Jumbled Numbers

by Carol Bova

The Virginia Mercury published an article by Kate Masters April 6th about Virginia’s $27 million order for personal protective equipment (PPE). As of April 20th, the Governor’s Office had not responded to the Mercury’s Freedom of Information Act request for a copy of the contract or the specifics of the deal.

The article did quote Virginia Health Commissioner Dr. Norman Oliver, who described the types of equipment ordered. In discussing how many sets of PPE are needed to care for those who are presumed positive for COVID-19, Oliver also explained why hospitalization numbers from the Virginia Hospital and Healthcare Association (VHHA) differ from those of the Virginia Department of Health (VDH).

“The new numbers vary from the state’s tally of hospitalized cases because VDH only counts the number of lab-confirmed patients who have been discharged from the hospital, Oliver said at the briefing,” he said. “That number lags behind the number you would get if you were to ask that same question of VHHA, which actually tracks the current census in the hospital.”

This may explain why VHHA began posting its COVID-19 dashboard online on April 6 with current hospitalization details, and why on April 13 it added the number of discharged  patients with positive tests. It does not explain why, as of April 20, VDH still posts a footnote to its hospitalization numbers that says, “Hospitalization status at time case was investigated by VDH. This underrepresents the total number of hospitalizations in Virginia.” It seems likely that Oliver misspoke.

At the April 20 press conference, Governor Ralph Northam said that the Department of Health will expand the data it shares with the public. On a daily basis, VDH will share number of cases, hospitalizations and fatalities by locality and at the health-district level with demographic information like age and race.

Health Commissioner Oliver said long-term care facilities account for 77 of 139 outbreaks and 10% of state cases, but 26% of deaths.

“We have been tracking as best we can, the race and ethnic breakdown on both cases and deaths,” he said. “African American cases number about 28 percent of the cases, for those cases for which we have race and ethnicity data, and for the deaths for which we have data, they number about 34 percent.”

He said they have been improving race and ethnicity data and are missing only about one-third for cases and 3% missing in death data. One-third is still a lot of missing information, but improved from the 50% unknown that Richmond/Henrico Health District Director Danny Avulo reported five days ago.

The VDH website on April 20 shows percentages by ethnicity based on all cases. (Deaths are not currently shown by ethnicity.)

African American: 18.5%; 1,659 cases of which 417 are hospitalized.
Other: 13.2%; 1,183 cases with 266 hospitalizations
White: 33.6%; 3,018 cases with 574 hospitalizations
Race/ethnicity not reported: 34.8%, 3,130 with 243 hospitalizations

Excluding the 3,130 cases with unknown ethnicity, the breakdown of the known 5,860 cases is:

African American 28.3%
Other: 20.2%
White: 51.5%

Oliver’s figure of 34% African Americans of all but 3% of deaths is an alarming number. Knowing the age breakdown will show how alarming that is, especially if more deaths are in younger categories or if the number includes many of the high percentage of deaths in long term care facilities.

Carol Bova is a writer who lives in Mathews County.

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21 responses to “Jumbled Numbers

  1. I have filed formal complaints against the Virginia Department of Health with both the Centers for Medicare/Medicaid Services (CMS) and with the Civil Rights Division of the Justice Department. CMS is the federal authority that oversees state inspections and oversight of nursing homes. The Civil Rights Division of Justice oversees the enforcement of the Americans with Disabilities Act as well as racial discrimination. I believe that the failure of the Department of Health to carry out its well defined duties in ensuring the health and safety of nursing home occupants will be exposed by those dual investigations. The numbers don’t lie. Virginia’s nursing homes including Canterbury are chronically and significantly understaffed. VDH, with the responsibility to prevent that, has failed in its duties.

    • By sheer chance the next book on my stack was something called “Overcharged” published by Cato Institute, on the financial morass which is our third-party payer health care system. Plenty of focus on the perverse incentives in the nursing home/rehab/hospice industries. Plenty of examples of bad actors, horrible criminals, fined, slapped on the wrist and then allowed to wriggle back into the field. Running those places up the standards we’d all like, and fully policing them, probably means much higher costs than families or taxpayers will tolerate. CMS just exists to shovel out the money, it seems. Bureaucracies hate boat-rockers.

      This crisis has displayed the weaknesses there, just ripped open the seams. And to another point of Carol’s, it is also clearly telling us that obesity and smoking are fatal mistakes. Nobody seems to want to focus but that is who is dying, other than the old and frail. If not old and frail, your chances of dying from COVID are strongly correlated with obesity and smoking (all too common among very young people.) It’s not race, it’s those co-morbidities.

    • I probably missed it in your earlier posts. Are Virginia’s nursing homes, including Canterbury, chronically in violation of licensing standards regarding staffing? Or is the “understaffing” relative to what is the national norm?

  2. “Virginia’s nursing homes including Canterbury are chronically and significantly understaffed. VDH, with the responsibility to prevent that, has failed in its duties.”

    Meanwhile, in Northam’s April 8th press conference, Northam went far out of his way to brag on how his Virginia was at the cutting edge of the nation in profiling and recording the harm done to minorities by Coved-19. How cheap and dishonest this Governor’s waggling forked tongue is. Look at damage his Administration’s action wreak on the very people he proclaims to protect. What a dangerous hypocrite this Governor is.

  3. When it comes to Virginia always follow the money. Always. Obviously the lowers the staffing levels in nursing homes the lower the costs of that nursing home. Lower costs, higher profits. But as the organization with fiduciary responsibility for Medicaid funds the state must ensure that the staffing meets appropriate levels. The state has not done that. Issues like this are rarely accidents in Virginia. How is money flowing from nursing homes into the pockets of the grifters in the General Assembly?

    I hope Capt Sherlock’s efforts to get the federal government involved are successful. Nothing reduces graft like seeing (former) politicians in orange jump suits.

    • “I hope Capt Sherlock’s efforts to get the federal government involved are successful. Nothing reduces graft like seeing (former) politicians in orange jump suits.”

      I appears beyond a doubt that has already happened. Trump announced that new initiate at his press conference day before last. The Feds are going direct, bypassing certain states, to get to the bottom of nursing home scandals revealed by the crisis. That is what I heard Trump say.

    • DJ. The opportunities for boodle in all this are astronomical. The PPP audit to come will be very revealing.

    • Please give other examples of “issue likely this are rarely accidents” in Virginia. The standards are set in regulation by the Board of Health. (See Sec. 32.1-127 of the Code of Virginia.) How do the “grifters” in the GA profit from that?

      • The same way they profit from unnecessary COPN regulation that enshrine incumbent health care providers in the “cat bird seat” – through a long stream of campaign contributions that can be spent on almost anything.

        The same way they neuter the SCC so that Dominion can keep a billion+ of money that should be repaid to ratepayers – through a long stream of campaign contributions that can be spent on almost anything.

        The question isn’t’ the regulations, it’s the lack of enforcement of those regulations. How many times was Canterbury found lacking and why was there no action taken? Now people are dead who probably didn’t need to die. Why?

        As Steve Haner writes, “The opportunities for boodle in all this are astronomical”.

        However, I must concede you may be right. The issue of a lack of enforcement at Canterbury might just be the standard incompetence of our state government. We’ll see what the audit finds.

        • Dick, the Great Vicar of Vinton, Sir Richard of Cranwell, is a fine trial lawyer but also was (still is?) owner (part?) of a nursing home chain. It is the chain which Sherlock has pointed out has a seat on the Board of Health. Duh. The best connected development firm in the Roanoke Valley, then called Fralin and Waldron, was heavily into that business and the Fralins still are. Politics and money have swirled around the industry from the day the government became the number one payer.

      • As to widespread problems, typically, where there is smoke, there is fire. A close reading of Jim S.’s fine reporting of state statistics suggests this. Perhaps Carol’s latest reported state numbers suggests it too. In my experience, just walking into nursing homes, and I’ve walked into many, tells you most of what you need to know, in terms of putting your own kin into one of these places.

        This is not rocket science!

  4. The VDH site is not showing deaths by locality as of yesterday?

    • Transparency and information sharing are out of bounds in Virginia. Virginia’s leaders do not want their Virginians to know what is going on, and are working overtime to cover their tracks. Otherwise those tracks will expose the state’s government incompetence, and those tracks will put pressure on the state to fix the mess the state allowed to happen, and can’t fix. It’s a repeat of what happened in C’ville in spring and summer of 2017, crooked government.

    • Cases, hospitalizations and deaths are there today for numbers reported as of 5 p.m. yesterday.

      They added confirmed and probable numbers to total cases, total hospitalizations and total deaths.

      Outbreaks are up to 148 Long term care are the largest group.
      Long term care facility 80 outbreaks, 939 cases, 77 deaths
      Congregate setting 28 outbreaks 12 cases 2 deaths
      Healthcare setting 80 outbreaks, 64 cases, 0 deaths
      Correctional Facility 13 outbreaks 185 cases 0 deaths
      Educational Setting 6 15 cases 0 deaths
      Gym/Spa 1 outbreak 8 cases 0 deaths

      No new racial locality breakdown.

      VDH total hospitalizations still at odds with VHHA current plus discharged since April 13

  5. The specific portion of the Code of Federal Regulations written to enforce the Americans with Disabilities Act that I believe has been violated by the Virginia Department of Health is
    CFR PART 35—NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES
    §35.130 General prohibitions against discrimination
    (a) No qualified individual with a disability shall, on the basis of disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any public entity.
    (3) A public entity may not, directly or through contractual or other arrangements, utilize criteria or methods of administration:
    (ii) That have the purpose or effect of defeating or substantially impairing accomplishment of the objectives of the public entity’s program with respect to individuals with disabilities;
    I contend that the methods of administration by VDH of its inspection and oversight of nursing homes had the effect of defeating the objectives of that program, to wit: providing for the health and safety of nursing home residents.

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