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As COVID-19 cases climb in long-term care homes, experts hope to avoid locking down residents

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As the number of people infected with COVID-19 continues to climb, the virus has crept back into long-term care and retirement homes across the country.

After spreading like wildfire through hundreds of facilities in the spring, killing thousands of seniors, health officials were able to bring it under control during the summer, said Dr. Samir Sinha, director of geriatrics at Sinai Health in Toronto.

But after Labour Day, as COVID-19 cases sharply rose among the general public, so too did the number of outbreaks in long-term care.

“It really reminds us that the outbreaks that we see in our nursing homes and our retirement homes across the country are really the product of community transmission,” Sinha told Dr. Brian Goldman, host of the CBC podcast The Dose.

 

The Dose23:15What have we learned about COVID-19 to keep my elderly loved one safe in long-term care this time around?

 

“What really worries me now going into the second wave is that as we’re seeing the community transmission ramp up, we’re seeing more and more homes get into outbreak,” Sinha said.

“It’s only going to be a matter of time before that translates into more deaths … deaths that unfortunately, I think, many of us feel are just utterly preventable.”

Based on data provided by provincial health ministries, CBC News estimates that as of Tuesday evening, there were active COVID-19 outbreaks in more than 120 long-term care homes in Canada’s hardest-hit provinces alone: Ontario, Quebec, Alberta and British Columbia.

On top of the LTC count, there are close to 100 outbreaks in retirement homes in those provinces, primarily in Ontario and Quebec.

“Outbreaks” are defined differently in various provinces. In Ontario, only one case — either a resident or a staff member — triggers outbreak protocols. Other provinces count two or more cases as an outbreak.

 

‘I think we’re going to do a better job this round … about making sure we’re not shutting families out’ from their loved ones in long-term care, says Dr. Samir Sinha, director of geriatrics at Sinai Health in Toronto. (Taylor Simmons/CBC)

 

Given how deadly COVID-19 has been among elderly Canadians, any resurgence of cases in long-term care facilities is concerning, experts say — but not surprising.

“It’s very similar to the schools, in the sense that what we see in long-term care homes is going to reflect what we’re seeing in the community,” said Ashleigh Tuite, an infectious disease epidemiologist at the University of Toronto’s Dalla Lana School of Public Health.

“So as we see community transmission increase, we expect to start seeing increases in long-term care homes and retirement homes because they’re not sealed off from the rest of our community.”

Staff who work in long-term care and retirement homes live in the community, Sinha said, so in places where there is a lot of coronavirus circulating — such as hot spots like Toronto, Ottawa and Montreal — it’s much more likely they “are inadvertently getting COVID and then inadvertently bringing it into [care] homes.”

Although it’s “early days,” Sinha sees some hope in the fact that the majority of outbreaks this fall appear to be much smaller than they were during COVID-19’s first assault on long-term care homes last spring.

“Perhaps we have better systems in place that we can identify it early, isolate quickly and not let small outbreaks become massive outbreaks,” Sinha said.

That’s the big question, Tuite said, that will determine whether COVID-19 will be less catastrophic this time around.

“What do those outbreaks look like?” she said. “Are we able to nip them in the bud and, you know, basically find infected staff before they transmit to residents?”

 

Infectious disease epidemiologist Ashleigh Tuite hopes long-term care homes now have the tools they need to nip COVID-19 outbreaks in the bud before they spread from staff to residents. (Nick Iwanyshyn/University of Toronto)

 

Whether that happens will reveal if the changes governments and long-term care homes have pledged since the spring are enough to combat this round of COVID-19, said Dr. Isaac Bogoch, an infectious disease specialist at Toronto’s University Health Network.

“What is disappointing is how much of it we’re seeing this early in the fall, knowing there’s a long fall and winter ahead,” Bogoch said.

“It’s not like we don’t know what we’re doing now,” he said. “We have a very good idea of how this virus spreads, who’s vulnerable, and we saw the tremendous vulnerabilities of our long-term facilities during the first wave.”

Some vital policy changes were promised as a result, he said, including fixing the problem of underpaid care workers moving between homes, ensuring access to personal protective equipment and integrating infection prevention and control measures in long-term care homes.

“This has theoretically been done, but has it actually been implemented to an extent that will protect the long-term care facilities throughout the course of the fall and the winter? The answer remains to be seen.”

Long-term care lockdowns ‘last resort’

In addition to protecting seniors from COVID-19 infection, Sinha emphasized the importance of protecting them from re-living the lockdown of long-term care and retirement homes that happened in the spring.

The thought of going through that fear, loneliness and isolation again is traumatizing, he said.

“I can’t imagine the emotions that people are feeling right now,” Sinha said. “[But] I think we’re going to do a better job this round … about making sure we’re not shutting families out completely.”

 

Dr. Isaac Bogoch, an infectious disease specialist at the University Health Network, says we know much more about how COVID-19 spreads and how to stop it than we did when the virus ravaged long-term care homes last spring. (Craig Chivers/CBC)

 

Even as COVID-19 cases rise, some provinces, including Ontario, have recognized that and aren’t locking long-term care homes down completely, allowing residents to have at least one designated “family caregiver.”

That caregiver not only provides much-needed emotional support, but also helps understaffed homes with tasks such as feeding and bathing their elderly family member, Sinha said.

In addition, it’s important for people to consider their loved one’s wishes when weighing the risks and benefits of seeing them in long-term care, he said. Many of his patients tell him the value of family visits overrides their worries about getting COVID-19.

The way to visit as safely as possible, he said, is to make sure that you’re following public health guidelines in all other aspects of your life, including avoiding crowds, physically distancing, wearing a mask and handwashing.

“If you know that you’re doing the right things yourself personally to protect yourself against COVID and then you’re following all the protocols and precautions [at the long-term care home],” then it’s likely pretty safe, Sinha said.

Tuite agrees that access to family visits should be maintained during this next phase of COVID-19.

“I think lockdowns should be a measure of last resort,” she said.

“At this point we know enough about the virus, we have enough tools that we can control it,” Tuite said.

“The fact that there’s COVID circulating doesn’t mean that we need to lock these homes down. It means that we need to have really strong infection prevention and control measures in place. It means that people who are going into the homes need to be screened.”

And, Tuite  said, it means flattening the COVID-19 curve once again.

“The best way to protect people living in long-term care homes is to keep community transmission low,”  she said.

Source: CBC.ca

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Enrollment halt recommended for sickest COVID-19 patients in Regeneron trials – MassLive.com

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The independent monitoring committee for Regeneron Pharmaceuticals trials of REGN-COV2, its promising antibody cocktail drug for COVID-19, has recommended placing a hold on further trial enrollment of hospitalized patients who require high-flow oxygen or mechanical ventilation.

The recommendation is based on a “potential safety signal and an unfavorable risk/benefit profile at this time,” according to a statement on Regeneron’s website.

The committee recommended continuing enrollment of hospitalized patients “requiring either no or low-flow oxygen as the risk/benefit remains acceptable” and “continuance of the outpatient trial without modification.”

The drug, along with the steroid dexamethasone, the repurposed Ebola drug remdesivir and supplemental oxygen, were given to President Donald Trump when he was hospitalized for COVID-19 in early October at Walter Reed National Military Medical Center.

It consists of two cloned antibodies designed to neutralize SARS-CoV-2, the virus that causes the respiratory disease, by blocking its ability to infect the body through binding with host cells.

The drug was said to show promise this summer in helping to reduce the viral load as well as alleviate symptoms in trials involving non-hospitalized patients being treated for COVID-19, and specifically in those patients who had not mounted their own immune response to SARS-COV-2.

Antivirals are generally considered to work better when given before an infection has taken hold in the body.

Regeneron said it is informing the U.S. Food and Drug Administration, which is currently evaluating REGN-COV2 for a potential Emergency Use Authorization in mild-to-moderate outpatients at high risk for poor outcomes.

It said it would share the recommendation with the independent committee monitoring the RECOVERY trial in the UK, which is evaluating REGN-COV2 in hospitalized patients.

Eli Lilly & Co. recently announced the clinical trial involving the use of its antibody drug bamlanivimab as an added treatment in hospitalized COVID-19 patients had ended as the trial showed it “is unlikely to help” these patients “recover from this advanced stage of their disease.”

It said other trials involving the drug would continue.

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Coronavirus: About 20% of grocery store workers in Boston had COVID-19, and most were asymptomatic, study found – WABC-TV

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Grocery store work in Boston puts employees at serious risk for infection, a new study found, particularly those who have to interact with customers.

These workers likely became a “significant transmission source” for COVID-19 without even knowing it because most in the study were asymptomatic.

The analysis, published Thursday in the journal Occupational and Environmental Medicine, is the first to demonstrate the significant asymptomatic infection rate, exposure risks and psychological distress grocery workers have felt during the pandemic.

In the study, 20% of the 104 grocery workers tested at a store in Boston in May had positive nasal swab tests.

This was a significantly higher rate of infection than what was seen in the surrounding communities, the researchers said. Workers who dealt with customers were five times as likely to test positive for COVID-19 as colleagues in other positions.

Myths about COVID-19 busted: Masks, indoor transmission, cold weather, and more

But three out of four of those who tested positive had no symptoms.

“We were definitely surprised to see that there were that many people that were asymptomatic,” said Dr. Justin Yang, an assistant professor at Boston University School of Medicine and a researcher at Harvard School of Public Health who worked on the study. “This is definitely very alarming as it means that retail grocery store employees are exposed to customers and sort of serve as a middleman for the virus – like a super spreader almost.”

Workers in the study had tried to take precautions. Nearly all, 91%, said they wore a face mask at work and 77% said they also wore masks outside of work. Yet only about 66% said they were able to practice social distancing consistently on the job.

This inability to social distance had an emotional, as well as a physical impact. Nearly a quarter of the people in customer service jobs said they had problems with anxiety and depression compared to 8% of workers who did not have to interact with customers. Employees who commuted to work by bike, car or by walking were less likely to experience depression than those who used public transportation, the study found.

“If you are in an environment when you’re literally in front of a customer, you can’t be more than six feet and that is really stressful for essential employees,” Yang said.

At least 108 grocery workers have died and more than 16,300 have been infected or exposed to Covid-19, the United Food and Commercial Workers International Union, or UFCW, said Thursday. The union represents 1.3 million employees.

The rates of infection among the workers in this study do seem high, Yang said. By comparison, an earlier study of Covid-19 infections among Dutch health care workers found the infection rate was about 10%.

Yang said he hopes this study prompts the government and store owners to provide better guidance, routine testing and protection for grocery store workers.

There has been a national movement to designate grocery workers as first responders which would give them priority access to testing and personal protective equipment.

In an editorial for CNN in August, Marc Perrone, the President of UFCW and Democratic Vice Presidential candidate Kamala Harris argued that grocery workers should also get hazard pay.

Non-union grocery workers often have little to no healthcare coverage, meaning they could potentially face expensive health care bills if they contracted COVID-19.

Some states have increased support for grocery workers by increasing access to childcare and requiring shoppers to wear masks. Three states offer free testing for these workers and four offer worker’s compensation, according to UFCW, but none of the states provide the full first responder status to grocery workers, and rules are inconsistent from state-to-state.

“We spend a lot of time talking about healthcare workers, and they are important, but we’re missing a lot of the pieces of the puzzle if we don’t look at non-health care workers exposure,” Yang said. “Their voices are really not being heard. I thought it was important to get this published so government agencies and store owners could take note of this and see that they should be protecting their employees more.”

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This Weird COVID Symptom Could Last Five Months, Study Shows – Yahoo Canada Shine On

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This Weird COVID Symptom Could Last Five Months, Study Shows

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="A new analysis of COVID "long haulers" has found that they may have skin symptoms for months—including the strange phenomenon "COVID toes," which one man had for almost six months. The analysis looked at nearly 1,000 COVID patients from 39 countries. Patients reported a number of skin-related symptoms, and the average duration was 12 days. But some conditions lasted much longer. Read on to learn more, and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had Coronavirus.” data-reactid=”19″>A new analysis of COVID “long haulers” has found that they may have skin symptoms for months—including the strange phenomenon “COVID toes,” which one man had for almost six months. The analysis looked at nearly 1,000 COVID patients from 39 countries. Patients reported a number of skin-related symptoms, and the average duration was 12 days. But some conditions lasted much longer. Read on to learn more, and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had Coronavirus.

COVID Toes Could Last For Months

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content=""When we started looking at symptom duration, some of these patients are having really incredibly long-lasting symptoms," Dr. Esther Freeman, the principal investigator of the registry and the director of Global Health Dermatology at Massachusetts General Hospital in Boston, told NBC News. "In particular, we saw that with chilblains, also known as COVID toes, where they’ve been having skin symptoms for more than 60 days."” data-reactid=”21″>“When we started looking at symptom duration, some of these patients are having really incredibly long-lasting symptoms,” Dr. Esther Freeman, the principal investigator of the registry and the director of Global Health Dermatology at Massachusetts General Hospital in Boston, told NBC News. “In particular, we saw that with chilblains, also known as COVID toes, where they’ve been having skin symptoms for more than 60 days.”

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="One patient had COVID toes for 130 days, and another had the condition for more than 150 days, the study said.&nbsp;” data-reactid=”22″>One patient had COVID toes for 130 days, and another had the condition for more than 150 days, the study said. 

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content=""They’ve had toe swelling and toe discoloration and toe pain for many months," said Freeman. "They’ve had this really kind of persistent inflammation."&nbsp;” data-reactid=”23″>“They’ve had toe swelling and toe discoloration and toe pain for many months,” said Freeman. “They’ve had this really kind of persistent inflammation.” 

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="RELATED: 11 Symptoms of COVID You Never Want to Get” data-reactid=”24″>RELATED: 11 Symptoms of COVID You Never Want to Get

Skin Symptoms a Common Sign of COVID

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="Other studies have shown that up to 20% of people diagnosed with COVID-19 report skin changes as part of their illness, including a rash, hives or breakouts resembling chicken pox or the scaly plaques of psoriasis. When doctors noticed several patients reported a rash on their feet, "COVID toes" became a common term and a source of curiosity.&nbsp;” data-reactid=”26″>Other studies have shown that up to 20% of people diagnosed with COVID-19 report skin changes as part of their illness, including a rash, hives or breakouts resembling chicken pox or the scaly plaques of psoriasis. When doctors noticed several patients reported a rash on their feet, “COVID toes” became a common term and a source of curiosity. 

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="Overall, COVID-related skin changes are so common that researchers behind the COVID Symptom Study say they should be considered a fourth key sign of COVID-19, along with fever, cough and loss of smell or taste.” data-reactid=”27″>Overall, COVID-related skin changes are so common that researchers behind the COVID Symptom Study say they should be considered a fourth key sign of COVID-19, along with fever, cough and loss of smell or taste.

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="The coronavirus has been observed to cause inflammation throughout the body, including in the lungs, heart and brain. COVID toes seem to be connected to this inflammatory process. "This data adds to our knowledge about how COVID-19 can affect multiple different organ systems, even after patients have recovered from their acute infection," said Freeman in a press release about the new study. "The skin can provide a visual window into inflammation that may be going on elsewhere in the body."” data-reactid=”28″>The coronavirus has been observed to cause inflammation throughout the body, including in the lungs, heart and brain. COVID toes seem to be connected to this inflammatory process. “This data adds to our knowledge about how COVID-19 can affect multiple different organ systems, even after patients have recovered from their acute infection,” said Freeman in a press release about the new study. “The skin can provide a visual window into inflammation that may be going on elsewhere in the body.”

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="RELATED: Dr. Fauci Says You Don’t Have to Do This Anymore to Avoid COVID” data-reactid=”29″>RELATED: Dr. Fauci Says You Don’t Have to Do This Anymore to Avoid COVID

What to Do About COVID Toes

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="According to the American Academy of Dermatology, children, teenagers, and young adults are most likely to develop COVID toes. Many never develop other symptoms of COVID-19, and when they do, symptoms tend to be mild. Applying a hydrocortisone cream to the affected area can reduce pain or itching.” data-reactid=”31″>According to the American Academy of Dermatology, children, teenagers, and young adults are most likely to develop COVID toes. Many never develop other symptoms of COVID-19, and when they do, symptoms tend to be mild. Applying a hydrocortisone cream to the affected area can reduce pain or itching.

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="If you experience any symptoms of COVID-19, including an unexplained skin rash, it’s best to contact your doctor for advice.&nbsp;” data-reactid=”32″>If you experience any symptoms of COVID-19, including an unexplained skin rash, it’s best to contact your doctor for advice. 

<p class="canvas-atom canvas-text Mb(1.0em) Mb(0)–sm Mt(0.8em)–sm" type="text" content="And do everything you can to prevent getting—and spreading—COVID-19 in the first place: Mask, get tested if you think you have coronavirus, avoid crowds (and bars, and house parties), practice social distancing, only run essential errands, wash your hands regularly, disinfect frequently touched surfaces, and to get through this pandemic at your healthiest, don’t miss these 35 Places You’re Most Likely to Catch COVID.” data-reactid=”33″>And do everything you can to prevent getting—and spreading—COVID-19 in the first place: Mask, get tested if you think you have coronavirus, avoid crowds (and bars, and house parties), practice social distancing, only run essential errands, wash your hands regularly, disinfect frequently touched surfaces, and to get through this pandemic at your healthiest, don’t miss these 35 Places You’re Most Likely to Catch COVID.

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