Minnesota health officials are noting a worrisome reemergence of COVID-19 infections among residents and health care workers of long-term care facilities.
Since early July, the weekly number of new infections among residents has nearly tripled, with 172 new cases last week.
That has been proceeded by an increasing number of infections among long-term care employees. Over the past four weeks, 580 employees have tested positive for the new coronavirus, compared to 438 residents.
The resurgence has public health officials renewing calls for everyone to help stop the spread of COVID-19. State regulators are also reviewing their guidance to facilities about the limited number of visits that were recently allowed, although they say that no decisions about changes have been made.
With Minnesota averaging about 700 new COVID-19 cases each day, health officials say the increased spread in communities is now having ripple effects that are being seen in facilities that house some of the most medically vulnerable.
“When there are high levels of the virus circulating, there is only so much we can do from a systems standpoint to prevent workers from being exposed in the community, getting infected and unknowingly bringing it into the facilities where they work,” said Dr. Ruth Lynfield, state epidemiologist and medical director at the Minnesota Department of Health.
COVID-19 is difficult to control because infected people can pass it on to others without feeling sick. Although some people do not develop any symptoms, those that do can be infectious before they feel any warning signs that they might pose a danger to others.
“What we are seeing with community spread should be a concern for everyone with a loved one in long-term care, everyone with a child who wants to be able to go back to in-person learning at school, and really everyone in Minnesota who wants to move ahead,” said Michelle Larson, the health regulations division director at the Health Department.
In the absence of a vaccine, health officials say the only way to control the virus is for everyone to wear a mask in public places, practice hand hygiene, social distance and avoid large gatherings.
Each new infection can start a chain of illness that can spread to those who have contact with someone who is more likely to develop COVID-19 complications, including the elderly or those with compromised immune symptoms.
The pandemic took hold in the state’s long-term care facilities early and it spread rapidly.
It started with four cases in the third week of March and two months later it reached its peak with more than 1,000 cases in the third week of May.
New cases decreased after new protocols were introduced to supply facilities with personal protective equipment and testing was expanded.
Still, there have been nearly 7,900 cases among long-term care residents and workers, with 1,241 resident deaths.
The outbreaks led to restrictions on visits by family members and friends. Many of Minnesota’s 1,700 senior care communities had become like small fortresses, with “No Visitor” signs blanketing their entrances. Families resorted to dropping off care packages at the front doors and waving at their loved ones from a distance.
But citing encouraging trends, the state began to relax the lockdown restrictions in mid-June, by allowing people to visit with their loved ones outside the homes, provided they wear masks and maintain social distancing. Then last month, many long-term facilities began allowing indoor visits by designated family members and outside caregivers, under new guidance issued by the state.
State regulators say they are not ready to pull back on these visits, mostly because they help counter the social isolation that can lead to health problems.
They are considering alterations that would set visitation policies based on the infection rates in the community, similar to the decentralized approach that was developed for schools.
“It would be very facility-driven based on what is happening in their community and what is happening in their own facility,” Larson said.
One statewide advocacy group for long-term care residents and their families strongly cautioned against any move to tighten visitor restrictions, arguing that family members serve a vital role in care during a pandemic and should be allowed access.
Kristine Sundberg, executive director of Elder Voice Family Advocates, said reversing or pulling back on access by family members would be “exactly the wrong thing to do” as coronavirus cases are on the rise in long-term care. “To be rethinking access by families is deeply misguided,” Sundberg said. “The rising spread [of COVID-19] is not about family caregivers getting access. It’s about keeping COVID out of these places, and you have to start with protective equipment and testing.”
She added, “The need for these families to get in to these facilities to monitor care has never been greater.”
For now, health officials say the best way to keep visitation policies intact is through compliance with safety measures during the pandemic, even for those who do not work in long-term care.
“We do know that people are participating in more and more events where they might not be socially distant,” said Karen Martin, senior epidemiologist in the Health Department’s infectious disease division.
In addition to cases linked to bars, the agency’s disease detectives have traced exposures to church gatherings, sporting events, weddings, funerals and family gatherings.
“In the broader community, there is a little bit of COVID fatigue,” she said. “We want to encourage people to remain vigilant ... knowing that we are all connected.”
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