Nursing home residents have been disproportionately affected by coronavirus disease 2019 (COVID-19). Prevention recommendations emphasize frequent testing of health care personnel and residents, but additional strategies are needed. Compared with community-dwelling older adults, nursing home residents are 5 times more likely to die of COVID-19. The concentration of COVID-19 mortality among nursing home residents can be explained by the high risk of contracting infection because of congregate living, exposure to staff, and difficulties with physically distancing because of cognitive and functional impairment. Residents who acquire infection are at high risk of mortality because of advanced age and multimorbidity.

The findings in this JAMA study align with a prior systematic review demonstrating that the risk of respiratory infection in occupants of 2-bed rooms was double that of those in single-occupancy rooms. Physical barriers such as walls separating bedrooms, predict deposition patterns of viral droplets more than absolute distances between beds in a shared room. Crowding can affect an entire home because higher risk among occupants of shared rooms may spillover to private room occupants as residents come into contact with each other directly, in common areas, or indirectly via health care workers.

In a perfect world, everyone would have a private room but as we all know, that isn’t always the case. We can’t usually change the physical plant but we can be sure we are providing appropriate PPE, education for staff and residents, and ongoing monitoring to ensure social distancing is maintained. Stay the course, stay strong, stay well, mask up, and stay tuned!