The coronavirus crept into Heartland Health Care Center, a nursing home in Moline, Ill., on the last day of July, when a member of the nursing staff tested positive.
It was an ominous sign: The virus can spread through a nursing home in a flash. Older people — who are often sick and frail and need regular hands-on attention — are uniquely susceptible. Staff members who care for residents are at high risk of infection and of unintentionally spreading the virus.
Although nursing home residents make up just 1.2 percent of the United States population, they account for about 40 percent of Covid-19 deaths.
But this time, the nursing home was not defenseless. Heartland was the first facility to participate in a large clinical trial of drug that might protect residents from the infection in nursing homes and assisted living facilities.
Drug companies and the federal government often avoid testing drugs in older people, even if they are the ones who need treatment most. The elderly may have a range of complicating conditions that make difficult to tell if the drug is working, and nursing home and extended care facilities are governed by a raft of complex regulations regarding privacy and access.
Experts say the new research, sponsored by Eli Lilly and the National Institutes of Health, is among the first large clinical trials to involve nursing home residents. And the scientists are delighted.
“These patients are so underserved,” said Dr. Rebecca Boxer, medical director of clinical trials at the Kaiser Permanente’s Institute for Health Research in Colorado. “They do not get access to innovative new drugs and trials.”
The experimental drug is a monoclonal antibody, an artificially synthesized version of coronavirus antibodies produced by the body. In this case, the antibody was “cloned” from those found in the blood of a Seattle man, one of the first patients to survive Covid-19, the illness caused by the coronavirus.
Monoclonal antibodies are one of the great hopes in the war on the coronavirus. They already serve as the basis for effective treatments for arthritis, cancer, lupus — even Ebola. They are difficult to manufacture, however, and expensive.
Despite the obstacles, two companies, Regeneron and Eli Lilly, have forged ahead with clinical trials. The trial in nursing homes is pivotal to Eli Lilly’s effort to determine whether its version can stop the coronavirus.
“Some people ask, ‘If we have a vaccine, why do this?’” said Dr. Myron Cohen, a University of North Carolina researcher who proposed the trial. “But a vaccine will take a month to produce antibodies, and some populations need a more emergent intervention.”
But it is not easy to do a trial in nursing homes. Because the residents cannot be expected to travel to a clinic for an infusion and subsequent testing and monitoring, the clinical trial must to come to them.
Eli Lilly’s researchers are watching facilities in which a single case of Covid-19 appears after having no active cases for at least 14 days. Once the case is reported, a sort of medical SWAT team scrambles to the facility as quickly as possible.
A nursing supervisor at Heartland called Eli Lilly as soon as the home learned of the employee’s positive test. The team wasted no time getting to the facility.
The next day, medical personnel pulled up in two vehicles. One was a moving truck carrying infusion chairs, poles for intravenous infusions, bedside tables, and privacy screens. The other was an R.V. with an interior retrofitted as a mobile lab with infusion materials, a centrifuge, freezers and computers to transmit data.
The team quickly turned Heartland’s large dining room — which was not being used, because the pandemic had put a stop to communal dining — into an infusion center. The day after the medical team arrived, the first residents and staff who agreed to participate received infusions.
Frequently Asked Questions
Updated August 17, 2020
Why does standing six feet away from others help?
- The coronavirus spreads primarily through droplets from your mouth and nose, especially when you cough or sneeze. The C.D.C., one of the organizations using that measure, bases its recommendation of six feet on the idea that most large droplets that people expel when they cough or sneeze will fall to the ground within six feet. But six feet has never been a magic number that guarantees complete protection. Sneezes, for instance, can launch droplets a lot farther than six feet, according to a recent study. It’s a rule of thumb: You should be safest standing six feet apart outside, especially when it’s windy. But keep a mask on at all times, even when you think you’re far enough apart.
I have antibodies. Am I now immune?
- As of right now, that seems likely, for at least several months. There have been frightening accounts of people suffering what seems to be a second bout of Covid-19. But experts say these patients may have a drawn-out course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may last in the body only two to three months, which may seem worrisome, but that’s perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it’s highly unlikely that it would be possible in a short window of time from initial infection or make people sicker the second time.
I’m a small-business owner. Can I get relief?
- The stimulus bills enacted in March offer help for the millions of American small businesses. Those eligible for aid are businesses and nonprofit organizations with fewer than 500 workers, including sole proprietorships, independent contractors and freelancers. Some larger companies in some industries are also eligible. The help being offered, which is being managed by the Small Business Administration, includes the Paycheck Protection Program and the Economic Injury Disaster Loan program. But lots of folks have not yet seen payouts. Even those who have received help are confused: The rules are draconian, and some are stuck sitting on money they don’t know how to use. Many small-business owners are getting less than they expected or not hearing anything at all.
What are my rights if I am worried about going back to work?
- Employers have to provide a safe workplace with policies that protect everyone equally. And if one of your co-workers tests positive for the coronavirus, the C.D.C. has said that employers should tell their employees — without giving you the sick employee’s name — that they may have been exposed to the virus.
What is school going to look like in September?
- It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California’s two largest public school districts — Los Angeles and San Diego — said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There’s no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.