These remarks from Chris von Csefalvay at City Journal should give us pause:
The March 25 order by New York governor Andrew Cuomo and state health chief Howard Zucker mandated that nursing homes and LTCFs accept patients discharged from hospitals, even if they received only emergency care and were still infectious; it is now reported that 6,300 Covid patients were sent to nursing homes throughout the state. The motivation behind the order was understandable: in late March, public concern was high that Covid-19 cases would overwhelm New York’s hospital capacity. Yet, despite an impressive deployment of surge capacity from the federal government (much of which went unused), Cuomo’s order remained in place for almost two months, not being rescinded until May 10.
By then, New York had lost 6 percent of its residents in nursing homes to the virus. Michigan would lose 5 percent, and New Jersey a harrowing 12 percent. Florida, which never implemented such a treat-and-return policy, suffered a mere 1.6 percent mortality among nursing-home residents, while California, which changed course in time, managed to keep nursing-home casualties at 2 percent. While the media were preoccupied with Floridians enjoying walks on the beach, Covid-19 raged unchecked through nursing homes and LTCFs throughout America, with little attention paid to the plight of their residents.
That we don’t really know how to keep SARS-CoV-2 out of nursing homes is fair comment but it’s also not the issue. What New York and, apparently, New Jersey did is introduce SARS-CoV-2 into nursing homes, a major policy fiasco. The states with the largest number of nursing home residents are New York, California, Texas, Pennsylvania, Ohio, Florida, Illinois, and New Jersey in descending order. So far the mortality in Illinois’s nursing homes is below 5%. If California, Texas, and Florida can somehow manage to spare their nursing home residents, I would conjecture that their policies have succeeded. Otherwise…
Most of our cases/deaths in my county are probably from a single nursing home outbreak that was severe and sudden and as far as I could tell unexplained. It seems like a well-regarded facility that implemented procedures before they were required, and the only thing that would appear to have stopped it is if they were doing continuous testing.
Still, there must be at least a hundred nursing homes in this county (I think?), and it was just this one. So its not impossible to keep it out of the nursing homes.
(The numbers officially attributed to the single outbreak are just residents and staff, but I can tell that they traced the infection back to staff family and others)
“What New York and, apparently, New Jersey did is introduce SARS-CoV-2 into nursing homes, a major policy fiasco.”
Right. And to PD’s point, difficulties may present themselves in successfully quarantining elderly care facilities, but it can be done. But not if you are mandating infected people be inserted into them like poison.
And the media slobber over Cuomo………..
The nation’s ability to think clearly keep perspective is nonexistent right now.
Some obvious problems here. First, if toured the title of the article the problem they are writing about is the return of Covid pts. So when you say “What New York and, apparently, New Jersey did is introduce SARS-CoV-2 into nursing homes, a major policy fiasco ” I have never actually seen that claim anywhere. They were not, AFAICT, putting Covid positive patients into nursing homes that had no Covid, they were returning Covid positive patients to their same nursing home. Quite a difference. (What do they mean by received only emergency care then sent back home? This is very poorly written.)
Also note that it appears that we still need someone to commit an act of journalism and find out when and under what conditions they were sending people back. At that time we thought pts who were asymptomatic were probably not infectious after about 10-14 days. For those who were symptomatic we let them go back to work 7 days after they were no longer having symptoms since it was thought they were not infectious anymore, no test required.
Finally, their metrics are weird. I would think that what you would also want to know the fraction of deaths in the state overall that were nursing home Covid deaths. If a given state was hit harder by Covid and that state had a lot more deaths then I would expect to have more nursing home deaths. So Florida, if we look at that data, had about 52% of its deaths in nursing homes/LTCFs vs the national average of 40%. Nursing home pts there do worse than average for the US, but they do benefit from Florida having, for now, an overall lower number of deaths.
Steve
In Illinois more than half of all COVID-19 deaths have been nursing home deaths.
Those data can be ferreted out from here.
@steve, I understood what happened to be that people with virus symptoms went to the hospital for diagnosis and care, and if they did not need intensive assistance provided by hospitals, they were discharged to nursing homes with which they didn’t have any previous relationship. My mother-in-law was similarly discharged to a nursing home a couple of years ago following a slip-and-fall hip fracture. Illinois acquired post-recovery medical facilities in Chicago and Springfield for this purpose, but didn’t use them because the surge didn’t really come.
In March, hospitals were afraid of being overrun, so they had two alternatives, one was to restrict access to hospital care. In Detroit, Jason Hargrove, a black bus driver coughed on by a woman getting on the bus was taken to the hospital three times before he was admitted, after which he died. There has been coverage comparing his treatment with a young white girl admitted around the same time for stomach flu. My assumption is that they knew how to treat her and that she would be discharged in 24 hours or so, but opinions vary given that one of them is dead.
The other option is to admit broadly, treat the most immediate needs, and then discharge to intermediate care facilities. That sounds like what New York did, but those facilities were nursing homes.
I think I’ve mentioned here before that I’m the legal guardian for my sister who has dementia and lives in a memory care facility.
In early March, as Covid was just getting going (Colorado had one of the early outbreaks), my sister fell and broke her hip. The hospital wasn’t yet restricting those surgeries, so an orthopedist went in, put some screws in and fixed it. Then she had to go to a rehab facility for a week. Then it was back to her memory care home. It’s very fortunate that neither of us got Covid and spread it to any of those places.
While I’m sympathetic to the argument that Cuomo and others made a huge mistake in dealing with nursing home patients, I have to wonder what the alternative was. Dealing with elderly in LTCF’s is not simply a matter of sending them home. Many, like my sister (who is only 66 and not elderly), need 24/7 supervision and care without Covid.
Colorado could have told me that my sister could not go back to her home. In that case, I suppose the only option would have been to try to keep her at my house which would bring up all sorts of other problems considering her cognitive impairment, incontinence, need for a strict med regime, her combativeness, and instinct to wander.
“I understood what happened to be that people with virus symptoms went to the hospital for diagnosis and care, and if they did not need intensive assistance provided by hospitals, they were discharged to nursing homes with which they didn’t have any previous relationship.”
PD- I find this frustrating as I have seen conflicting stories on this so I feel as though we don’t really know what was going on. I will tell you that in my experience it is incredibly difficult, to the point of being inconceivable in normal times, that you could leave an ED to get directly admitted to a nursing home. I have never heard of that happening.
Steve