Health director's blunt advice for families with loved ones in nursing homes

'This is a really, really challenging situation'
Posted at 2:40 PM, Apr 19, 2020

RICHMOND, Va. -- A health director offered frank advice for families with loved ones in long-term care facilities amid the COVID-19 global health pandemic: consider bringing them home.

"For some families, if they have the option to bring their loved one home, this would be a good time to do that," Richmond and Henrico County Health District Director Dr. Danny Avula said during a news briefing Friday. "I know that's extremely difficult, and that the reason that most of our long-term care facility residents are in those places is because they need the daily support. They need support with their activities of daily living, they need... help them get through their day. So I don't have better advice than that."

Virginia is grappling with 74 outbreaks at long-term care facilities with a total of 901 COVID-19 cases and 77 deaths as of Sunday. That is up 168 cases and 36 deaths linked to long-term care facilities from the previous day's report.

The local health departments are working with facilities that are willing to accept their help in co-managing the outbreaks.

Nineteen facilities in the Richmond and Henrico County Health District had confirmed COVID-19 cases Friday, according to Avula.

"We're helping manage outbreaks in those environments," Avula said. "We have had 74 deaths in the County of Henrico and 68 of those have been associated with long-term care facilities."

Avula said he believes there will be more cases at nursing homes.

"I think that as we have expanded access to testing, we're going to see a number of other outbreaks," Avula said. "And it's not because people are doing anything wrong, it's because this disease seems to transmit much more than we realized at the beginning of this pandemic -- before you have symptoms."

Avula believes health care workers brought the virus into the facilities in the most instances.

"There's just no way to put up a defense against asymptomatic transmission in facilities that weren't built for that degree of infection control," Avula noted.

Avula also urged family members to make sure they are communicating with staff at the facilities.

"We've got to keep families updated, you've got to help them stay in the know," Avula said he reminded administrators. "Otherwise that is going to create a lot more anxiety and fear throughout our community."

Avula said that many facilities have done "a really good job" communicating and providing updates for families.

"This is a really, really challenging situation," Avula acknowledged. "I think for the families, it's the hardest time. They are on the outside of these facilities. They can hardly visit their loved ones."

Avula has been working with staffers at Canterbury Rehabilitation and Healthcare Center in Henrico's West End since shortly after the virus was discovered at the facility.

Avula said officials have learned a lot, but acknowledged "there's not much that we have been able to do" to prevent surges at long-term care facilities.

"When people ask me what still worries you most about where we are, and where we're headed, it's our long-term care facilities," Avula said. "There are things that we've learned from the experience with Canterbury Rehab and things that Dr. Wrighthas really helped his colleagues learn, but none of it is 100 percent."

But access to rapid testing will be a game-changer in the health care industry, according to Avula.

"I can very much envision a situation where every day, a health care worker shows up, and they have either a finger prick or a swab test," Avula said. "And that comes back in 15 minutes. And if it's negative, they can work, and if it's positive, they can't. But we're a long way from that."

Canterbury Rehabilitation & Healthcare
Canterbury Rehabilitation & Healthcare

'Calm before the storm.'

Avula also said social distancing is working as hospitalizations have not spiked and less than 25% of nearby ventilators are in use.

"It feels like a calm before the storm. And and hopefully that storm will never come," Avula said. "I have no doubt that we'll see an increase in cases and an increase in hospitalizations. But the goal of all of this was to keep our health systems from being overwhelmed so that the most vulnerable members of our community could get the care they needed to make it through."

Avula said if things continue on this trajectory, we might be able to pivot away from the plans to make Richmond Convention Center an overflow hospital.

He said he believed the peak in Richmond would be this summer, meaning we have flattened, but also lengthened the curve.

"So much of the beginning was all about flattening the curve, this idea that we wanted to keep that peak lower to preserve the capacity of our health systems. But that also does and likely will mean that we have a lower but longer curve," he said. As I talk to more people who have been looking at this, I think will will see a peak a little bit earlier than originally projected. But the good news about all of this is that that peak will be significantly lower."

Avula said we're about a month away from antibody testing, which will be useful in determining when it's safe to reopen all of our businesses and offices again.

"There are a couple of other things that will change the course of how we as a community begin to come out of this," he said. "The wider availability of testing and actually knowing where the disease is. We've been hearing about the prospect of this for weeks. I think we're probably still a month away from widespread antibody testing. But the idea is that once that is made available, we'll be able to widely test and see who actually has had exposure already. That information will be really useful for us in terms of being able to decide when are we going to open back up as a society."

Depend on CBS 6 News and for the most complete coverage of the COVID-19 pandemic.

COVID-19 Precautions

Most patients with COVID-19 have mild to moderate symptoms. However, in a small proportion of patients, COVID-19 can lead to more severe illness, including death, particularly among those who are older or those who have chronic medical conditions.

COVID-19 spreads primarily through respiratory droplets produced when an infected person coughs or sneezes.

Symptoms include fever, cough, and difficulty breathing. Symptoms appear within 14 days of being exposed to an infectious person.

Virginia health officials urged the following precautions:

  • Wash your hands often with soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizer only if soap and water are not available.
  • Avoid touching your eyes, nose, and mouth.Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
  • Clean and disinfect frequently touched objects and surfaces.Stay home when you are sick.
  • Avoid contact with sick people.Avoid non-essential travel.