OHCA The Oregon Caregiver Spring Summer 2021

The Oregon Caregiver SPRING/SUMMER 2021 www.ohca.com 14 DATA & RESEARCH T he past year has been one of the most challenging ever experienced by the long term care services sector, but there is now light at the end of the tunnel. We know far more today about SARS-CoV-2 (the virus causing COVID-19) than we did just a few months ago. Daily cases have declined from their winter 2020 peak. Multiple vaccines have been prioritized and thoroughly tested and funded, resulting in the ability to be safely developed in record time. Efforts to vaccinate the majority of Oregon’s long term care residents have been by all accounts largely successful. Yet, several risks remain that may prevent or delay moving on beyond the pandemic. At a structural level in long term care, the usual turnover in both residents and staff means there will be a continual need to keep up the vaccination efforts. Further, the vaccination rate amongst long term care staff is still lower than where it needs to be to prevent future outbreaks. This is particularly true amongst communities and geographic areas where vaccine hesitancy is highest. The full impact of newly emerging virus variants, and the effectiveness of our current vaccine arsenal against these new variants, is not yet fully clear. The B.1.1.7 variant, first identified in the United Kingdom, is quickly becoming the dominate variant circulating in the United States, including Oregon. While the evidence appears to suggest that the B.1.1.7 variant is far more easily transmissible, perhaps by as much as 40–50 percent, it is not fully clear how vaccines will respond. These uncertainties require answers to important questions. What about the other new virus variants we may encounter in the months ahead, including the B.1.351 (initially detected in South Africa) or B.1.1.248 (first identified in Brazil)? Will the vaccines continue to have the same level of effectiveness against these as during clinical trials and the first months of rollout? Further, do these new variants pose a risk for more serious illness when infections occur? These questions will be answered over time and with more research. What is clear now is that the emergence of new virus variants under- scores the need for continued vaccination efforts as well as the use of strategies that mitigate against infection, specifically the proper use of personal protective equip- ment and other infection control measures. Together, these are powerful tools to fight all forms of the virus. The research is also coalescing on the primary drivers of COVID-19 infections within U.S. long term care facilities. According to researchers from the University of Chicago and Harvard University, these include facility size (e.g., larger facilities appear to be at higher risk) and a high prevalence of the virus in the wider community where a facility is located. Due to the congregate nature of licensed facilities that support a highly medically fragile population, it is unsur- prising that buildings with more residents might be at higher risk of infections and outbreaks. It also stands to reason that long term care facilities located within communities where the virus is widely circulating would also be at higher risk of COVID-19 infections. Despite the best efforts to control the spread of the virus, staff, family, and new residents will, at times, inadvertently pass on COVID-19 if virus circulation is high within the community in which those individuals move back and forth. The disproportionate impact of COVID-19 on ethnic and racial minority groups is also clear. Nationwide, buildings with a higher proportion of residents from ethnic and racial minority groups appear to have an increased risk of COVID-19 cases compared More Than One Year Into the COVID-19 Pandemic: Where to Go From Here? By Walt Dawson, D.Phil to facilities with a resident population that is more white. One possible explanation is that many buildings with a higher number of residents from ethnic and racial minority groups tend to be located in neighborhoods and geographic areas with higher levels of COVID-19 circulating in that location’s general population. All of this underscores yet again the need for the vaccination of not only long term care residents, but also staff and the general population of the commu- nity in which facilities are located. More than one year into the pandemic, where do we go from here? First, as a nation, better public health measures are desper- ately needed. This was true long before the start of this pandemic. And while improve- ments have been made, there are continued gaps in our ability to adequately respond to COVID-19 and other public health risks. Within long term care, there continues to be a need to work toward ensuring all residents and staff who want a vaccine are able to receive one. Once again, with the standard turnover in residents and staff that occurs within the sector, this will be a continual process. And yet, while vaccines are an essential part of the response, they alone are insufficient to control the virus as long as COVID-19 continues to circulate freely within the general population. The use of personal protective equipment must continue as must other measures that reduce the spread of infection such as social distancing. Together, these approaches will allow us to move forward from the pan- demic and finally reach the light at the end of the tunnel. All information provided here is accurate as of April 1, 2021. The views expressed here are those of the author and not a specific organization. Walt Dawson is an Assistant Professor at Oregon Health & Science University and a Senior Atlantic Fellow with the Global Brain Health Institute.