Category Archives: Health Care

Wise King Ralph Rules: Less Choice for the Self-Employed

Wise King Ralph

by James A. Bacon

According to Governor Ralph Northam, the way to ensure access to quality, affordable medical insurance for Virginians is to reject bills that would… expand access to health insurance for Virginians.

Yesterday Northam vetoed two bills passed with broad bipartisan support that would have allowed self-employed people to buy insurance through professional groups such as Realtors’ associations. He also vetoed a third, which would have permitted small businesses to band together to buy group health insurance for employees.

Northam’s logic was that the legislation could undermine the Affordable Care Act by providing an alternative to buying coverage on the state exchange, reports the Washington Post.

“Governor Northam’s administration has worked to expand access to affordable quality care for all Virginians,” said a statement released by the Governor’s Office. “The vetoed bills would address health insurance cost concerns for targeted segments of the population, but in doing so, could increase the cost of insurance for sicker Virginians in the marketplace.” Continue reading

COVID-19 Update

Highlights from the Virginia Department of Health and Virginia Hospital and Healthcare COVID-19 databases based on yesterday’s reporting:

Mortality statistics
COVID-19 deaths: 37
Nursing home deaths: 13
Percentage of deaths occurring long-term care settings: 35%

Testing data
Tests administered: 6,553
% positive: 14.7%

COVID-19 Hospitalization data
New hospitalizations: 52
New discharges: 185
Total COVID-19 patients hospitalized: 1,459 (lowest in 19 days)

— JAB

COVID-19 a Danger to Individuals but Not an Existential Threat to Society


We’ve published variations of this graph in the past, but the perspective never grows old. This data, provided by John Butcher of Cranky’s Blog fame, shows how the COVID-19 virus stacks up against other causes of death in Virginia (using 2017 data, the most recent available). The number is almost as high as it was for the flu and pneumonia.

But… but… but one can argue that if it weren’t for the extreme lockdown measures put into place by Governor Ralph Northam, the COVID-19-related deaths in Virginia would be much higher. That may be true. However that argument takes us into esoteric territory. One could argue that we haven’t “prevented” the COVID-19 deaths so much as displaced them in time. That was precisely the logic behind the “flatten the curve” strategy — to spread out the infections over time to avoid overwhelming the healthcare system. Continue reading

COVID Confusion

by Kerry Dougherty

Looks like it may be safe to lose the grocery gloves. We can take it easy with the Clorox wipes, too.

No longer must we let Amazon packages marinate on the porch for days. Or scrub milk cartons with bleach in case some super-spreader touched it in the supermarket refrigerator case and left invisible viral bits on its waxed surface.

Yep, in a reversal of its earlier hair-on-fire warnings, the CDC admitted this week that it appears the Covid-19 virus is not easily transmissable from surfaces.

The CDC made another key change to its website, clarifying what sources are not major risks. Under the new heading “The virus does not spread easily in other ways,” the agency explains that touching contaminated objects or surfaces does not appear to be a significant mode of transmission, reported The Washington Post.

Now they tell us, 5,000 Clorox wipes later. Continue reading

A Great Idea from Pennsylvania to Help Nursing Homes

by James C. Sherlock

Perhaps the Governor can call the General Assembly into special session to copy the best idea I have heard for a short-term fix to nursing home medical care.

The Pennsylvania House of Representatives has just passed the “Senior Protection Act” by a vote of 201-1 to appoint the state’s academic medical centers to take over responsibility for infection control, testing, surveillance and medical care supervision in the state’s nursing homes.

Says Pennsylvania Speaker of the House Mike Turzai:

“To ensure consistency of programs, response and study of clinical and public health outcomes, the legislation would establish a coordinated, collaborative public-private-partnership approach of regional health system collaboratives. These health collaboratives would administer/manage personnel, protocols, testing and expenditures to protect the seniors in these facilities.”

A 125-member Virginia COVID-19 Long-Term Care Facility Task Force was established on April 10. Go to https://www.vdh.virginia.gov/emergency-preparedness/ and click on Partner Briefing COVID19 Healthcare Coordination 5/8/2020 to find out what they have done. Continue reading

VDH Outlines Contact Tracing Initiative

by James A. Bacon

Virginia’s COVID-19 contact tracing program will be organized around case investigators, contact tracers, and regional surge teams, all of whose efforts will be supplemented by technology, said Virginia Department of Health (VDH) officials in a media teleconference this morning.

VDH had 129 people doing contact tracing for infectious diseases such as tuberculosis and STDs before the COVID-19 outbreak. The department has boosted the number to about 470 by reassigning departmental personnel, and could add another 1,300 through new hires, said Mona Bector, deputy commissioner of administration.

In a related initiative, VDH officials said the state is close to selecting a technology company that will enable Virginians to download a smart-phone app that will alert them if they have come into close contact with someone infected with the virus. The GPS-enabled app also will provide data that makes it possible to map hot spots.

“Contact tracing is a fundamental component of public health,” said Marshall Vogt, VDH Division of Immunization’s epidemiologist. “It’s something we’re very familiar with. It’s something we do day in and day out to prevent the spread of infectious disease.” New funding will enable the department to expand what it already does. Continue reading

The Shutdown As Mass Casualty Event

by James A. Bacon

More than 600 physicians have signed a letter to President Trump calling for an end to the national shutdown aimed at slowing the spread of the coronavirus. The letter describes the unmeasured and overlooked health consequences of skyrocketing unemployment and income loss as a “mass casualty incident.”

The letter makes the same point I have been emphasizing over the past several weeks, but with the authority borne of first-hand interactions with patients: The policy response to the COVID-19 virus has been driven by adverse health effects that we are measuring and reporting in real time rather than adverse effects that we either cannot measure or are reported only after delays of weeks, months, or years.

“We are alarmed at what appears to be the lack of consideration for the future health of our patients,” write the doctors. “The downstream health effects … are being massively under-estimated and under-reported. This is an order of magnitude error.” Continue reading

COVID-19 Update: Eighteen More Nursing Home Deaths

This morning the Virginia Department of Health published the following COVID-19 data based on information reported yesterday:

Statewide deaths: 25
Deaths in long-term care facilities: 18

Seventy-two percent of coronavirus deaths involved patients in long-term care facilities.

Repeat after me: The COVID-19 epidemic is a nursing home epidemic. The virus may propagate itself through the population at large, but the primary impact, as measured by deaths, is taking place in Virginia’s nursing homes. That’s where public health authorities need to concentrate their efforts.

— JAB

Virginia Ranks 41st Nationally in Nursing Home Ratings

by Carol J. Bova

Medicare offers a “Nursing Home Compare” website. It uses a one- to five-star rating system for four categories: Overall Rating, Health Inspections, Staffing,  and Quality Measures. There is a category called Special Focus Facility for a nursing home with a persistent poor quality of care, subject to more frequent inspections and escalating fines. New nursing homes are unrated until more information is available. The website reports also include facility details, ownership, inspections, deficiencies, and fines.

The list below combines the percentage of special focus, one and two star (below average and much below average) nursing homes in one column, three, four and five star (average, above average and much above average) nursing homes in the second, and the percentage of new unrated facilities in the third for the 50 states and the District of Columbia.

Sorted by overall rating, from best to worst, Virginia ranks 41st in the country with 41.8% of its nursing homes below average. Only Missouri, New Mexico, North Carolina, Mississippi, West Virginia, Kentucky, Oklahoma, Georgia, Texas and Louisiana had more below average facilities than Virginia. Continue reading

2/3 of COVID-19 Deaths Yesterday Traceable to Long-Term Care Settings

According to the latest Virginia Department of Health data:

  • 33 COVID-19-related deaths were reported May 19 and published today.
  • 22 new deaths were reported for long-term care facilities.

That’s just one day’s results. But it’s consistent with yesterday’s data. Can we agree that the COVID-19 epidemic in Virginia is, at this point in time, primarily a nursing home epidemic?

Meanwhile, according to the latest Virginia Hospital and Healthcare Association data, 10 of 262 Virginia’s nursing homes reported having difficulty obtaining N95 masks, 4 had trouble getting surgical masks, 7 finding face shields, and 21 obtaining isolation gowns. Is there a correlation between PPE shortages in nursing homes and the spread of the virus (and resulting deaths) at those same nursing homes? It would be nice if the VDH would make the data public so citizens could find out for themselves.

— JAB

The Epidemic Is Occurring in Nursing Homes, Not the Beach

by James A. Bacon

Here are a couple of data points to chew on. Yesterday, according to the latest data published by the Virginia Department of Health, Virginia recorded 27 deaths from COVID-19. Of those, 19 occurred in long-term care facilities for the elderly. In other words, 70% of the coronavirus-related deaths occurred in long-term care settings.

That’s just one day’s worth of numbers, but it is not atypical.  Over the course of the epidemic, 59% of all deaths were of residents of long-term-care facilities.

By contrast, the big news from Governor Ralph Northam’s Monday press conference was that the Governor will “allow” the City of Virginia Beach to reopen its beaches beginning Friday. But people had better follow the rules, the Governor warned. If they don’t, he “will not hesitate” to slap restrictions back on.

If only there were some way to track how many people contract COVID-19, get hospitalized, and die from frolicking at the beach. The state is in the process of hiring hundreds of contact tracers. It’s not clear yet how they will be used. Perhaps the Governor could deploy some to follow up beach-related infections. That way we could test the proposition, for which there is absolutely no evidence at this point in time, that congregating in the sun and salty air of the beach could reignite the spread of COVID-19. Continue reading

Reopening: Know and Avoid the Risks

Musical chairs goes viral

By DJ Rippert

The Bromage Broadcast. Erin Bromage is a professor of biology and a blogger. She will tell you that she’s not an expert epidemiologist but she recently wrote a blog entry that proves she is an eloquent writer when it comes to explaining the physics of Coronavirus to the layman. As Virginia reopens after the lockdown people will have to make personal decisions about what activities to undertake and what activities to avoid. Ms. Bromage’s plain English explanations make a good starting point for making such decisions.

Continue reading

Nursing Home Data Raises New Questions about COVID-19 Policy

by James A. Bacon

The Virginia Hospital and Healthcare Association has just published a data dashboard focusing on Virginia nursing homes. And the picture it presents is very different from that of the state’s acute care hospitals.

While acute care hospitals have solved their shortages of personal protective equipment, the nursing homes have not. According to the VHHA dashboard, 11 nursing home report difficulty obtaining N95 masks, four obtaining surgical masks, three obtaining gloves, seven obtaining face shields, and 18 laying hands on gloves.

Another noteworthy reveal from the data: The number of active COVID-19 patients currently in nursing homes is almost as large as that in acute care hospitals — 1,427 in nursing homes yesterday (and published today) compared to 1,502 in acute care hospitals.

The dashboard also tells us that 520 nursing home patients have recovered from COVID-19, compared to 4,107 who have recovered from acute care hospitals. Continue reading

Could the Low Testing Numbers Be Telling Us that COVID-19 Is Receding?

by James A. Bacon

Just a couple of weeks ago — under surreal COVID time, who knows how long ago it really was — Governor Ralph Northam told Virginians that he wanted to see 10,000 or more tests per day before relaxing his Vulcan Death Grip on the state economy. With the exception of a single day, a statistical anomaly caused by a catch-up in the reporting of data, Virginia has fallen short of that 10,000 benchmark. Thankfully, the Governor has ignored his own dictum and permitted a timid incremental rollback of his emergency restrictions — not enough to make a big difference, but a step in the right direction.

Judging by the time dedicated to the subject on cable television, there is a national mania for testing. More testing and contact tracing are absolutely imperative if we’re to get out of this COVID-19 mess alive. Perhaps that’s true. If it is, the Northam administration is falling on its face. Testing, rather than inching closer to that 10,000 threshhold over the past couple of weeks, has been trending down, as can be seen plainly in this chart.

Counting the number of tests is more difficult than one would think. For a long time, the Virginia Department of Health was not capturing tests performed by private labs. More recently, it backtracked on lumping together antibody tests with RNA tests. Whatever the case, it is clear that Virginia has yet to reach the 10,000 benchmark.

Here’s the point where readers no doubt expect me to lambaste the Northam team for another administrative failure. I hate to disappoint, but disappoint I must. Continue reading

Flight from New York

Source: New York Times. Click for larger image.

“New York is a great place to live, but I wouldn’t want to ride out a deadly viral epidemic there.” That pretty much sums up the attitude of tens of thousands of Gothamites — mostly of the wealthier sort — who have fled the city during the onset of the COVID-19 tribulations. In March, the U.S. Post Office received 56,000 mail-forwarding requests from New York City, more than double the monthly average. In April the number of requests reached 81,000, reports the New York Times

More than 60% of the forwarding requests were for destinations outside the city. Many people fled to nearby areas in Long Island, New Jersey and upstate New York. Otherwise, the Washington metropolitan area was the third most popular out-of-region destination, following the Miami and Philadelphia metros.

No speculation from the NYT regarding how many might have carried the coronavirus with them — although it may not be total coincidence that the Washington metro has the highest incidence per capita of COVID-19 infection in Virginia.

— JAB