I believe that many of our staff and families are hoping this is true. We are now living in the post-pandemic era and have seen the benefits of natural and vaccine immunity with people still acquiring COVID, but for the most part not getting as sick, with most self-managing their illness and often not reporting it, or not even testing. We know that both are transmitted by the aerosolized modality and that new cases occur without an obvious source. The vaccine for both flu and COVID has waning illness prevention protection after about 6 months. The protection of both vaccines from infection in elders is imperfect and may only be in the 40-70% range. Flu has been most prevalent in the winter months in part due to people living in more crowded indoor conditions at that time of the year, but this is not true for COVID. Outbreaks have occurred in the Spring, Summer, and Fall and seem to correlate with the prevalence of a new variant of concern. The mortality this past flu season has also been quite different with COVID having almost 10 times the mortality of influenza with most of the mortality occurring in those aged over 60 or in younger persons who are high-risk for serious illness. 

With this reality in mind, we need to approach COVID as a serious infectious threat for our SNF residents. Virtually all of our SNF residents are at substantial risk for serious illness. The updated COVID vaccine has been consistently effective for reducing this risk even in SNF patients. On January 28, 2024, the CDC Advisory committee recommended a 2nd Updated COVID vaccine for adults over 65 and high risk patients who are 6 months beyond their first dose.

With both Influenza and COVID, asymptomatic, presymptomatic, and minimally symptomatic presentations do not determine whether the resident will become seriously ill days later. This is why all those over 60 should receive preventive oral therapies at the onset of symptoms. For COVID, if you wait until somebody becomes seriously ill, medicines like Paxlovid will be much less effective and are not indicated beyond 5 days from + test or onset of symptoms. 

The CDC has national data that consistently show most SNF residents and staff have lower COVID vaccination rates and use of serious illness prevention medicines than those for influenza. We should strive to do better in encouraging residents and staff to stay updated on vaccination, and in recommending therapeutics (e.g., Paxlovid) for all symptomatic SNF residents. In addition, our residents rarely leave our SNFs, so their respiratory infections are coming from our staff or visitors. 

For these reasons, we must educate our residents, staff, families, and visitors that COVID is a serious threat to our residents, and our infection preventionists and medical directors should be our primary source for the latest public health guidance. Many facilities are using surgical or cloth masks for their frontline staff, but these masks provide little protection from acquiring or transmitting either infection. Instead, we should encourage our staff and visitors to use N95 or KN95 masks at work and should consider using these masks when in high-risk transmission settings like public transportation settings or indoor sporting or entertainment events. This provides a further layer of protection for our residents.

We are still learning to live with COVID. I hope that your facility leadership reviews your respiratory infection prevention program and finds opportunities for improvement.

Suggested Reading:

CDC vaccine advisers say older adults should get 2nd coronavirus shot - The Washington Post