Following Up: Nursing Home Deaths Still Dominating U.S. CCP Virus Fatalities

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assisted living facilities, CCP Virus, CDC, Centers for Disease Control and Prevention, coronavirus, COVID 19, Following Up, Foundation for Research on Equal Opportunity, Kaiser Family Foundation, lockdowns, nursing homes, shutdowns, The New York Times, Worldometer.com, Wuhan virus

Given the recent U.S. surge in reported CCP Virus infections (but not yet U.S. deaths, according to sources such as the Worldometers.com website), I thought it was time to take another look at the nursing homes dimension of the pandemic. Depressingly, most of the evidence signals that it’s still at least as central to America’s virus fatality story.

RealityChek‘s last update, from mid-August, found that, since the pandemic’s early stages, the share of CCP Virus deaths linked with these facilities had more than doubled – to at least 41 percent. The phrase “at least” matters a lot because U.S. states’ reporting of these losses is far from uniform.

The New York Times, which had been doing an admirable job of tracking the scattered statistics that are available, hasn’t focused on the issue since then, but several others have stepped into the breach and some suggest that the problem has worsened.

In early September, the non-partisan Kaiser Family Foundation reported that “People in long-term care facilities make up 8 percent of coronavirus cases, but 45 percent of all COVID-19 deaths.” And worrisomely, Kaiser found signs, as of August, of an uptick.

Moreover, in a second September report, Kaiser examined another set of institutions in which senior citizens are heavily concentrated – assisted living facilities. It concluded that, despite data even less complete than for nursing homes, CCP Virus deaths were strongly increasing among residents and staff alike between June and August.

Similar figures were published in late August by the Foundation for Research on Equal Opportunity, a think tank that bills itself as non-partisan but that looks like of right-of-center-ish to me. (“Not that there’s anything wrong with that.”). Actually, the organization published three sets of figures, each using a different methodology and each covering both nursing homes and assisted living facilities. The low end number pegged virus deaths associated with both at 42.1 percent, the middle at 42.7 percent, and the high end estimate was 46.9 percent.

What says the U.S. government, you might ask? Nothing terribly helpful. The Centers for Disease Control and Prevention (CDC) does try to monitor the situation, and its data are more recent than those of the other two outfits – bringing the story up to October 18. But it only includes information from the relatively small number of states that voluntarily send in their numbers. That is, there’s no reporting requirement. The two private sector organizations discussed above use other sources, like press accounts – which are admittedly not definitive.

If you do look up these numbers, however, you’ll find that the agency pegs the nursing home death toll at 61,765 as of October 18. But you’ll also find that no overall U.S. death total is provided for that date.

The Worldometers site’s number for the day is 224,792. Do the math, and nursing home deaths as a share of total deaths comes to 27.47 percent. Yet not only is the result missing many states’ fatalities. It doesn’t include assisted living facilities, either.

I’ve argued in my previous posts that the high share of total U.S. virus-connected deaths is argues strongly for concentrating prevention and mitigation efforts on such unusually vulnerable populations, rather than the economy or the society as a whole. As new infections climb once more, and talk of major lockdown increase just as quickly, this still sounds like the strategy to choose.

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Following Up: America’s CCP Virus Deaths Story is More of a Nursing Homes Story Than Ever

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CCP Virus, coronavirus, COVID 19, Following Up, lockdowns, nursing homes, reopening, The New York Times, The Washington Post, Wuhan virus

Starting in late April, RealityChek reported a major characteristic of the CCP Virus’ impact on the United States with huge implications for the kinds of shutdown and reopening approaches have been pursued and supported by the federal government and individual states.

That characteristic: The wildly outsized share of U.S. virus deaths linked to nursing homes and similar facilities, among residents and employees alike. And the biggest implication: The high concentration of the worst of the CCP Virus problem in a relatively small number of locations among an especially vulnerable population strongly indicated that massive lockdowns of the entire economy and society were far from the best anti-virus strategies. The nursing homes-heavy nature of pandemic deaths also strengthened the argument that the overall damage from widepread lockdowns was exceeding their benefits, whether looking at the economy or public health, and especially both combined.

So since Americans have rightly become so worried about the recent rise in national virus infections and deaths – both in states that reopened relatively early, and in those that didn’t – it’s crucial to know that the nursing homes factor has grown steadily larger, at least according to one important source.

The nursing homes data for previous posts came from ABC News and The New York Times, and as RealityChek reported, as of late April, deaths related to these facilities amounted to about 20 percent of all virus fatalities (as reported by ABC). Three weeks later, the percentage was up to 35 (as reported by The Times). Just this past week, The Times updated its statistics and the share is up to at least 41 percent. (Exact certainty is impossible because the federal government doesn’t yet track these trends, and neither do some states. So the paper has assembled its own database.)

The state-by-state situation varies considerably in this incredibly diverse country. The state with the highest share of virus deaths linked to nursing homes is New Hampshire, at 81 percent. Nevada’s share is the lowest, at 17 percent, and The Times judged the information to be insufficient for six states: Wisconsin, Arizona, Alaska, Alabama, Hawaii, and Missouri.

Nonetheless, the phenomenon is widespread enough to result in nursing home-related deaths accounting for more than half of all CCP Virus-related deaths in 20 states.

And what’s especially interesting: Many of the states where deaths have climbed the most recently have been states with high percentages of nursing home deaths. Some leading examples: California (a nursing home death share of 41 percent), Florida (42 percent), Georgia (43 percent), Oregon (53 percent), Iowa (53 percent), Mississippi (42 percent), and North Carolina (47 percent). At the same time, Texas has seen deaths increase steadily since early July, and remain elevated, but a relatively small 31 percent of its total fatalities have been nursing home-related. (The overall death rate figures come from The Washington Post‘s tracking feature, which is the best for U.S. data that I’ve seen.) 

One of my favorite expressions (and pieces of advice) holds that when everything is a priority, then othing is a priority. It’s easy to look at the immense nursing homes factor in America’s CCP Virus deaths picture, and the continuing popularity of sweeping lockdowns, and conclude that little of the country’s leadership is familiar with it.

Im-Politic: The CCP Virus Crisis Has Become Even More of a Nursing Home Crisis

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Canada, CCP Virus, coronavirus, COVID 19, Europe, Following Up, lockdown, nursing homes, reopening, seniors, shutdown, Sweden, The New York Times, United Kingdom, Wuhan virus

About three weeks ago, I posted about the degree to which total U.S. CCP Virus-related deaths were occurring in nursing homes and other special facilities for seniors. And I noted that the answer – “really big” – provided significant evidence for the idea that substantial reopenings of the U.S. economy were much more feasible than widely believed.

The reason: If the virus’ main dangers were so highly concentrated in a single, highly vulnerable, and already confined population, then by definition, such dangers to the rest of the public were considerably less serious than widely believed. Therefore, relatively low-risk populations could be permitted to reengage in normal economic activity sooner rather than later.

Three weeks later, the case for faster, wider reopenings is even stronger – along with the arguments for focusing virus containment measures on seniors, and especially those inside or outside such facilities.

For example, that previous post cited data indicating that about twenty percent of all U.S. virus deaths were taking place in elder care facilities. More recently, a comprehensive New York Times survey pegged the share at 35 percent.

Moreover, data are coming in making clear that this pattern is hardly confined to the United States. In Canada, the share has been reported at 81 percent. Across Europe, national shares are thought to be between 42 percent and 57 percent. In the United Kingdom, it’s estimated at 25 percent.

Possibly the most intriguing findings concern Sweden. That’s because its lockdown was the lightest imposed among the wealthier national economies. The overall Swedish virus death rates, however, have been right in the middle of the pack for Europe.  (See here for the latest numbers.) Yet the Swedish government has also reported that nearly half those deaths have taken place in elder care facilities.

In other words, if Sweden had its nursing home act together, its virus fatalities would have been about 185 per million people – which would have put it well behind the United States, Spain, the United Kingdom, Italy, France, Belgium, the Netherlands, and Switzerland. Sweden’s economy, unfortunately, seems unlikely to escape taking a major virus-related economic hit anyway. But the toll seems largely due to its relatively small size and as a result its relatively heavy reliance on foreign trade – not to its failure to shut down more broadly.

The United States, of course, is much less reliant on foreign trade. In theory, then, if its nursing and similar facilities get the aid they need, America’s economy can continue reopening – and even faster than at present – without running major further health risks. Indeed, as I’ve also noted previously, such reopening per se could well curb other emerging public health dangers. Moreover, as observed by the Washington Post editorial board, moving toward the Swedish model might speed up progress toward creating herd immunity in the United States. This status would mean considerable protection against the second virus wave that might arrive along with cooler weather this fall.

As always, “reopening” doesn’t mean an immediate, complete return to the pre-virus normal. And serious uncertainties continue surrounding the nursing homes data, and indeed all virus-related data. But a pattern visible in so many high income countries can’t be dismissed, either, and it should put ever more pressure on backers of slower reopenings to justify their positions.

Im-Politic: The Cost of a Governor’s CCP Virus Grandstanding

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Andrew Cuomo, CCP Virus, conservatives, coronavirus, COVID 19, Im-Politic, Larry Hogan, Maryland, New York State, nursing homes, Republicans, seniors, test kits, testing, The Washington Post, Trump, Wuhan virus

First, full disclosures: I’ve been a Maryland resident for more than 15 years now (though still a New Yorker at heart). I’ve voted for Larry Hogan for governor twice (different elections!) and think he’s done as good a job in Annapolis as could any Republican in a state that’s heavily Democratic (albeit one with a long tradition of choosing moderate Republicans as governor).

But I’ve always thought that he’s spent a little too much time and energy sniping at President Trump and fostering an image as a moderate, unifying, possible GOP and conservative alternative to Mr. Trump’s needlessly polarizing brands of politics and policy.

And my irritation at Hogan just ticked up a notch upon reading this Washington Post piece reporting his decision yesterday to test all nursing home residents and staff for the CCP Virus.

Yes, you read that right: “Yesterday.” Even though the unmistakable and tragic nationwide concentration of virus deaths and infections in such facilities has been clear for months now – in part because of their elderly populations and in part because of their confined quarters. Even though the state’s own new data show that “half of Maryland’s confirmed covid-19-related deaths and more than a fifth of its cases were linked to skilled-nursing facilities.” That’s a higher nursing home death rate even than in New York State, whose Governor Andrew Cuomo is catching flak for his own costly decisions in this regard.

Where’s Hogan been? In part, keeping busy by missing few opportunities to show up the President, and winning praise even from Democrats – most recently by crowing about his Korean-American wife’s success at procuring half a million test kits from South Korea — and conspicuously dissing the President in the process. Interestingly, though, it now turns out that the governor is discovering that turning this showy purchase – which may have been wholly unnecessary – into an effective testing program even in his smallish state isn’t as easy he and other Trump critics have implied. (See here for details.)

If Hogan runs for reelection, I’ll almost surely vote for him again – assuming that Maryland Democrats keep nominating tax-and-spending-happy, Sanctuary State- and city-backing, identity politics-obsessed rivals. But I’ll certainly be hoping that Hogan starts remembering those adages about people living in glass houses and tending to their own gardens.

Im-Politic: A (Huge) Nursing Home Factor in U.S. Virus Deaths

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ABC News, CCP Virus, coronavirus, COVID 19, demographics, Europe, Im-Politic, lockdown, long-term care facilities, nursing homes, reopening, restart, seniors, shutdown, WHO, World Health Organization, Wuhan virus

Whenever I hear about a CCP Virus outbreak at a nursing home or similar seniors facility, I wonder how these especially tragic episodes have been influencing the national data. The issue matters greatly, because the numbers could reveal much about the virus’ spread and virulence among Americans not so aged and confined – i.e., the vast majority of the population.

Of course, avoidable and unavoidable testing shortcomings are making all the statistics dodgy.  And state and local authorities’ standards for identifying and reporting CCP Virus cases – and therefore deaths – are both highly diverse and constantly changing.  What’s emerged so far, though, shows that nursing homes and the like are indeed where the disease’s worst effects are appearing, and by wide margins. As a result, however, these statistics also strongly indicate that the virus is much less dangerous for other Americans than originally thought.

The most comprehensive picture we have of nursing homes’ role has come from ABC News. Its examination of state-level numbers concluded that, as of yesterday, at least 10,631 of nationwide CCP Virus-induced fatalities had been long-term care residents. That’s about a fifth of the U.S. total. But the “at least” in the previous sentence is really important. For the ABC numbers are based on information from only 28 of the states plus the District of Columbia. That leaves the nursing homes’ share of fatalities unknown for 22 states. ABC didn’t say which states were and weren’t included in the count, but it’s almost certain that the more state figures are examined, the higher the nursing home share will rise.

One reason for confidence in this conclusion: The World Health Organization (WHO) stated on Thursday that as many as half of all of Europe’s coronavirus-related deaths have occurred in long-term care facilities. Of course, WHO’s performance during the pandemic has been roundly criticized. But you have to assume that it’s found it much easier getting reliable data from Europe than from dangerously secretive China.

It’s also important to note that Europe’s populations are significantly older than the United States’, which no doubt explains much of that towering European estimate. In addition, Europe was hit by the virus earlier. But along with the incomplete nature of the U.S. data, the the demographic gap is narrow enough to suggest that nursing home residents’ share of American deaths will continue growing.     

Combined with mounting evidence (see, e.g., here and here) that the CCP Virus has infected many more Americans than first estimated – meaning that the disease’s lethality looks considerably lower than once feared – the apparent concentration in nursing homes is unquestionably good news for most of the nation (except, of course, if any of your loved ones lives in these facilities). One possible implication:  With the right, targeted, precautions, a more extensive earlier reopening of the U.S. economy is warranted. The bad news, however, is that the virus’ impact is most deadly in one of America’s most vulnerable populations. Let’s all hope that, if this finding holds up, one result will be more mitigation where it’s needed most.