Protecting the Most Vulnerable in Connecticut

In this time of coronavirus, older people face particular risk.

And those living in long-term care facilities (LTCF) are particularly vulnerable to a virus that spreads easily amongst people living in close proximity to one another. For those with a pre-existing condition or a compromised immune system, the danger is greater still.

One recent media account reported that the number of elderly and nursing home residents who died in Connecticut after contracting COVID-19 doubled over a 10-day period—reaching 768 by April 22. Nursing home residents now represent a startling 50 percent of all COVID-19-related deaths in the state.

At the request of the Connecticut Department of Public Health (DPH), a cadre of student volunteers and faculty led by the Yale School of Public Health are working daily to help alleviate this mounting health crisis.

Initially, DPH nurses were calling each facility daily, but they were already overstretched. Now, trained students are calling the state’s approximately 215 facilities seven days a week, either to remind them to enter data about illnesses online or to fill it out over the phone with the volunteer. The initiative also tracks outbreak conditions within particular LTCFs (e.g., the total number of new cases and hospitalizations). Students are also checking in with LTCFs to see how the DPH can assist them during this outbreak. By afternoon every day, all the information entered into an online portal is gathered and goes into forming a report to notify DPH of the conditions within all of the state’s LTCFs. Issues are still being worked out, but the team is working rapidly to adapt the system to these challenges.

“The need for real-time data is essential,” said Yale School of Public Health Professor Linda Niccolai, who is leading the effort in collaboration with the Yale Institute for Global Health and Yale School of Medicine. The goal is clear: reduce the size and scope of COVID-19 outbreaks in LTCFs through early detection and rapid response.

Niccolai noted that universities like Yale can provide unique services to public health departments, whether state or municipal, during a crisis. Academia has much-needed resources and can offer a wide range of expertise across many fields. They also have the capacity to act quickly and nimbly.

“These partnerships are absolutely vital to protecting public health in times of emergency,” she said.

While Yale’s efforts are currently focused on the situation in Connecticut’s long-term care facilities, the pandemic’s toll on the elderly is being felt almost everywhere. As of late April, six states (including Connecticut), have reported that over 50 percent of their COVID-19-related deaths have been in nursing homes.

There were early indications that such facilities would be hard hit. In Washington state in early March, for example, more than 130 people were diagnosed with COVID-19 in a single facility. Twenty-three of those people subsequently died.

“Nursing homes are the epicenters of COVID-19,” said Sunil Parikh, an associate professor at the Yale School of Public Health who is working closely with Niccolai and the outbreak response team at DPH to address the situation in Connecticut. “As a nation, we need to urgently refocus our attention and efforts to those who need our help the most.”

Parikh, a physician and researcher of infectious diseases, said he has been heartened by the dedication and effort of the DPH staff, health care workers and others to protect the most vulnerable during this crisis. They have made a huge difference.

But more needs to be done—and quickly.

He is calling for testing in nursing homes to be drastically ramped up, for PPE supplies to be increased and for more workers to be dedicated to nursing and veterans' homes to address a growing crisis at the national level.

“This can’t wait a week. This must happen now,” Parikh said. “The people in these care facilities (both residents and workers) are suffering the consequences of the pandemic disproportionately. We need to recognize this and take measures to better protect their health.”

Casey Chu, an MPH student at the Yale School of Public Health (YSPH), is one of the volunteers working with Niccolai’s team to help people living in long-term care facilities. With her classes now online and extracurricular activities largely on hold, Chu said she wanted to get involved in what is the defining public health issue of our time.

“YSPH has taught us to be activists, to never be complacent,” Chu said. “I feel profoundly fortunate to be a public health student at this time, not just because the main topic at the forefront is public health, but because being at YSPH has provided this powerful opportunity to contribute to the statewide pandemic response.”

As a health policy student, this current crisis has only underscored the importance of finding ways to innovate to improve existing health systems. This became increasingly apparent for Chu through her daily calls with LTCF nurses and general staff. The public-private partnership is starting to make a difference.

“I am more motivated than ever to learn as much as I can from this crisis and about where gaps in the health systems exist, and I hope to be a part of preventing the severity of similar public health crises in the future,” she said.

Other Yale School of Public Health students are helping out in other innovative ways not directly related to the LTCF initiative.

Leslie Asanga, a pharmacist and student at the Yale School of Public Health in the Advanced Placement MPH program, founded Pills2Me, a web-based platform that helps connect elderly and immunocompromised people with volunteer drivers who pick up their medications and deliver them to their doorsteps the same day.

“The goal is to help this vulnerable population maintain social distancing while still having access to their medications,” Asanga said.

As a pharmacist working in a retail pharmacy during the early stages of the pandemic, Asanga noticed crowds of older people gathering for their medications, putting themselves at risk for contracting the virus. Other elderly people were not picking up their medications at all because they were frightened to leave their homes and catch the virus.

His startup also accepts orders by phone for people unable to use technology. So far, Pills2Me has 42 volunteer drivers in New Haven, mostly Yale students and faculty and have completed more than 20 deliveries. The numbers keep growing.

“There is real need out there. This pandemic has hit the elderly really hard,” said Asanga, who hopes to expand the service beyond New Haven in the near future. “If Pills2Me helps alleviate this crisis in even a small way, well, then I will be happy.”