Families who have been in the dark about coronavirus spread in their loved one’s nursing homes now have limited insight into facility outbreaks.
The state health department released a list of 116 facilities that have current outbreaks – considered one case among residents and staff – late Wednesday, after a judge ruled last week that the agency had to disclose the names.
In total, MSDH is reporting 1,718 resident cases, 1,003 employee cases and 310 resident deaths in long-term care facilities with active outbreaks. Of the 116 facilities with active outbreaks, 27 facilities – about a quarter – have only had one case among staff or residents, despite the disease’s quick-spread in residential facilities.
State Health Officer Thomas Dobbs said on Wednesday that facilities with proper infection control can either keep the virus out or keep it to minimal spread once it does come in, adding that a good rule of thumb in facilities is to assume everyone has it and protect staff and residents accordingly.
“We’ve seen places that had one employee (test positive) and had really great protocols for infection prevention and that was it – it just stopped,” he said. “That’s the kind of thinking we’re going to have to have going forward – we cant test our way out of it, though its an important tool – but combined with proper infection prevention we can do a good job.”
The list comes in the backdrop of drastic case growth over the last two weeks in Mississippi. New cases started to slow mid-May but have quickly reversed, worrying state officials particularly when it comes to not overburdening the health care system – the goal of flattening the curve.
Active outbreaks maxed at 137 on Sunday, when the state tested all 211 facilities across the state. The number declining to 116 by Wednesday, as listed on the new facility list, means the state is considering some facilities recovered. On Wednesday, however, the state estimated 126 active outbreaks on their daily long-term care outbreak list by county – the source of the discrepancy is unclear. The case data is self-reported from facilities and is only as accurate as they report.
It’s still difficult to assess recoveries because cases are listed cumulatively for any facility or county with an outbreak, not differentiating between which cases within the facility might have recovered. Comparing the county list and new facility list, MSDH considered at least 275 residents – 14 percent of all long-term cases over time – recovered.
Ninety-five facilities are nursing homes, though nine developmental disability centers and six assisted living communities – centers for aging adults but who live more independently than nursing homes – also have active outbreaks. One personal care home and one “other” are also listed.
Hinds, Jones and Lauderdale counties are most represented on the list, each with seven facilities comprising 598 cases, almost a quarter of all cases among active outbreaks in the state. Central Mississippi, where five counties are still under shelter-in-place orders until Monday, has driven new cases recently and seen health care strain due to coronavirus spread and normal hospital use, according to Dobbs.
In Hinds, most long-term care cases are among residents, but in Jones and Lauderdale, cases are split fairly equally among staff and residents, echoing Dobbs’ point Wednesday to reporters that though there are still “significant” outbreaks in long-term care, they’re driven by staff and community spread, which can lead to hospital strain he says is happening in Jackson and the Pine Belt.
“We’re seeing more and more outbreaks associated with shrimp boils and parties,” Dobbs said, pointing to a “reverse scenario where people are bringing it into work because they’re catching it in the community.”
In Mississippi, facility outbreaks are not necessarily correlated with high community cases – suggesting that it could be facility protocol that’s contributing to the spread as well, like Dobbs mentioned. Of the 20 counties with the most COVID-19 cases per capita, only seven also have the most long-term care cases.
Facility outbreaks are also not driven by older age of a county’s population or high number of nursing homes. Only half of the counties with the most facilities also have the most long-term care cases, and even fewer – just four counties with the most long-term care cases – also have the highest proportions of those over the age of 75.
Still though, long-term care facilities are not driving the overall new case spikes seen across Mississippi over the last two weeks, nor are specific community outbreaks, says Dobbs. General community transmission – folks spreading the virus at small or large gatherings by not socially distancing – seems to be the main source of cases, Dobbs says.
That community spread lead to 12 days of steady new case growth late May to early June – average new cases growing by nearly 20 percent in less than two weeks and surpassing unprecedented daily averages in the 300-new-case range for more than a week now. Over the same time, weekly case totals continued to peak for nine days, maxing out at 2,294 weekly cases on June 1 – the most ever reported.
Over that time, an average of 4,500 daily viral tests were conducted, increasing total diagnostic tests by over 50 percent in two weeks, due largely in part to universal long-term care testing that just wrapped up. In total more than 62,000 Mississippians were tested over the last two weeks, not including antibody tests.
During the last two weeks of steady case growth, long-term care cases grew by 27 percent, while overall case growth grew by 34 percent.
Though older folks and those with weakened immune systems are most at risk of complications and still comprise most deaths and hospitalizations – those over the age of 60 accounting for 87 percent of deaths and 61 percent of hospitalizations – these trends are moving younger, a sign that community transmission is growing among asymptomatic people returning to normal activity.
Long-term care residents are still driving deaths, even while only accounting for 12 percent of all cases and 10 percent of new cases over the last two weeks.
As Dobbs mentioned Wednesday, new cases are diversifying by age. Younger people have driven new cases over the last two weeks – 18 to 29-year-olds now accounting for majority cases, and their case-load growing by 57 percent in just two weeks.