What Hospices Need to Know about Emerging COVID Strains

COVID-19 cases are rising in various parts of the country with potential implications for hospice and palliative care operators.

Cases of the virus began to uptick in July, and some fear an even bigger surge as winter moves many people indoors and in closer quarters.

More than 18,000 people in the United States were hospitalized due to COVID between Sept. 24 and Sept. 30, a slight decline from the prior week, according to the U.S. Centers for Disease Control & Prevention (CDC). However, deaths were up nearly 4% from the week prior.

A number of new COVID-19 strains are driving the uptick, known as “Eris” and “Pirola,” according to Dr. Shoshana Ungerleider, founder of End Well.

“The Omicron variant of the SARS-CoV-2 virus has evolved into multiple subvariants, with EG.5 and BA.2.86, or ‘Eris’ and ‘Pirola,’ respectively, emerging as significant strains in the U.S.,” Ungerleider told Hospice News in an email. “While EG.5 has become dominant and potentially contributed to a summer uptick in COVID-19 cases, little is known about Pirola, although it carries over 30 mutations in its spike protein, which may influence its transmissibility and severity.”

Thus far, cases associated with these variants have milder, cold-like symptoms, but they spread more rapidly than previous strains, Ungerleider added.

The population to whom hospice and palliative care operators provide care is among the most vulnerable. Of particular concern are immunocompromised individuals, the elderly and patients with chronic conditions that could make them more susceptible to a severe case, according to the CDC.

The potential implications for hospice providers are multifaceted. A significant surge in cases could lead to the return of some COVID restrictions, increased staff quarantines, impeded access to facility-bound patients or an influx of infected patients.

Already, some mask mandates are returning in some hospitals and nursing homes. Some, like St. Peter’s Health Regional Medical Center in Helena, Montana, are implementing visitor restrictions.

“Our number one priority is the safety of our patients and staff,” St. Peter’s Health Chief Medical Officer Dr. Shelly Harkins said in a statement. “We are taking a very proactive approach in protecting our workforce and instituting these changes ahead of peak virus season. It’s our job to help prevent the spread of viruses and protect those who are immunocompromised, like the elderly, young children and those who are ill or undergoing medical treatments in our facilities.”

Though the federally declared COVID-19 Public Health Emergency (PHE) has expired, the federal and some state governments are taking steps to help reduce the spread of the disease.

The Biden administration recently allocated $600 million to by COVID tests from U.S. manufacturers, which will be available to U.S. residents free of charge.

New York state is providing masks and rapid test kits to schools, Gov. Kathy Hochul (D) announced last month. The virus has caused recent school closures in Kentucky and Texas.

To date, most states are leaving decisions related to COVID prevention to the individual health care providers or facilities. Many nursing homes and hospitals have continued to require masks or reinstated lapsed requirements.

‘There’s been a lot of debate about restrictions both in the nursing home setting and in the hospital setting. The State of New York has not changed any specific guidance related to nursing homes. The majority of nursing homes still have a mandate for masking with direct care of patients,” Dr. Christopher Comfort, CEO of New York City’s Calvary Hospital, told Hospice News. “The directives that are coming from the state offer a tremendous amount of choices that can be made, and most of the instructions about masking and restrictions for patients are at the discretion of the hospital.”

The Greater New York Hospital Association, a trade group, will soon convene to discuss a unified response to COVID surges, including potential mask mandates, according to Comfort.

He said that the New York City region has seen an uptick in infection rates, but the number of hospitalizations has remained relatively stable. Mortality rates are well below those seen in 2020.

‘The positivity rates of tests of individuals who are tested for COVID are at levels that we were seeing at the end of 2020. They are about a quarter of the levels that we were seeing at the beginning of 2020 when the pandemic really first hit New York,” Comfort said. “So the strains that we’re seeing look like they’re pretty infective, but if you look at the severity of the illness and associated hospital rates or with death rates, those are actually at pretty steady levels.”

The CDC in September recommended that all Americans older than 6 months receive at least one dose of the recently released COVID vaccine booster.

As cases ramp up, hospices should consider safety measures to protect patients, families and staff, including the vaccine, Ungerleider indicated.

“The new COVID-19 variants are highly transmissible, therefore in order to reduce risk of transmission, wearing adequate respiratory protection with an N95 mask is advised,” Ungerleider said. “Additionally, the new COVID vaccine is effective at reducing hospitalizations and death from COVID. It is now available and I recommend all eligible health care workers and patients (who want it) receive it.”