• The San Juan Daily Star

For nursing homes, complacency could be a killer

By Zeynep Tufekci

Lab studies, genomic analysis and data from Botswana, South Africa and Europe strongly suggest that the omicron variant will cause a lot more breakthrough cases by evading the antibodies generated by vaccines and prior infections.

Based on very preliminary data, there have been suggestions that many such breakthrough infections could be mild and vaccines will continue to provide substantial protection against severe disease. Even if it is too early for conclusive answers, there are already many reasons to think that omicron could be a major threat to the elderly.

In younger people who have been vaccinated or were infected earlier, the immune system can still potentially prevent progression to serious illness by mounting a “memory response” — essentially remembering that it encountered a similar virus before and unleashing more action. As we age, this response is less robust because our immune system becomes weaker. Even common colds can cause fatal outbreaks in nursing homes.

Plus, the older you are, the more dangerous COVID can be: Someone who is 75 to 84 years old has about six times the chance of being killed by the virus as those between 50 and 65, for example, while the risk goes to about 15 times as high for those older than 85.

All this means we have to act immediately to ramp up protections for the elderly in nursing homes, assisted living facilities and retirement communities.

Omicron has demonstrated a propensity for superspreading, so places where vulnerable populations live together need to be on high alert.

About a hundred people at a holiday party of about 120 vaccinated people in Norway that was attended by a guest with omicron ended up infected; 13 of those initially sequenced cases confirmed the variant, with more expected to follow. Similar omicron superspreading events have been reported in Denmark and Britain.

The most obvious and important step is to give boosters to all residents immediately. Studies have long made it clear that booster shots can improve both the quality and the quantity of the antibody response to SARS-CoV-2. It takes a few weeks for boosters to take better effect, so starting now is crucial.

“Elderly people can struggle to mount and maintain effective memory responses, making the presence of neutralizing antibodies, which function to block the virus from efficiently infecting our cells, all the more critical at the moment of exposure,” Andrew Croxford, an immunologist based in Zurich, explained to me.

Croxford said that all this could compound risk in the most frail, making a third dose for these individuals a matter of utmost importance.

Incidentally, many non-coronavirus vaccines are given in a three-dose primary series because that number of exposures has been shown to create a more robust immune response. It looks as though these vaccines may well follow a similar path.

Since this variant will cause breakthroughs in fully vaccinated individuals, it’s important to expand nursing home staff vaccine mandates to include third shots because of the gravity of the threat to the vulnerable population they work with. If staff members are less likely to get infected, they will be less likely to transmit.

The stakes are high enough to request that all visitors should be required to have received boosters, and also do a rapid test right before entering.

Rapid tests are good at detecting people when they are infectious, so workers should receive one before every shift. It’s not a big deal. It can take about 60 seconds, with results in about 15 minutes. Employees should be guaranteed paid sick leave if infected so there would be no excuse for coming to work while sick. (Raising pay would also help make these jobs attractive enough for people to feel more motivated keep them by adhering to the necessary standards.) The costs of all this are far less than the costs of hospitalizations.

Residents should be closely monitored for symptoms and randomly tested. Increasingly, there are therapeutic drugs that can save lives, but most of them need to be administered early in the disease, which makes early detection crucial. Exactly how effective antivirals will be for the most frail remains to be seen, so an ounce of prevention is worth a pound of cure.

Plus, mitigations need to target the means of transmission correctly. The coronavirus is airborne, so stopping its spread requires more focus on ventilation, air filtering and better masks, like N95s or KF94s, or surgical masks, preferably with braces that make them fit better. (Those more protective masks should be mandated for staff members and distributed for free to them.) Air can be filtered with HEPA filters, and opening windows can help when the weather allows. (Plexiglas barriers, however, are not only a waste of money but can create dead spots with less ventilation, increasing risks.)

All these facilities should have outbreak plans in place. It’s inhumane to simply lock everything down. Social support is crucial at every stage of life, and too often we are both late to react to threats and slow to relax restrictions.

Protocols should allow the elderly to interact with one another and with their loved ones, not preemptively cut them off without paying attention to the measures that could keep them safe.

In case of an outbreak, swift action should be taken to contain it, by testing everyone daily and isolating those infected till tests indicate they are no longer infectious.

Fortunately, we have a lot more tools available than we did in the dreadful first year of the pandemic, and a lot more understanding. It would be a shame if we went through yet another winter, with more suffering, as if we hadn’t learned any lessons.