ANATOMY OF AN OUTBREAK: THE SECOND YEAR

The first positive test among Fields residents and staff for the virus was reported on 3/17/20.

No residents have tested positive at Bellamy since the initial outbreak ran its course. No residents of Watson have ever tested positive.

Staff of both communities have tested positive, as have their family members.

Masks, social distancing, hand hygiene and now vaccinations (Pfizer two-shot) plus acquired immunity among residents who recovered or acquired the virus after they were all tested and remained a-symptomatic have contributed to the health of the communities.

In the second year, we’ll continue weekly testing of staff as long as the state runs the program and we’ll test residents when indicated by their symptoms.

The Pfizer vaccine has been administered to 99%of the Fields residents and there are plans to start or finish vaccinations for new residents.

New residents undergo testing before admission and modified quarantine after admission, depending on their capacities to cooperate.

Social isolation of elders with dementia in extended quarantine is being studied and reported to have dangerous psychological and physical effects.

New Hampshire Health and Human Services/Department of Public Health estimates 150,000 diagnosed cases and about 1200 deaths. The true number of cases is probably twice the number of those diagnosed. The controversies over the cause of death- direct consequence of the virus or indirect effect on frail people with multiple other illnesses- continue.

As a student and doctor of Public Health, I endorse the statistic excess deaths as the best indicator of the mortality of the virus. Here’s how it works:

The elderly die in consistent and predictable numbers every year, depending on their general health and it’s easy to look at five years of data, by living arrangement (personal home/apartment, assisted living, nursing home) to calculate an annual average.

There are seasonal effects (winter influenza) and regional variations but as long as we’re counting apples and apples, the statistics are meaningful. Race and socioeconomic status have increased risks of illness and mortality, as they always do, and are more of a negative impact in a pandemic in the US for many sociological reasons.

The excess deaths, from all the attention to long-term care outbreaks, was not the highest among the elderly, Let me repeat that

In the 25-44-year-old group the percentage of excess deaths was the highest of all groups let me repeat that

I’ll explain that to varying degrees in the future, depending on my readers or listeners patience and/or interest.

For now, let me leave it this way. I expect old people to die at a higher rate than I expect people in the 25-44-year-old age range. Generally, they do but the excess of deaths sensationalized in the non-scientific media simply was not as meaningfully medically, especially for the future.

The 25-44 year olds are not supposed to die but they do, from accidents, overdoses, car crashes and some diseases. Beware of statistics: when I brag that none of my residents has ever died in a car crash well, you get it

THE FUTURE

M-RNA vaccine and other applications of m-rna science will change medical science and treatments in dramatic ways.

In the elderly, however, the delivery of new treatments for chronic diseases will still have to be measured against the most basic human equation: quality of life verses quantity of life. Our elders and their families will have more options but the fundamentals still apply. Extending life that simply extends suffering and discomfort is a personal and family choice and dilemma.

With the addition of a new nurse practitioner doing primary care for the Fields, we are positioned to provide more care in the communities and be less dependent on going out for medical routine care. We’ll collaborate with specialists and guests can maintain their long-standing relationships with any practitioners they wish.

The workforce in long-term care is anchored by Licensed Nurses Aides and they are in high demand. The Fields has two training programs for LNA’s and another? for MLNA’s (the additional training that entitles the holder to dispense medications.

In 2020, the Fields own staff development program trained people for a total of nearly 2000 hours at no cost to them and they are also paid for the time they spend on improving their skills.

Changes implemented in the acute care hospital and skilled rehabilitation sectors of health care during the height of the outbreaks are likely to persist, making medical assisted living a key resource for elders.

People are coming in with more chronic illnesses and staying home during the pandemic added another year of debilitating dementia and related disorders of the brain and mind.

The Fields adjusted social and medical services successfully, once the virus was better understood. Precautions and quick, comprehensive responses to any public health challenge have been improved at a terrible cost to society.

The learned lessons now have to become part of the everyday fabric of geriatrics with a sense of humor.