As worst of pandemic fades, North Dakota seeks ‘new normal’
The shift away from COVID lockdown has been a welcome change throughout the long-term care industry in particular.
GRAND FORKS — Brett Ulrich has been the administrator at Luther Memorial, a Mayville, North Dakota, assisted living home — for almost 35 years. None of it, he said, prepared him for the pandemic, and especially the frantic early months, when Ulrich was swept into the country’s hectic and hastily assembled defense against the virus.
Two and a half years later, Ulrich senses that the thaw is well underway. Where lockdown was once practically airtight, Ulrich now describes Luther Memorial as “pretty much open.”
“You know, we're not screening our visitors when they come in. They don't have to sign in and take their temp,” he said in October. Though he noted the facility still has plenty of masks because of the county’s COVID status, “as far as eating and group activities, and things like that, you know, we're really opening up.”
Around the country, that attitude is growing more typical. Restaurants and malls are full. Big public events are back on the calendar. Classrooms are back in increasingly normal session; at Grand Forks Public Schools, a COVID advisory says the district no longer does contact tracing or requires classes to physically distance, based on state and federal guidance.
A memo from the Centers for Medicare and Medicaid Services announced the organization was revising nursing home visitation guidelines in September, underscoring that “nursing home residents derive value from the physical, emotional, and spiritual support they receive through visitation from family and friends.”
The shift away from COVID lockdown has been a welcome change throughout the long-term care industry in particular, for precisely those reasons. Leaders and residents both say it’s time to get back to something more like regular order — for their residents’ and their facilities sakes.
Chris Larson, a 33-year-old with spina bifida, is a resident at Luther Memorial as well as chairman of a recent task force in North Dakota’s long-term care industry. The group has aimed to push back on restrictions that have grown onerous over the course of the pandemic.
"I am very involved in my community. I volunteer my time at the college, at the high school here in Mayville,” he said. “And so when the pandemic hit, the isolation became real. I was used to being out every single day of the week.
“And so residents that were used to having a family come in and visit or residents that may have been declining — but not to a point where it was an end-of-life situation — they couldn't have visitors in,” Larson said. “And that, to me, that was the most troubling thing I have ever dealt with in my life.”
Part of the pressure for change is logistical, too. Mark Johnson, administrator at the North Dakota Veterans Home in Lisbon, described frustrations working with a tight labor market exhausted by COVID and stringent protocols. He also said employees’ shifts could be consumed with wiping and disinfecting surfaces.
“We've had a lot more people that were working, maybe four-hour shifts, and they were just walking around, you know, using cloth or something like that to clean handrails and surfaces,” he said.
But it’s good to be cautious. Shawn McBride, public health epidemiologist with Grand Forks Public Health, points out that while the rest of the world is starting to move ahead, nursing homes can be very different places — full of more immunologically vulnerable people.
But for the average North Dakotan, McBride said the situation is indeed looking a lot different, though. There are loosening public health guidelines on quarantines and isolation periods, and the CDC’s change to those broader risk models that factor in health care availability are heralding a new era for COVID.
“All of these changes, they are based on what we feel is the risk now to people,” he said. “And a big part of that is that most of the population has either been vaccinated or infected.”
Kari Jensen, director of quality and safety at Grand Forks-based Altru Health System, also noted that the pandemic has appeared to cool. COVID patients — which once required dedicated units — now can be cared for in the hospital’s existing isolation rooms. Centers for Disease Control safety guidance has continued to loosen.
“As the pandemic has evolved, so has the guidance,” Jensen said. She offered the example of masking procedures at the beginning of the pandemic, which recommended stringent protection.
“Well, as changes have occurred, depending on your transmission level within your community, you may be able to change to masking only for staff and recommended masking for others,” she said.
But just as the pandemic’s arrival brought questions about safety, so too does its slow retreat. COVID is still circulating — in North Dakota and beyond. NBC News frets over Australia’s severe flu season, a potential prelude to a large outbreak in the U.S. The New York Times warns of a “tripledemic” of flu, COVID and respiratory syncytial virus, or RSV.
Keeping current on vaccines is important, McBride stressed, as is viral testing as necessary. But he also downplayed concerns that there could be more massive swings in COVID infection rates ahead. It’s likely the winter season will bring more airborne illness — but the days of whipsawing COVID case counts and widespread fear are much less likely now because of vaccines and high rates of prior infection.
McBride added that he doesn’t see serious concern for “pandemic potential” in the flu or RSV based on current evidence. Particularly for RSV, he said, a recent bump in cases is likely linked to a lack of exposure that children had to regularly circulating viruses during social distancing and masking during the pandemic.
“We used to have complaints from people concerned about us doing too much,” he said. “And now we sometimes experience things about people concerned that we're not doing enough. It's been a little surreal in a sense, but there's reasons like we discussed for that transition.”
In the nursing home world, Ulrich is as grateful — and hopeful — for a less viral world as anyone.
“I've been thinking about this for a while and when it comes time to retire, I wanted to get us through this,” he said. But as proud as he is to be on the other side, he shares some credit with his staff, too.
“It was them that did,” he said. “It wasn't me.”