From the U.S. Government Accountability Office, www.gao.gov Transcript for: Widespread COVID-19 Outbreaks In Nursing Homes Description: Widespread outbreaks of COVID-19 in nursing homes and the resulting deaths of elderly residents have been widely reported in the news. Why were nursing home so much more susceptible to outbreaks, and what were the key practices used by some nursing homes to control the spread? We talk with GAO's John Dicken to find out more. Related GAO Work: GAO-21-367, COVID-19 In Nursing Homes: Most Homes Had Multiple Outbreaks and Weeks of Sustained Transmission from May 2020 through January 2021 Released: May 2021 [Intro Music] [John Dicken:] Nearly all nursing homes have experienced at least one outbreak and often three or more outbreaks during the peak of the pandemic. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report. Your source for news and information from the U.S. Government Accountability Office--celebrating 100 years of fact-based, nonpartisan government oversight. I'm Holly Hobbs. Widespread outbreaks of COVID-19 in nursing homes and the resulting deaths of elderly residents have been widely reported in the news. Why were nursing home so much more susceptible to outbreaks, and what were the key practices used by some nursing homes to control the spread? Today, we'll talk with John Dicken, an expert on health care policy and a director in our Health Care Team, who has a new report out about COVID-19 in nursing homes. Thank you for joining us, John. [John Dicken:] Thank you. [Holly Hobbs:] So John, our report looked at more than 13,000 Medicare and Medicaid-certified nursing homes in the U.S. Of those 13,000 facilities, do we know how many had COVID outbreaks? [John Dicken:] As you know, COVID-19 has been really devastating in nursing homes, and accounting for more than 30% of deaths from COVID-19 reported to CDC. So more than 99% of nursing homes have had COVID outbreaks in the 9 months from May 2020 through January 2021. [Holly Hobbs:] And why were nursing homes so much more susceptible to outbreaks versus, say, dorms or homeless shelters, or other communal living facilities? [John Dicken:] The communal living aspect of it is really a key aspect of the pandemic. But nursing homes have been particularly vulnerable for a couple of other reasons. One is just a very vulnerable population with the elderly more at risk for being infected or having serious effects from COVID. And many nursing home residents also have other conditions such as heart disease or respiratory problems that can place them at higher risk for negative outcomes from COVID. The other thing is that the very nature of nursing homes is that social distancing is just not possible. The residents are there cause they require assistance with basic activities of daily living--things such as bathing or eating or being moved out of bed. So that requires close personal interactions with nursing home staff. And with the inability to socially distance, we found actually that about 2/3 of outbreaks began with the staff case during the first week of an outbreak. And so that interaction between staff and residents in the congregate setting just put nursing homes at a very high risk. [Holly Hobbs:] And what do we know about the duration of these outbreaks? [John Dicken:] Since we found that more than 99% of nursing homes had at least one outbreak, we did look to see how long those outbreaks lasted. Using CDC's definition, an outbreak begins with the first reported case and would end when there were at least two weeks with no new cases. So 85% of nursing homes had outbreaks that lasted at least 5 weeks. In most cases, those lasted 5 to 10 weeks, but a significant minority of 40% of homes had even longer duration outbreaks lasting 10 to 20 weeks. And we did find that most homes had more than one outbreak during the nine months that we were examining the experience during the pandemic. On average, homes had about 3 outbreaks, either of short or long duration. [Holly Hobbs:] So why were some nursing homes able to stop the spread of the virus faster than others? [John Dicken:] Yeah, that's really a key question, and one that we're continuing to explore. Certainly larger nursing homes are more likely to have long-duration outbreaks in part because they are inherently at higher risk of having at least one case; and then more opportunity more residents that can continue that outbreak for an extended period of time. But researchers have noted other factors that can complicate the ability to contain outbreaks. There's a strong association between nursing homes that had outbreaks and the broader community, especially as there are the staff and visitors and residents transferring from outside of the nursing home that can introduce COVID into the homes. And then finally just importance of taking strong infectious control efforts--things like being able to isolate residents when they are exposed to or infected with COVID. Having the protective equipment. Thankfully, we're at a point now where nursing homes were prioritized for vaccinations, and we've seen the case rates really go down very sharply since February. [Music] [Holly Hobbs:] So it sounds like the vast majority of nursing homes in the United States had COVID outbreaks that lasted for a month or more, but that some nursing homes were better prepared to prevent and respond to outbreaks because they had infection controls in place. John, Congress has asked us to keep monitoring this issue. What future work do we have planned? [John Dicken:] Yes, we do continue to evaluate the federal response to COVID in nursing homes. We have been reporting on that regularly, and we'll be reporting again in July, including looking at the experience of nursing homes more recently in COVID cases and deaths, as well as the efforts to vaccinate nursing home residents. Beyond that, we will also continue to look at lessons learned from the pandemic. Looking further at the types of nursing homes and staffing and other factors that may have contributed to nursing homes having better or worse experiences. We're talking to experts and nursing home administrators and staff in a number of states to really understand the experience during this pandemic. [Holly Hobbs:] And last question, what's the bottom line of this report? [John Dicken:] As nursing homes have experienced really catastrophic challenges during the pandemic, we found that nearly all nursing homes have experienced at least one outbreak and often three or more outbreaks during the peak of the pandemic. That many nursing homes have had outbreaks have lasted for a long duration of time for five or more weeks, and that continue to need to examine to make sure that we can learn lessons from this pandemic to help reduce infectious disease in nursing homes and better prepare for future emergencies in nursing homes. [Holly Hobbs:] That was John Dicken in talking about GAO's recent review of COVID-19 in nursing homes. Thank you for your time John, [John Dicken:] Thank you. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts. Subscribe to us on Apple Podcasts, Stitcher, and Google Podcasts. And make sure you leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog -- the U.S. Government Accountability Office -- visit us at GAO.gov.