The lockdown strategy to combat COVID-19 may be saving lives, but it is also breaking hearts—especially those of the ones we should honor the most: our elderly.
COVID-19 has recently been dubbed the “nursing home disease.” Of course it is. No one should have been remotely surprised that a highly infectious virus would more adversely impact the elderly—having naturally diminished immune systems, living in close conditions, and likely also suffering from other serious ailments including dementia.
But instead of taking specific steps to protect those most at risk from a pandemic, the strategy pushed by government and public health officials was a near-total lockdown of everything and everyone. This was required and must continue, they said, in order to “save granny.”
The lockdown narrative was further reinforced by panic-inducing headlines on rising COVID-19 death counts. Definitions changed, from people dying “from COVID-19” to dying “with” it or “assumed,” and high numbers of nursing home deaths added fuel to the fire. Likewise there was confusion over whether to include among nursing home deaths only those who died at the nursing homes or also to include the residents who died after being admitted to the hospital. In addition, significant financial benefits have created an incentive both for hospitals and nursing homes to code deaths as COVID-19.
But now that some of the states’ wrong-headed COVID-19 orders for nursing homes have been made public, the “save granny” lockdown narrative is coming back around to bite the order-writers. New York Governor Andrew Cuomo has been charged with treating nursing home residents as “expendable.” Tragically, his orders requiring infected residents to return to nursing homes do seem to have caused more problems than they solved.
Of course, when Cuomo responded, “Older people, vulnerable people, are going to die from this virus. That is going to happen. Despite whatever you do. Because with all of our progress as a society, we can’t keep everyone alive”—he was not wrong. Even so, that doesn’t mean that his orders were right.
Like all one-size-fits-all decisions, these nursing home orders are ripe for criticism. A proper response to COVID-19 would consider specific circumstances—a hospital, a facility, a situation, and of course, a patient—one at a time.
In certain circumstances, it is not inconceivable that leaving COVID-19 infected patients in their nursing homes, or sending them back after hospitalization, may actually be the best course of action—assuming the homes are adequately prepared to properly quarantine and treat them.
One reason is called “hospital delirium.” Delirium is an acute medical condition, often presenting in the elderly, especially those with dementia and during hospitalization. Triggered by the stress of the illness or injury compounded with being in unfamiliar surroundings and facing treatments, IVs, flashing lights and the beeping of equipment. According to Dr. Leslie Kernisan:
Delirium is strongly associated with worse health outcomes. Short-term problems linked to delirium include falls and longer hospital stays. Longer-term consequences can include speeding up cognitive decline, and a higher chance of dying within the following year.
It’s a heartbreaking scene: an elderly patient with hospital delirium, physically restrained or tied to the bed because of his extreme confusion, often giving the patient a surprising strength and ability to harm himself and others, and requiring constant monitoring.
Because of the tendency to delirium, doctors treating the elderly work to limit hospitalization, preferring treatment in the familiar surroundings of home (with caregivers), assisted living facility, or nursing home. Hospital admission is limited to circumstances of absolute necessity and are encouraged to be limited to the shortest duration possible. It may take weeks, even when the patient returns to familiar surroundings, for the delirium to resolve.
Now imagine the reaction of an elderly individual with dementia during an infectious pandemic being forced to cope with mitigation strategies. Orders to socially distance or to wear a mask are likely to be impossible to enforce and, in any case, may significantly affect the patient’s mood, behavior and overall health. Prohibiting in-person visits with family compounds these effects. If elderly patients need to be transferred to the unfamiliar surroundings of makeshift quarantine facilities or admitted to a hospital, odds are delirium will follow.
Hospital and nursing home administrators and clinicians—the in-the-field, hands-on experts—are the most experienced and capable of handling medical crises, not government officials. Government should assist—with equipment procurement, increased staffing, etc.—and not prescribe.
Our nation’s healthcare system should be designed to treat patients as individuals, not as whole populations ruled by a few pages of sweeping guidelines from governors’ or public health officials’ offices. Just as lockdowns should look different in New York City than they do in North Dakota, coronavirus quarantine and treatment should look different for every nursing home, facility, and patient. Neither draconian lockdowns of all of society nor moral imperatives and proclamations make granny safer or healthier or happier.
Writing at the New York Times on the devastating situation of COVID-19 and nursing homes, Dr. Charles Camosy concluded:
Instead of denying the reality of cognitive impairment, aging and death, could our culture begin to embrace it forthrightly in ways which lead us to honor the final years we have with the family members and friends who go before us?
But—is it “honor” to protect our elderly from this virus by requiring them to live their final days, months, and moments in quarantined isolation? To prohibit visits from family members and friends? Because as it stands, those have been the orders since March, and they’re strictly enforced. Even if granny doesn’t catch the virus, statistics indicate that she will not live many more months after that, and these months will have been lived alone.
And is it “honor” to shut down her grandchildren’s and great-grandchildren’s schools? To put her sons and daughters on unemployment because their jobs were considered “non-essential?” To implement and enforce a nationwide lockdown strategy in order to “keep her safe”?
The elderly with failing bodies but sharp minds likely feel as though the weight of the massive collateral damage of the lockdowns on our nation has been placed, even though unintentionally, onto their frail shoulders. That is grossly unfair, and certainly not honoring them.
The honorable thing to do is to implement a robust strategy to protect our elderly along with an immediate reopening of everything else, especially our nation’s schools. These children have been prohibited from visiting Granny anyway, and their lack of school attendance doesn’t make her a bit safer, but it probably does make her sad.
In our efforts to protect our elderly against physical suffering from the virus we must also consider their emotional and spiritual well-being. Family visits are an essential and necessary part of that. For patients with dementia, “window visits” and FaceTime calls are mostly unworkable and often means that they are unable to comprehend that anyone is there to love them. We can surely do better by figuring something out that is more compassionate. Even prisons allow visits in booths behind glass partitions.
I had nearly finished writing this when I heard that Senator Elizabeth Warren (D-Mass.) had experienced the kind of heartbreak I am describing with the recent death of her brother. She said:
It just feels like something that didn’t have to happen. He had had pneumonia and had been hospitalized. This is back in February. He wanted to go home after he’d been hospitalized and his doctor said, “No, I want you to just go to a rehab and just get some of your strength back.” . . . And so he went to the rehab and was ready to go home . . . when somebody tested positive, and they wouldn’t let him leave. And I called him every day for 11 days, and every day he would say, “I’m just fine.” . . .
And then he got sick, and then he died, by himself . . . It’s hard to process things like this because everything is happening at a distance. And human beings—we’re not set up for that. We’re wired to be with each other. It makes it hard.
Yes, it does. COVID-19 can make hearts stop beating, but the present COVID-19 lockdown strategy, tragically and unnecessarily, is breaking them.