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Commentary COVID-19 in Maryland Health Care

Opinion: COVID-19 and Nursing Homes — A Path Forward

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The COVID-19 pandemic has exposed the grossly inadequate protection of Maryland residents in nursing homes where over 50% of the deaths from the novel coronavirus have occurred. In Maryland, we need to re-think how we address the continuing near-term needs of those residents and to consider longer term approaches using lessons learned.

Near-term needs

Regular testing of all nursing home and assisted living residents, staff and contract caregivers for COVID-19. A comprehensive approach to testing is essential to stop the cycle of infection in nursing homes and assisted living facilities. Testing of nursing home residents and facility staff is now in progress and might soon begin at assisted living facilities as well. Contract caregivers hired by health care services to supplement support for residents are not routinely being tested, however, adding unacceptable risk to residents and staff.

While one-time testing of residents and staff is a start, it is not sufficient given the persistence of the virus. All caregivers should be tested twice a week, an approach which was mandated by Gov. Andrew Cuomo in New York. Maryland should do the same.

Sufficient PPE for all caregivers at nursing homes and assisted living. Isolation gowns, masks, gloves and hand sanitizer must be distributed in a timely manner to nursing homes for all caregivers, both in-house staff and contractors. As part of standard practice, PPE should be required for all caregivers, and regular training in the use of PPE and basic sanitary practices should be mandated to prevent the spread of any infectious disease.

Vaccine deployment. A logistics plan for distribution of future vaccines needs to be developed now, with phased deployment based on vaccine accessibility and populations at greatest risk. A cadre of experienced professionals should be trained and ready to quickly distribute and deploy vaccines to the most vulnerable.

Longer-term approaches

One lesson that has been painfully learned during the pandemic is the need for self-reliance at the state and local level. It is not a good assumption to depend on reliable support from the federal government in the future, given that their infrastructure, resources and staffing have eroded and will take time to rebuild. What additional systems should be in place and what resources and expertise will be needed at the state level?

An early warning system that is nimble and responsive. Scientists are continuously tracking emerging novel viruses that might pose a future threat. A Maryland science adviser should be appointed by the governor who could lead a team of health care experts and front-line workers, and who would work closely with the governor to rapidly marshal resources to protect vulnerable populations. We should not rely solely on the Maryland Department of Health, which was sluggish in addressing the nursing home cases and slow to provide transparency of data on nursing home residents.

Stockpiles of PPE and access to other essential materials. We should never again be in the position of relying on others — whether it is the federal government, other countries, other states or unproven companies — for isolation gowns, N95 masks, gloves or test components. Maryland is home to a vibrant community of biotechnology scientists. The state should establish a network within this industry that could provide complete test kits, with a quick turnaround.

Strict independent oversight on nursing home compliance. An independent commission should be established to ensure that the Maryland Department of Health monitors compliance and data release by nursing homes in a timely and systematic manner. An online statewide system should be made available to family members of nursing home residents to report any problems at these facilities.

Strategies to encourage compliance with restrictions. We need to engage in a broad based discussion on how to promote compliance with restrictions in a manner that is acceptable to our society. Community engagement and outreach campaigns should be developed with input from our state and local leaders, educators, and medical and social scientists — including experts in human behavior.

We have all learned from this horrific experience that novel viruses can emerge anytime, with little warning. Now is the time for a thoughtful discussion on how we can improve the protection of all Marylanders, especially those who are most vulnerable.


The writer is a microbiologist and director of Marylanders for Patient Rights.

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Opinion: COVID-19 and Nursing Homes — A Path Forward