by Michael Ainscough, MD, MPH
In other articles, I’ve addressed what we can do to protect ourselves and our immediate families. This article brings attention to a couple issues that affect the larger community.
The United States is experiencing the worst pandemic in 100 years. COVID-19 is the most contagious and deadly virus we have seen in generations. Many county residents have put their life on hold to deal with it. Ordinary people have sacrificed much and risen to the occasion. As individuals we have done what has been asked of us, and the sum of all our efforts has protected the community. If you are reading this paper, you probably understand the gravity of the situation. Yet, some people just don’t get it.
Washington County is now entering our next phase of the epidemic. Previously the problem was somewhere else, but now more virus is circulating in our County. As other parts of the country are flattening their curves, getting past their peak infection rates, and watching for any resurgence of cases, Washington County is now starting to see an uptick of infections, five in the last week. As areas are deliberating how to loosen their restrictions to reopen their businesses, that freedom of movement will put Washington County residents at increased risk of the virus.
The virus is not going away anytime soon. As it comes to our county, there are two places that we need to make safer: grocery stores and long term care facilities. We need plastic shields at grocery store check-out counters. We need optimal medical monitoring for employees and infection control procedures at nursing homes. We need to have confidence that these places are protecting our health and the health of our loved ones.
The single most important thing to be done for the general community is to install plastic shields at check-out counters in every store. Stores in larger city hot spots already have them. We shouldn’t wait. When we have obvious community spread of the virus, infected people will be shopping at grocery stores. That is inevitable. People will shop where they feel safest. At some point, people may quit shopping at stores where they do not feel safe – where there are no plastic shields – where the owners/managers have not taken the threat seriously.
A plastic shield at a check-out counter protects both the customer and the clerk from exposures. Although not perfect, these shields provide an alternative for the “6-foot social distance rule” which is obviously impossible to maintain across a 3-foot counter top. With a plastic shield in place, the employee feels less risk of exposure from multiple customers on a shift. In my opinion, these should be installed at every essential business in the county, but most importantly at businesses near interstate exits, convenience stores, groceries and pharmacies.
The Nashville Country Mart, Kroger, Circle K, Dollar General, and near I-64 the BP and CITGO stores all have their shields up. In Okawville the Circle K and Road Ranger have them. They got the message. On March 31 the Illinois Department of Public Health (IDPH) sent out a memo with preventative actions for grocery stores. One of the actions was “Place shield guards in front of the cashier and/or bagger who may not have the ability to stand 6 feet away from the customer.”
If store owners think they can wait it out and not have the expense of putting up shields, that is the wrong approach. The virus will be with us for months to come. If a store clerk gets sick with coronavirus, the first question asked will be “Did that store have a plastic shield at the checkout counter?”
When you shop at a store without a protective plastic shield at the checkout counter, you should tell the cashier, manager, or owner they need to install one for employee and public protection. Encourage them to do the right thing to protect our community.
Long Term Care Facilities (LTCF)
Assisted living, extended care facilities and nursing homes are like small communities. During the epidemic, these facilities have initiated lockdowns as a precaution to prevent the spread of the virus. Employees continue to go back and forth between work and home every day. Outbreaks in LTCFs are frequently traced back to employees. The single most important thing we can do for our loved ones in LTCFs is to ensure the employees do not spread the virus.
The IDPH also updated their COVID-19 Control Measures for LTCFs on March 20. Among the 13 items required for employees are “All employees should be pre-screened for fever and symptoms prior to shifts” and “All asymptomatic employees must wear a mask during their shift to protect residents.” All employees need to self-identify to their supervisor any symptoms of illness or known exposure to the virus.
There have been coronavirus outbreaks in LTCFs. The first was a nursing home in Seattle. As of Apr 19, seven nursing homes in SW Illinois had reported outbreaks. Garden Place Senior Living in Columbia, IL, had 49 cases and 6 deaths. As of Apr 10, Murray Center in Centralia had reported positives in 6 employees and 18 residents. As of Apr 19, GreenTree Assisted Living in Mt. Vernon had reported 9 employees and 14 residents tested positive. On Apr 19, Washington County Hospital Nursing Care Center (long-term care) reported a positive resident. All the employees and residents are being tested. Nationwide, more than 6,400 deaths due to COVID-19 have been linked to nursing homes, according to the Associated Press.
During lockdowns residents don’t come and go. Family members aren’t allowed to come and go. The only people who come and go each day are the employees and a few delivery people. Under epidemic lockdown conditions, our vulnerable senior citizens are totally dependent on LTCF employees. It is a responsibility of the staff not to bring the coronavirus into the facility. It does no good to lock the front door, yet let the virus come through the back door with an employee.
The most vulnerable segments of our population are the elderly and the poor. In many LTCFs there are situations of many minimum wage workers taking care of many frail senior citizens. The employees have the freedom to abide by public health restrictions to avoid coronavirus, or not. We can’t control what employees do or where they go in their off-work time. It is a cruel irony that employees who have freedoms sometimes bring the virus to work and pass it to locked down residents. Living at a long term care facility should not be a death sentence. It is a cruel reality that we can’t be with our family elders in their time of sickness and death. Even funerals are limited to 10 people.
Another way to look at this is if LTCFs are managed by medical staff who enforce extensive infection control precautions to prevent communicable diseases, then the coronavirus is more silent and infectious than previously thought. Even small amounts of virus from asymptomatic carriers or very mild cases can cause infections. If that is the case, the risk of spread is even greater in public places as discussed earlier in this article.
Every facility we entrust our loved ones with should have the highest standards and procedures in place to monitor their employees. When you talk to the administrator or head nurse on the phone, ask them what infection control procedures and precautions they have in place during this epidemic.
In the case of locked down LTCFs the source of virus becomes obvious, but too late. In the case of grocery and convenience stores, we may never know that’s where we got the virus.
You just can’t assume that grocery stores and LTCFs are doing all the right things. Hold them accountable. Ask questions. Your health is at stake at a grocery store, and the health of your loved ones is at stake at a nursing home or assisted living facility. It is unacceptable if they fail.
We are experiencing the worst pandemic in 100 years, the biggest public health emergency in our lifetimes. This is one for the history books. Years from now, your children will be telling stories about the coronavirus of 2020. This is not the time to assume all things are going well. Ask questions to protect the health of yourself and the community.
Michael Ainscough is a local retired physician who has contributed several articles on the coronavirus pandemic. He can be reached at [email protected].