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COVID-19: The Nursing Home Disease

The opinions expressed by columnists are their own and do not necessarily represent the views of
Darren McGee/Office of Governor Andrew M. Cuomo via AP

I recently testified before the House Select Coronavirus Subcommittee on the meltdown in nursing homes, which excluding New York (which deliberately underreports) now account for over 55 percent of deaths with COVID. The House Democrats' goal was to blame these high death rates on President Trump - but the blame should belong squarely to the handful of governors who presided over these disasters.


More than 60 percent of both nursing home deaths and total COVID-19 deaths occurred in just seven blue states with about 20 percent of the U.S. population: New York, New Jersey, Connecticut, Pennsylvania, Massachusetts, Illinois, and Michigan. The governors in each of these states ignored federal guidelines and pursued some version of the policy of admitting infectious patients to nursing homes as soon as they were clinically stable.

Nationally about 2 percent of the long-term care population has died with COVID-19 - but over 12 percent in Connecticut, 10 percent in New Jersey, 9 percent in Massachusetts, and about 4 percent in Illinois. Even New York's dishonest underreported number is 4.4 percent of the state's long-term care population.

Carnegie Mellon and University of Pittsburgh mathematicians showed back in March that efforts to shelter everyone would lead to a far higher death total than efforts focused on the elderly, but the liberal governors chose to ignore that reality - even as we've seen over 80 percent of COVID deaths among seniors.

New York's policy was implemented via a March 25 advisory that said: "No resident shall be denied re-admission or admission to the [nursing home] solely based on a confirmed or suspected diagnosis of COVID-19. [Nursing homes] are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission."


The Society for Post-Acute and Long-Term Care Medicine warned in response: "Unsafe transfers will increase the risk of transmission in post-acute and long-term care facilities which will ultimately only serve to increase the return flow back to hospitals, overwhelming capacity, endangering more healthcare personnel, and escalating the death rate."

This caution was ignored and the policy stayed in effect until May 10. New York presently reports 6,413 deaths physically in long-term care facilities. Adding hospital deaths, which the state refuses to report, would likely double or triple that number.

Similar policies in New Jersey, Massachusetts, Connecticut, Illinois, Michigan, and Pennsylvania - where the state health secretary moved his own mother out of a nursing home while sending infectious patients in - produced similar outcomes.

As Dr. Anish Koka described it: "Two weeks into the lockdown, Philadelphia hospitals had been emptied waiting for a New York-style surge that never came... But nursing home patients were treated like patients from the community who were too well to be admitted to the hospital - they were sent home. The consequences of keeping these patients at the nursing home meant the health system had to eventually deal with the entire nursing home being infected."


Pennsylvania now reports at least 4,345 long-term care resident deaths; all others are at least 2,054.

It isn't just state size. California nearly adopted substantially the same policy as the meltdown states, but reversed it just two days later - they didn't ignore the backlash. With a markedly different policy in place, including sending COVID-negative nursing home residents out of Los Angeles area facilities to the USN Mercy hospital ship to establish COVID-only facilities, the state so far has lost only 1.1 percent of its long-term care population, fewer total deaths in this cohort than little Connecticut.

By prohibiting readmission without effective infection control and deploying the national guard, adequate testing, and PPE, Florida reported long-term care COVID deaths at 1,664 as of June 21 - a quarter of New Jersey's, and 1.1 percent of the state's large long-term care population. Texas has fared even better, with less than half its COVID-19 deaths in long-term care and presently at only 0.6 percent of that population.

Most states are now finally making serious efforts to test their entire long-term care population.That's great, but if the CDC does not fix its definition counting any death in the presence of the coronavirus, nursing home residents with mild or asymptomatic infections will still show up in the count when they die of other causes. The median nursing home stay before death is just five months. If this definitional problem isn't fixed, deceptive counts will add to the problem of misperceived public fear.


We need honest reporting and counting to understand the risk of serious illness or death with COVID, and we need policies targeted to protect the vulnerable - not to scare the public. And the governors who presided over the carnage need to be held to account.

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