about deaths for long-term care. However, it has refused to identify the facilities due to long-standing protocols and fear of stigmatizing residents. In May, Pine Belt News sued the state department for failing to release names via a public records request. Tuesday’s judge ruled that the health department had to release the names, or provide a legal excuse. Long-term care facility residents made up 10 percent of all deaths and a third when death data was first published by the health department. Although residents now account for over half of all deaths, their cases have grown to just 13 percent of all cases. Residents’ deaths grew by 337 per cent in a matter of a month, while those in long-term care experienced a 116 percent increase in their deaths. It spread exponentially after the inflection point. The number of long-term care cases soared to 470 on April 21. This figure nearly tripled in three weeks and eventually surpassed 1,700 by May 31. Despite best efforts to clean up and difficult choices to keep relatives out, the risk of spreading too high was too great. At the suggestion of the health department and soon after, the federal government, most long-term care facilities have banned visitors from mid-March. Many families feel they are kept in the dark about the condition of their loved ones without visiting. Dr. Keith Mansel is a palliative medicine physician at the University of Mississippi. He specializes in helping families to work out their end of life and health care goals. This includes integrating their emotional and medical needs. He says that this is unlike anything he has ever seen and that it can lead to complicated medical issues. In palliative medicine, I’ve seen two things become more important as we age: our function, our ability get up and move, and our socialization. This lack of socialization is a danger factor for our health, and it’s actually risk factor for life or death, as we are social beings.” He said. COVID-19 also prevents relatives from visiting the facility. Most residents are restricted to eating in their rooms, and they are banned from participating in group activities like card games, trips, and other cards. Mansel said, “And what it’s doing for other comorbidities is really worrisome.” I worry about people who may have mild cognitive dysfunction, mental health issues… All this is especially concerning in a state with so many underlying health problems. It will take years to find out, but I believe it will be many years.” He says that while face masks and social distance requirements for health workers are vital, they can cause confusion among older people and lead to a loss of human connection which is so crucial for their well-being. Mansel stated that doctors have been sitting at the bedside for centuries and touching when necessary. “It’s difficult on patients when they (providers), can’t do this.” Carla, who lives near Attala County, only spoke to her sister at Vaiden once in the two months that she was not allowed to visit. A nurse called Carla and handed her the phone. She says she has had difficulty getting to the facility, and she fears for her sister’s safety because she cannot check on her without her eyes. She said that it is not appropriate to notify family members that an elderly person has been diagnosed with a deadly disease. However, communication improved a few days after the news was received. This is the blessing of dementia, she can’t recall. It’s terrible as dementia can be, but when they’re in a position like this, it is a blessing.” Ethridge, Carroll County’s spokesperson, said that it has been all hands on deck for months. This makes it difficult to make ends meet, especially after losing two dozen employees to the virus. Sammie Johnson, Eddie Johnson’s dad, lives at the Vaiden nursing facility and shares Carla’s concern about communication. His father was also positive in late April, but has since been well. Johnson, Sammie’s only child, stated that Sammie doesn’t have access to a cell phone and this has made Sammie’s situation even more worrying. It’s not the fault of the nursing home. Johnson stated that the state did what they believed was right to stop the spread of the disease, but cut off our contact. Johnson said that this was the most difficult part of the whole thing. Johnson is a resident outside Memphis so he has gotten used to not being in a position to visit frequently. Johnson relies on the frequent reports from his family after Sammie visits. He says that it has been difficult without those reports, even though his father is physically safe. Johnson is still concerned about Johnson’s father’s mental state. Johnson expressed concern about Johnson’s father’s mental health when he received a call from his doctor advising him that his dad had been tested positive for pneumonia. Johnson also said that Johnson was 84 years old and has suffered from health issues, including the recent deaths of his daughter and wife. Johnson said, “That’s been the terrifying thought in my mind all the time. Then you call multiple times per day — first thing in the morning and mid-day, before bed, and sometimes they’re unable to answer at all. He’s always been a fighter, and he has a lot of things to live for.” Smith, Kemper, and Carroll counties are scattered throughout the central belt of the state, from the Delta to Alabama line. They have seen rapid case growth. This was initially due to a single outbreak at a long-term care facility. Each county has only one nursing home. All three have at least 28 COVID-19-related cases. Some have recovered, while 21 have died. According to the health department, there have been 103 resident cases in the three facilities. This does not include staff cases. The compounding of enough cases has allowed them to fill almost half the beds at the facilities. Thomas Dobbs, the state health officer, announced universal testing in nursing home facilities mid-May. He said that every resident and every staff member of each nursing home would be tested within two weeks. This will cover 27,000 Mississippians. Centers for Medicare & Medicaid recommends that all facilities perform baseline tests to detect any potential cases, and then have a weekly testing protocol in place if any are discovered. The state stated that they would make testing kits available to any nursing home in dire need. Dobbs stated Tuesday that he expected the nursing home testing process to be completed soon. The testing has so far helped to identify previously undiagnosed cases, including staff and residents who are asymptomatic. It also increased the number of long-term care outbreaks, which reached a peak of 121. The state has 211 nursing homes. Ethridge from the Vaiden facility said that they have just completed facility-wide testing. However, they are anticipating the impact of retesting after having diagnosed 45 residents and decimated staff. In a time where the nation is aging, the pandemic is threatening aging health care models. The emphasis has shifted to aging in place and keeping people out of facilities, as this is what the models have been focusing on. It’s possible to have autonomy and independence when it is not possible. According to population estimates, the national and Mississippi median age will change from 37 in 2010 down to 39 in 2040. The Mississippi 65- and over population will grow slightly faster that the national rate from 13 percent in 2010, to 20 percent by 2030. Experts say that while the leaps may not be dramatic, they are a significant step towards an older America. This will force both industry and health care to think differently. Teresa Carithers, head of Applied Gerontology at the University of Mississippi says that the pandemic has spawned new innovation and will help set a new standard for aging care. She leads the program that helps students see the science behind aging from a new perspective. It is less about how to care for older people and more about how to age well throughout life. She said that despite the projections, there will not be enough assisted living or nursing homes to meet the needs of the population. “We can’t build enough. We have to innovate. We are living longer so we need to encourage healthy aging. This can be done in many ways. “We need to talk about healthy aging early, not waiting until we are 60 to start an exercise regimen — we look at healthy ageing from birth to the end of our lives.” Carithers says that in cases such as Sammie’s, health care should focus on resilience even when there is a chance of death. She said that while death is something we strive to prevent, when you have the most vulnerable population and the two groups most likely to transmit it, visitors and health professionals, then we need to accept that some numbers are inevitable. “You have to give every elder who survives COVID hope for their remaining years of aging.” David Buys, an assistant professor at Mississippi State University Extension program, said that it is important to have accurate data. He focuses on state-level data and population health. He has been keeping daily statistics about COVID-19 death and case rates and believes that long-term care is an example. After comparing federal statistics with data from the state’s health department, Buys discovered some surprising facts when he separated long-term care rates for the general population. While COVID-19 is more common in African Americans, it’s much more prevalent among white people. This means that if someone gets the virus, they are more likely to die. After Buys removed long-term health care from the equation, he realized the setting was responsible for the high white death rate. He also noted that white people are more likely than other races to live in long-term facilities. “Given the knowledge we have about Mississippi’s health disparities, I was shocked by this, so I began to investigate what could be driving these differences. Buys stated that it was only about this time that we began to hear about outbreaks in long-term care facilities in Mississippi. We found that African Americans had higher cases, fatalities, and deaths than whites in long-term care settings. However, in long-term care settings, African Americans had higher cases, but lower population deaths and case fatalities.
Partment apologized for not releasing more data than they already have, but they hope to continue expanding. Buys stated that they hope to learn more about the nuances and to be able release more data as the agency identifies their pace and rhythm. “This will help us to determine where to concentrate our efforts to prevent, treat, and recover from this pandemic,” Buys said. “It would be wonderful to have more detailed data about where the outbreaks are occurring, including LTC (long term care) names and places; age breakdowns, and other data points that can be linked to one another.” _x000D