Over 40 percent of all coronavirus deaths in America have been linked to nursing homes. How did it happen, and how bad could it get?

Staff writer Olga Khazan joins James Hamblin and Katherine Wells on Social Distance to explain.

What follows is an edited and condensed transcript of their conversation.

Katherine Wells: You've been reporting and talking to people who are working in nursing homes and living in nursing homes. What are you hearing?

Olga Khazan: Coronavirus has been getting into nursing homes. And the second you have one infection—especially early on in the pandemic—it was basically spreading like wildfire, and inevitably leading to deaths because as we know, older people are more susceptible to dying from the virus. A lot of the people who have been talking about reopening have said: Well, let's reopen the economy and then let's just protect the vulnerable. That's usually how it's phrased, which often means nursing homes. But they have completely not been protected. By no definition of being protected. When you have 40 percent of all deaths in nursing homes, that shows you that something is going terribly, terribly wrong.

James Hamblin: Was it inevitable that nursing homes would be hit really hard?

Khazan: Actually, no. I talked to a few examples of nursing homes in other countries. In Hong Kong, there were no nursing-home deaths or even cases, basically because they were freaked out by SARS. They had a really bad SARS outbreak in Hong Kong in 2003. That caused them to come up with this new plan for nursing homes in case of an outbreak like this. They stocked up on masks. They isolated nursing-home residents in special hospital wards instead of in the nursing homes. They had government-trained infectious-control officers stationed inside the nursing homes.

They really took it seriously, and it worked. Starting in January of this year, they set this plan in motion and it prevented nursing-home deaths. And I think, hearing the Hong Kong example, people might think, well, you have to have a different government in order to do that but there was an example in Baltimore. The Maryland Baptist Aged Home did something similar and also prevented any coronavirus deaths.

Hamblin: How did they do that?

Khazan: They basically stopped family visits in early February, which is pretty early. They stopped having the residents do community meals. They stopped having lots of foot traffic into the nursing home—vendors and delivery drivers, people like that. They brought in extra cleaning. They started screening their staff really intensively for their temperature and their symptoms and what they've been doing outside of work.

Hamblin: It seems like the resources that you would need to do that grow exponentially as the outbreak is bigger and bigger in a community. It might be possible if you've got the virus relatively contained in a certain city to keep your nursing homes safe. But if there's this huge outbreak all around, it's going to be really hard to keep people in the nursing homes safe.

Khazan: Yeah, that's what experts told me. Essentially, if you have a big outbreak outside the nursing home, there's a really high chance you're going to have an outbreak inside the nursing home. Workers will leave work and go to the grocery store. They brush up against someone who has it. They bring it back into the home. When you don't have masks, when you don't have tests ... A lot of experts believe that asymptomatic staffers essentially brought the virus into nursing homes and were never tested, and it kind of spread silently for a while earlier this spring.

The Centers for Medicare and Medicaid Services (CMS) is the agency that regulates nursing homes, and it could have stepped in and given them masks, for example. Guidance from CMS—even on when to use masks—came really late in the game. Hospitals were prioritized and they got priority for the stockpile of masks. But nursing homes weren't.

They were competing against large hospitals and states trying to get extra PPE supplies, paying tons of money for masks that were not actually effective or that were in some cases defective in various ways. In early June, data showed that 250 nursing homes had no masks left and 800 more were a week away from running out. The federal government left it up to individual nursing homes to protect their residents. And what these nursing homes are saying is: We don't have the money to do that. We're not trained to do this. We don't have a stockpile of masks. And we don't have access to tests. That's where it all broke down.