As the federal government and state governments decide how best to proceed with plans to reopen the economy, elderly Americans, particularly those in nursing homes, continue to die at alarming rates from COVID-19.  Now more than ever, it is critical that the federal and state governments offer more protections to America’s seniors and nursing facilities.

As of May 26, 38.2% (over 37,600) of the 98,426 COVID-19 deaths in the US are from residents and staff at long-term care facilities.  Per-capita COVID-19 deaths in US nursing homes are well over 100 times the average for the rest of the country (around 2.9% in nursing homes vs. 0.0186% for the US’s non-nursing home population).  The actual numbers may even be significantly higher because of incomplete reporting in some states.

In at least 18 states, nursing homes account for a majority of COVID-19 deaths.  Harmful policies in some states that required nursing homes to admit COVID-19 patients, such as in New York, New Jersey, and Michigan, have contributed to the spread of the virus.  Notably, as of May 20, New Jersey, one of the hardest hit states, had 19,646 COVID-19 cases and 5,410 confirmed deaths among long-term care residents.  With an estimated 44,000 residents in New Jersey nursing homes, close to 45% of nursing home residents have contracted COVID-19 and about 12% of these residents have died of the disease (or 27.5% of those infected), and in New York close to 6% of residents have died of it.

As our nation proceeds to reopen, the federal government can lead the way by providing guidance and assistance to protect elderly and vulnerable Americans in nursing homes. Steps that can help significantly stem the spread of COVID-19 in nursing homes are listed below:

Staff housed on-site: Federal and state governments should subsidize on-site housing for staff members at nursing homes to significantly reduce potential exposure to the coronavirus.  The government should also subsidize significant temporary pay increases for staff members who agree to be housed on-site.

Avoid public exposure: Wherever on-site housing is not feasible, states, in conjunction with the federal government, should enact rules mandating that all employees at nursing homes restrict unnecessary contact with the public, including not entering grocery stores (these individuals and members of their household can get groceries by delivery or pick-up) and other public venues.

Report exposure to COVID-19: Employees should be required to report if anyone they were in contact with tested positive for, or has symptoms of, COVID-19 and be temporarily denied entry to the facility so long as this exposure continues, even if they test negative.

Ensure universal testing capacity at nursing homes: All nursing facilities, including ones not known to have cases, should be provided with enough testing capacity to test all staff and residents on a regular basis with reliable rapid tests.  At least a dozen states already plan to do this.

Regular testing of staff and residents: It is crucial to mandate that each day, prior to entry, all staff and visitors test negative with rapid testing devices and that all residents be tested on a weekly basis.  Real time results at facilities would enable the immediate removal of staff and residents who test positive to prevent any outbreaks.  On May 11, President Trump declared it “important” to mandate nationwide testing at all long-term care facilities.

Use the Defense Production Act (DPA) to mass produce COVID-19 test kits: To better ensure adequate testing capacity available quickly for all nursing homes and for the general population, it is imperative that President Trump invoke the DPA to mass produce enough tests and testing devices to be able to test tens of millions of people in the coming weeks.

Employ only those rapid tests with high accuracy: The federal government should determine the reliability of various tests.  Research conducted at the Cleveland Clinic found the CDC test and rapid tests made by Cepheid and Roche had high accuracy rates, but the Abbot rapid test had about 15% false negatives, or up to 48% false negatives according to an NYU study.  The FDA warned that the Abbot test could return inaccurate and false data.

Decertify substandard nursing facilities: Review the nursing home COVID-19 policies of every US state and territory and compel the correction of harmful policies.  The federal government has the power to decertify substandard facilities and must inform all long-term care facilities nationally that admission of any COVID-19 positive patients to their facility in a manner that may risk the health of other patients will result in immediate decertification.

Ventilation and air filtration: According to a study conducted in conjunction with the University of Nebraska Medical Center (UNMC), the coronavirus has been shown to move outside of rooms that housed coronavirus patients.  A study published in JAMA Insights showed that the coronavirus can remain airborne for hours.  Facilities should therefore be directed how to properly mitigate possible airborne spread and also how to decontaminate the facility and frequently touched surfaces.  All facilities must also ensure that they have proper ventilation to decrease the spread of COVID-19.  Facilities must also install MERV filters rated 13 or higher which capture over 80% of airborne viral particles compared to typical building filtration that captures less than 20%.

Train nursing home staff on mitigating spread of COVID-19: Mandate participation in training sessions designed by health experts and the CDC that focus on measures to diminish the chance of introduction or spread of COVID-19 in their facility.  The federal government should encourage other states to replicate Florida Governor Ron DeSantis’ Rapid Emergency Support (RES) teams to quickly arrest the spread of the virus in nursing homes through widespread testing and decontamination.

Mass produce personal protective equipment (PPE): Federal and state governments must ensure that all long-term care facilities (including those not certified by Medicare and Medicaid) be provided with adequate supplies of PPE to last for an extended period of time. To do this, President Trump should invoke the DPA and order additional mass production of PPE for all nursing homes, hospitals, first-responders, and others.  This would be a natural follow-up to President Trump’s more limited DPA on N-95 face masks from April 2 and his plan to send a two-week supply of PPE to over 15,000 nursing homes.

Assign staff to specific residents: To limit viral spread, nursing home staff should be assigned to care for the same residents each day, and must only work at one facility.

Separate facilities for COVID-19 residents: All patients readmitted or admitted to nursing facilities must be denied entry until they test negative.  The federal government should strongly encourage and support state governments to send every patient who tests positive to a separate facility designated solely for COVID-19 patients, similar to what has been done in Connecticut and Massachusetts.

While it is our obligation as a country to protect all life, it is particularly important to defend and protect those who are most vulnerable.  Defending life must never be viewed as a tradeoff to protecting the economy.  Rather, protecting life at this challenging time will help mitigate the spread of the virus and fuel a historic economic resurgence.  In the long-term, this nation will come out better morally and economically because of it.