Tag Archives: James A. Bacon

The Epidemic is Receding. Why Do We Need a Mask Mandate Now?

by James A. Bacon

As Governor Ralph Northam ponders the details of a statewide order mandating Virginians to wear face masks, he might do well to consider the latest COVID-19 data in his deliberations.

A record number of test results, 11,609, were incorporated into the Virginia Department of Health COVID-19 database yesterday and published on the VDH dashboard this morning. (Only one day, May 1, saw a higher number, and that reflected a major change in reporting methodology.) This is the first time that Virginia has met Northam’s professed goal of a minimum of 10,000 tests daily.

Only 495 new COVID-19 cases were confirmed, the lowest number in more than a month. The percentage of positive tests fell to 4.3%. That was the lowest since March 18, before COVID-19 had reached epidemic proportions. Northam has cited evidence of declining positive-test ratios as an indicator for loosening his Vulcan Death Grip on Virginia’s economy.

But Northam appears to be committed to issuing a mask-wearing edict “especially for individuals going into businesses.” The only thing holding him back is that some issues remain unresolved. One is the “equity” implications of a mandate. Said he: “We want to make sure everyone has access to a mask.” In other words, he wants to ensure that members of poor and minority communities are not prevented by their inability to obtain masks from entering places of business. Another issue, he said, “We also want to talk about how we enforce that.” Continue reading

The Nursing Home Industry Responds

Virginia’s long-term care facilities have come under close scrutiny during the COVID-19 epidemic, understandably so, considering that roughly 60% of all COVID-19 deaths in Virginia have afflicted patients living in long-term care facilities. The nursing home industry has remained remarkably quiet throughout the crisis. But yesterday I received a communication from Amy Hewett, vice president of strategy and communications for the Virginia Health Care Association.

Bacon’s Rebellion has been pretty tough on the nursing home industry and its regulators, so I thought it fair and reasonable reasonable to re-publish Hewett’s communication. Here, after deleting prefatory material, is what she had to say. — JAB

As you know, the coronavirus is of a particularly voracious nature. Even with the best infection control, it can spread at nursing homes and assisted living centers, which require high-touch care such as feeding, bathing and dressing residents – especially given the frequency of asymptomatic spread. The people we care for are high risk – not just now, but always. Public health policy must reorient itself to our community’s needs so we can do everything possible to keep our residents safe.

That said, confirmed coronavirus cases account for just 6% of all residents in our care. Long-term care facilities are taking significant steps to prevent further spread. Despite the challenges we face, most residents and staff members who are diagnosed with the virus make a full recovery – many without hospitalization. With the proper resources, we can ensure even more positive outcomes.

I wanted to pass along a few items that I thought would be of interest to you: Continue reading

Latest Data Supports Continued Reversal of Shutdown

The red line shows the number of confirmed and suspected COVID-19 patients in Virginia hospitals. Graph credit: John Butcher

by James A. Bacon

We’re a week into Phase 1 of relaxing the COVID-19 lockdown, and there is no sign of an acceleration of the virus. To the contrary, the virus seems to be receding. It may be too soon to reach definitive conclusions — there is a one- to two-week lag between an infection, the display of symptoms, testing, and hospitalizations — but so far, all signs are positive.

The most reliable indicator is COVID-19 hospitalizations, and the daily number is trending down strongly, as can be seen in the graph (courtesy of John Butcher) shown above. Since May 15, the count of confirmed and suspected COVID-19 patients in Virginia hospitals has declined from 1,511 to 1,384. Meanwhile the number of new hospitalizations yesterday dropped to 36 — the lowest number in 25 days. The number of deaths remains significantly below previous peaks.

The one disconcerting note in the numbers comes from nursing homes. The number of nursing home patients confirmed to have COVID-19 has increased markedly over the past week — from 1,427 five days ago (the first day for which the numbers were reported) to 1,886 yesterday. Whether that reflects an increase in testing at long-term care facilities, an increase in the number of nursing homes sharing data, or an actual spread of the virus is impossible to determine from the published data on public dashboards. Continue reading

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

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

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

Virginia to Hire 1,000 Contact Tracers. What Will Their Priorities Be?

by James A. Bacon

Virginia is committing $58 million in federal emergency aid to expand contact tracing of people testing positive for the COVID-19 virus, reports the Richmond Times-Dispatch. The epidemic-fighting tool will be all the more necessary as Virginia eases its Vulcan Death Grip on Virginia’s economy and people begin moving around more freely.

“As we interact more, there will be more opportunity for [positive cases] to infect others,” Virginia State health Commissioner Norman Oliver told the Senate Finance & Appropriations Committee yesterday.

The state health department already uses contact tracing to prevent the spread of sexually transmittable diseases, tuberculosis and other communicable diseases. “This is what local health departments do every day,” Oliver told the committee. Hiring 200 communicable disease investigators and 1,000 contact tracers will cost an estimated $7 million to $8 million a month. 

The RTD article did not say how the activities of the contact tracers would be prioritized, presumably because Oliver did not tell the committee. Twelve hundred people sounds like a lot — and maybe it’s more than enough to handle the job. But consider that the number of new COVID-19 cases every day has ranged between 700 and 1,300 over the past couple of weeks. Roughly speaking, that’s one new case per contact tracer per day. Continue reading

Jerry Falwell Jr., COVID-19 and the Insufferables

Jerry Falwell Jr.

by James A. Bacon

Writing for the Washington Post means never having to say you’re sorry. If you’re looking for examples, consider the case of Jerry Falwell Jr. and his decision to keep Liberty University open during the COVID-19 epidemic, even as virtually all other colleges and universities were shutting down.

“This public response indicates the staggering level of ignorance that informs Falwell’s leadership,” opined columnist Michael Gerson. “It is possible for students with mild or unnoticeable symptoms to spread the disease. … Yes, the fatality rate of infected colleges students is likely to be low. Yes places with broad community spread are more likely to see infection of the elderly and vulnerable, who are more likely to fill premature graves.”

“Irresponsible decisions like Jerry Falwell Jr.’s put untold numbers of people at risk,” ran the headline of a WaPo editorial. “These foolhardy, irresponsible decisions endanger not just those who … resumed their college studies but untold others who now run the risk of the novel coronavirus being passed on to them and their families.”

Liberty University moved most of its classes online. About 1,200 students made the choice to return. The New York Times reported that nearly a dozen students promptly came down “with symptoms that suggested Covid-19,” a factoid that was repeated endlessly in the media and mutated into the assertion that a dozen students actually had contracted the virus. Continue reading

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

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