Md. easing child care capacity, nursing home visit rules

As coronavirus infections and deaths continue at a low, steady pace in Maryland, Gov. Larry Hogan relaxed more pandemic-induced restrictions Thursday - and encouraged residents to prepare for the upcoming flu season.

Nursing homes that have limited visitors to outdoor meetings now will be able to offer indoor visits if the facility hasn't had any new cases in 14 days and isn't testing for a possible outbreak, Hogan said. If the local jurisdiction's positivity rate rises above 10%, no visitors will be allowed, as well.

And child care centers statewide can increase the number of children they serve. Providers now will be able to operate at pre-pandemic capacity.

Since May, the Republican governor has lifted restrictions gradually so that almost all businesses are open in some fashion, though most must operate with capacity limits and must follow health precautions. Masks continue to be required in indoor spaces and outdoors when social distancing is not possible.

The expansion of child care likely will come as a relief to both child care businesses that operate on tight margins and parents who have struggled to find quality care while public schools continue to operate remotely.

Child care centers have been limited to no more than 15 individuals per classroom since July - an increase over restrictions from earlier in the pandemic, but less than the pre-pandemic limits of up to 20 children per group for certain ages.

State schools superintendent Karen Salmon said health officials have seen few cases in child care centers, calling the operators "heroes" who go out of their way to keep children safe. But even as 82% of providers have reopened, demand remains high due to classroom restrictions.

Salmon said that hopefully this action will help reduce the number of unlicensed child care centers that have opened up to address the demand, which are not qualified to keep children safe.

The indoor visits at nursing homes could provide a crucial emotional lift for residents, as the weather turns colder and makes outdoor visits less comfortable. This will provide extra access and "compassion" to the most vulnerable in the state who need in-person interaction the most, Hogan said.

Nursing homes and assisted living facilities have been particularly hard hit in Maryland and around the country. Early in the pandemic, they were responsible for many of the largest and deadliest outbreaks. The facilities now account for almost 15,800 cases and 2,155 deaths, or more than half of the deaths in Maryland, according to state health department figures.

But the number of nursing homes with active cases has dropped by more than 40% over the past two months. As of Wednesday, 76 nursing homes had cases, down from 130 on Aug. 5.

The lack of visitation at nursing homes has been devastating to many families who say they were deprived of time with their loved ones. They also complained about losing the ability to check on care and advocate for better medical care and living conditions.

Haydee Rodriguez's grandmother was in a Baltimore-area nursing home until she died in July at age 99. Though she had dementia, she recognized Rodriguez and her dog and would smile at them in video calls until Rodriguez said she fell and the facility began heavily medicating her.

Rodriguez said she wrote Hogan and asked him to lift the visitation limits.

"These visits are critical and not having them has had devastating results in many cases," she said. "In our case, by July our grandmother had gone four months without seeing us, hugging us and knowing we were there for her."

Rodriguez said she understood the caution, particularly at the beginning of the pandemic, but after so many months she believes some people aren't just dying without family there, they are dying because there is no family there.

Joseph DeMattos, president and CEO of the Health Facilities Association of Maryland said the new initiatives "are deeply appreciated and are to be applauded."

"As Governor Hogan said today, nursing homes were ground zero for the virus in March and April," DeMattos said. "Our sector is a major front in our fight against COVID because nursing homes care for people with multiple pre-existing conditions. We will review these guidelines in detail."

Testing also has been an issue in nursing facilities, which are required by the state to test staff and residents weekly. Health inspectors have fined dozens of nursing homes for falling short on testing.

The state stopped paying for the tests in mid-August, and the facilities say the tests are expensive, costing from $40 to more than $100 each. Hogan said Thursday he would send $6 million to nursing homes to pay for employee testing.

Nursing homes asked health officials in recent weeks to be permitted use of so-called rapid tests that can be done on-site in many cases and are far cheaper.

Hogan said Thursday that some of the state's newly purchased rapid antigen tests will be sent to all 227 nursing homes in the state next week.

The state ordered 250,000 rapid coronavirus antigen tests from Becton Dickinson last month, at a cost of about $30 per test. The antigen tests look for a protein associated with the virus and can return results on-site within 15 minutes, compared to the molecular coronavirus tests that must be processed at a lab and can take a day or more.

The Becton Dickinson order accounts for half of Hogan's pledge to buy half a million antigen tests.

Hogan's announcements came as the state reported no deaths from the coronavirus for the first time since late March - an "encouraging milestone" in the state's ongoing effort, the governor said. He attributed Thursday's count to the hard work of health care workers.

Still, more than 125,000 people in Maryland have tested positive and 3,805 have died to date from COVID-19, the disease caused by the virus. On Thursday, the state reported that 331 people were being treated in the hospital, including 74 in intensive care.

The state reported the positivity rate for the past seven days at 2.88%, which, while low, has inched up slightly for six straight days, including a 0.2% increase on Thursday.

The Johns Hopkins University, which calculates its rate using people tested rather than tests performed like the state, puts Maryland's seven-day positivity rate at 5.2%.

Hogan said the state should be encouraged by the positivity rate.

And, as the state continues to cope with the coronavirus, Hogan reminded Marylanders to be wary of the upcoming flu season.

Hogan posted photos of himself on social media getting the flu vaccine at an Annapolis doctor's office last month, and urged Maryland residents to follow suit.

If the flu season is severe as the pandemic rolls on, it could prove tricky for residents and medical professionals alike. The two illnesses come with many of the same symptoms, and both have the potential to be deadly, especially for the elderly and those with other health conditions.

The state and the University of Maryland have been in discussions about transitioning a university lab to a test that would look for both flu and coronavirus at the same time.

Baltimore Sun reporter Nathan Ruiz contributed to this article.

Caption: Maryland Gov. Larry Hogan speaks at a news conference at the State House in Annapolis.

Pamela Wood/Baltimore Sun Media