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How Nursing Homes Failed to Protect Residents From Covid

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How Nursing Homes Failed to Protect Residents From Covid

The first terrifying wave of Covid-19 caused 60,000 deaths among residents of nursing homes and other long-term care facilities within five months. As the pandemic wore on, medical guidelines called for promptly administering newly approved antiviral treatments to infected patients at high risk of severe illness, hospitalization or death.

Why, then, did fewer than one in five nursing home residents with Covid receive antiviral treatment from May 2021 through December 2022?

It’s hardly the only way that the nation’s nursing homes proved unable to keep patients safe. A series of studies assessing their attempts to protect vulnerable patients and workers from Covid, along with interviews with experts inside and outside the industry, presents a very mixed pandemic report card.

Brian McGarry, a health economist at the University of Rochester, and David Grabowski, a health care policy researcher at Harvard Medical School, both gave the health care system a D grade overall for nursing homes’ pandemic performance.

“I kept waiting for the cavalry to come, and it really hasn’t, even today,” Dr. Grabowski said. “At no time during the pandemic did we prioritize nursing homes.” More than 167,000 residents have died, Medicare reported this month, along with at least 3,100 staff members.

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It was Dr. McGarry, Dr. Grabowski and their co-authors who discovered the failure to deliver antiviral medications. Early on, antivirals meant monoclonal antibodies, a difficult treatment. The drugs were in short supply and administered intravenously; patients might need to leave the facility to receive them.

But in December 2021, the Food and Drug Administration granted emergency authorization to Paxlovid, a pill taken for five days. It drastically improves the prognosis for eligible patients who are 65 and older, sick and frail.

Virtually every nursing home resident meets that description. This is “the highest of the high-risk groups,” Dr. McGarry said. Age and chronic illnesses make the residents vulnerable, “and they’re living in an environment that’s perfect for spreading airborne viruses,” he added, with shared rooms, communal spaces and staff moving from one patient to the next.

As the saying went, a nursing home was like a cruise ship that never docked.

But research recently published in JAMA found that only a quarter of infected residents received antivirals, even during the last six weeks of the study — by which time Paxlovid was widely available and free.

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About 40 percent of the nation’s approximately 15,000 nursing homes reported no antiviral use at all.

“They’re basically depriving people of treatment,” said Dr. Karl Steinberg, a medical director at three nursing homes in Southern California and former president of AMDA, the medical association representing providers in long-term care. “It’s surprising and disturbing.”

One bright spot, several industry leaders agreed, was the federally coordinated rollout of the Covid vaccine, which sent providers to facilities in late 2020 and early 2021 to vaccinate residents and staff.

“A remarkable achievement, a collaboration between science and government,” said Dr. Noah Marco, chief medical director of Los Angeles Jewish Health, which cares for about 500 residents in three skilled nursing facilities.

By early 2022, Medicare reported, 87 percent of residents and 83 percent of employees had been vaccinated, though it took a federal mandate to reach that staff rate. Studies have shown that high staff vaccination rates prevent infections and deaths.

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But “we totally dropped the ball on boosters,” Dr. McGarry said. “We just left it up to each nursing home.” Medicare reported this month that about 62 percent of residents per facility, and just 26 percent of staff, are up-to-date on Covid vaccinations, including recommended boosters.

“It’s disappointing,” Dr. Steinberg said. But with workers less likely to perceive Covid as a deadly threat, even though hospitalization and death rates recently began climbing again, “people say no, and we cannot force them,” he said.

Other grounds for poor grades: Early federal efforts prioritized hospitals, leaving nursing homes short of critical protective equipment. Even after the federal government began sending point-of-care testing kits to most nursing homes, so they wouldn’t have to send tests off to labs, getting results took too long.

“If we can find and detect people carrying Covid, we’ll keep them out of the building and prevent transmission,” Dr. McGarry explained. That largely meant staff members, since Medicare-mandated lockdowns shut out visitors.

Nursing homes apparently didn’t make much use of the testing kits. By fall 2020, fewer than a fifth had the recommended turnaround of less than 24 hours. “It negates the value of doing the test in the first place,” Dr. McGarry said.

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As for those lockdowns, which barred most family members until November 2021, the consensus is that however reasonable the policy initially seemed, it continued for far too long.

“In retrospect, it caused a lot of harm,” Dr. Steinberg said. “We saw so much failure to thrive, people losing weight, delirium, rapid onset of dementia. And it was usually the staff who were bringing in Covid anyway. A big lesson is that family visitors are essential,” assuming those visitors are tested before they enter and that they use protective gear.

Dr. David Gifford, a geriatrician and the chief medical officer of the American Health Care Association, which represents long-term care providers, pointed to a variety of frustrating problems that prevented nursing homes from doing a better job during the pandemic.

Point-of-care kits that required 15 minutes to read each test and thus couldn’t screen workers arriving for a shift. Prescribing information emphasizing such a long list of possible drug interactions with Paxlovid that some doctors were afraid to use it. And the same suspicion and resistance toward boosters and antivirals that now affect the country as a whole.

“Nursing homes did as much as they could with what they had,” he said. “The health care system as a whole sort of ignored them.”

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Staffing, already inadequate in many facilities before Covid, took a hit it has yet to recover from. “It’s our No. 1 issue,” Dr. Gifford said. His association has reported that nursing homes lost nearly 245,000 employees during the pandemic and have regained about 55,000.

“The people working in nursing homes certainly get an A for effort” for persevering at their dangerous jobs, Dr. Steinberg said. But so many have left that nursing homes now often restrict new admissions.

Some long-proposed changes could help protect residents and staff from future pandemics.

Facilities could improve their ventilation systems. They could abandon “semiprivate” rooms for private ones. Dividing buildings into smaller units with consistently assigned staff — an approach pioneered by the Green House Project — would both bolster relationships and reduce residents’ exposure to infection from workers coming and going.

All those changes would require more investment, however, principally from Medicaid, which underwrites most nursing home care. And with more money would come increased federal oversight, which the industry rarely welcomes.

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“Investment in our industry, in order for us to provide the highest-quality care, is absolutely necessary,” Dr. Marco said. “But where is the government and public will to do that? I personally don’t see a lot of encouragement right now.”

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Kennedy’s Plan for the Drug Crisis: A Network of ‘Healing Farms’

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Kennedy’s Plan for the Drug Crisis: A Network of ‘Healing Farms’

Though Mr. Kennedy’s embrace of recovery farms may be novel, the concept stretches back almost a century. In 1935, the government opened the United States Narcotic Farm in Lexington, Ky., to research and treat addiction. Over the years, residents included Chet Baker and William S. Burroughs (who portrayed the institution in his novel, “Junkie: Confessions of an Unredeemed Drug Addict”). The program had high relapse rates and was tainted by drug experiments on human subjects. By 1975, as local treatment centers began to proliferate around the country, the program closed.

In America, therapeutic communities for addiction treatment became popular in the 1960s and ’70s. Some, like Synanon, became notorious for cultlike, abusive environments. There are now perhaps 3,000 worldwide, researchers estimate, including one that Mr. Kennedy has also praised — San Patrignano, an Italian program whose centerpiece is a highly regarded bakery, staffed by residents.

“If we do go down the road of large government-funded therapeutic communities, I’d want to see some oversight to ensure they live up to modern standards,” said Dr. Sabet, who is now president of the Foundation for Drug Policy Solutions. “We should get rid of the false dichotomy, too, between these approaches and medications, since we know they can work together for some people.”

Should Mr. Kennedy be confirmed, his authority to establish healing farms would be uncertain. Building federal treatment farms in “depressed rural areas,” as he said in his documentary, presumably on public land, would hit political and legal roadblocks. Fully legalizing and taxing cannabis to pay for the farms would require congressional action.

In the concluding moments of the documentary, Mr. Kennedy invoked Carl Jung, the Swiss psychiatrist whose views on spirituality influenced Alcoholics Anonymous. Dr. Jung, he said, felt that “people who believed in God got better faster and that their recovery was more durable and enduring than people who didn’t.”

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Children exposed to higher fluoride levels found to have lower IQs, study reveals

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Children exposed to higher fluoride levels found to have lower IQs, study reveals

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The debate about the benefits and risks of fluoride is ongoing, as RFK Jr. — incoming President Trump’s pick for HHS secretary — pushes to remove it from the U.S. water supply.

“Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease,” RFK wrote in a post on X in November.

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A new study published in JAMA Pediatrics on Jan. 6 found another correlation between fluoride exposure and children’s IQs.

RFK JR. CALLS FOR REMOVAL OF FLUORIDE FROM DRINKING WATER, SPARKING DEBATE

Study co-author Kyla Taylor, PhD, who is based in North Carolina, noted that fluoridated water has been used “for decades” to reduce dental cavities and improve oral health.

Fluoride exposure has been linked to a variety of negative health effects, yet benefits oral health. (iStock)

“However, there is concern that pregnant women and children are getting fluoride from many sources, including drinking water, water-added foods and beverages, teas, toothpaste, floss and mouthwash, and that their total fluoride exposure is too high and may affect fetal, infant and child neurodevelopment,” she told Fox News Digital.

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The new research, led by scientists at the National Institute of Environmental Health Sciences (NIEHS), analyzed 74 epidemiological studies on children’s IQ and fluoride exposure.

FEDERAL JUDGE ORDERS EPA FURTHER REGULATE FLUORIDE IN DRINKING WATER DUE TO CONCERNS OVER LOWERED IQ IN KIDS

The studies measured fluoride in drinking water and urine across 10 countries, including Canada, China, Denmark, India, Iran, Mexico, Pakistan, New Zealand, Spain and Taiwan. (None were conducted in the U.S.)

The meta-analysis found a “statistically significant association” between higher fluoride exposure and lower children’s IQ scores, according to Taylor.

“[It showed] that the more fluoride a child is exposed to, the more likely that child’s IQ will be lower than if they were not exposed,” she said.

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Little girl drinking water from a glass

Scientists found a “statistically significant association” between higher fluoride exposure and lower children’s IQ scores. (iStock)

These results were consistent with six previous meta-analyses, all of which reported the same “statistically significant inverse associations” between fluoride exposure and children’s IQs, Taylor emphasized.

The research found that for every 1mg/L increase in urinary fluoride, there was a 1.63-point decrease in IQ. 

‘Safe’ exposure levels

The World Health Organization (WHO) has established 1.5mg/L as the “upper safe limit” of fluoride in drinking water.

“There is concern that pregnant women and children are getting fluoride from many sources.”

Meanwhile, the U.S. Public Health Service recommends a fluoride concentration of 0.7 mg/L in drinking water.

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“There was not enough data to determine if 0.7 mg/L of fluoride exposure in drinking water affected children’s IQs,” Taylor noted.

FDA BANS RED FOOD DYE DUE TO POTENTIAL CANCER RISK

Higher levels of the chemical can be found in wells and community water serving nearly three million people in the U.S., the researcher noted.

She encouraged pregnant women and parents of small children to be mindful of their total fluoride intake.

little boy filling fresh water from water tap in sports bottle

Nearly three million people have access to wells and community water with fluoride levels above the levels suggested by the World Health Organization. (iStock)

“If their water is fluoridated, they may wish to replace tap water with low-fluoride bottled water, like purified water, and limit exposure from other sources, such as dental products or black tea,” she said.

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“Parents can use low-fluoride bottled water to mix with powdered infant formula and limit use of fluoridated toothpaste by young children.”

For more Health articles, visit www.foxnews.com/health.

While the research did not intend to address broader public health implications of water fluoridation in the U.S., Taylor suggested that the findings could help inform future research into the impact of fluoride on children’s health.

Dental health expert shares cautions

In response to this study and other previous research, Dr. Ellie Phillips, DDS, an oral health educator based in Austin, Texas, told Fox News Digital that she does not support water fluoridation.

Mother and her toddler drinking a glass with water from the tap

The study researcher encouraged parents of small children to be mindful of their total fluoride intake. (iStock)

“I join those who vehemently oppose public water fluoridation, and I question why our water supplies are still fluoridated in the 21st century,” she wrote in an email.

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“There are non-fluoridated cities and countries where the public enjoy high levels of oral health, which in some cases appear better than those that are fluoridated.”

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Phillips called the fluoride debate “confusing” even among dentists, as the American Dental Association (ADA) advocates for fluoride use for cavity prevention through water fluoridation, toothpaste and mouthwash — “sometimes in high concentrations.”

mother checks son's brushed teeth

Fluoride is used in water, toothpaste and mouthwash to help prevent cavities. (iStock)

“[But] biologic (holistic) dentists generally encourage their patients to fear fluoride and avoid its use entirely, even if their teeth are ravaged by tooth decay,” she said.

“Topical fluoride is beneficial, while systemic consumption poses risks.”

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Phillips encouraged the public to consider varying fluoride compounds, the effect of different concentrations and the “extreme difference” between applying fluoride topically and ingesting it.

“Topical fluoride is beneficial, while systemic consumption poses risks,” she cautioned. 

“Individuals must take charge of their own oral health using natural and informed strategies.”

The study received funding from the National Institute of Environmental Health Sciences (NIEHS), the National Institutes of Health (NIH) and the Intramural Research Program.

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Treating Other Diseases With Ozempic? Experts Weigh In | Woman's World

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Treating Other Diseases With Ozempic? Experts Weigh In | Woman's World


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