To the Editor: In their Research Letter, Dr Smith and colleagues1 reported that nursing homes may be expected to help with hospital patient overflow during an influenza pandemic. Of the 451 Nebraska and Michigan nursing homes responding to their survey, 38% reported that they would accept hospital overflow influenza patients requiring low levels of care.
Nursing homes are prone to infectious disease outbreaks because of their immunocompromised geriatric population. During the SARS epidemic in Singapore, a cluster of SARS cases arose within a nursing home because the index case was transferred from a tertiary hospital after contact with a patient with SARS. This index case led to a cluster of 7 cases involving a nursing home visitor and a health care worker.2 The index case and the health care worker eventually died from SARS.3 If nursing homes are to be counted as alternative care sites for hospital overflow during an influenza pandemic, care must be taken to prevent disease transmission to a vulnerable population in the transfer process. This will be more difficult with influenza because transmission can occur a day before symptoms develop, and patients with weak immune systems may remain infectious for 10 or more days after onset of symptoms.4
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