The Cruise Ships in Our Backyard
Dr. Steven Berk compares COVID-19 outbreaks in nursing homes to the severity of cruise ship outbreaks
It is tragic but not surprising that nursing homes should suffer such heavy losses from covid-19. When it comes to a contagious pathogen, nursing homes are like cruise ships, with large numbers of people confined to finite spaces and sharing common dining and recreation areas. Except nursing homes come with a smaller crew that has repeated, hands-on contact with an aging and often sickly population that requires assistance with intimate daily tasks.
Historically, nursing homes in the United States evolved to sit somewhere between almshouse and hospital. The modern nursing home has a superficial and deceptive resemblance to a medical environment, with aides in uniform, hospital beds, bedside tables and a few nurses. But they lack the resources and personnel to allow them to live up to that appearance. The backbone of the institution is the poorly paid nursing assistant. Infection control and good sanitary conditions are championed but often difficult to execute. One of us (Abraham) worked in a nursing home as an aide as his first job in this country, before becoming a doctor. Although astonishing changes have taken place in hospital care, the nursing home remains frozen in time...