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.

Meanwhile, we haven’t heard much tough talk from the Governor’s Office about nursing homes, where we know for a fact 614 people have died. Bacon’s Rebellion contributor Jim Sherlock has documented how many nursing homes have fallen short in state inspections, and has shown how even profitable nursing homes have scrimped on staffing. But not one, to my knowledge, has earned a gubernatorial reprimand — or even a warning.

Here’s a thought: If Northam wants to reduce COVID-19 deaths, he should focus state resources on where the deaths are occurring! 

That would mean prioritizing nursing homes for the limited supply of state lab testing capacity — targeting facilities where the virus has been identified. It also would mean prioritizing the same facilities for attention by contact tracers. Finally, if there’s any sector of the economy where draconian restrictions and hygienic standards are called for, it’s the confined, hot-house environment of nursing homes. It is imperative to identify the virus and quash it before it spreads.

Perhaps the Governor could dedicate his next press conference to telling Virginians how he plans to halt the nursing home epidemic, which, if yesterday’s numbers are any indication, are continuing without let-up.

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24 responses to “The Epidemic Is Occurring in Nursing Homes, Not the Beach

  1. re: who dies from COVID19 and what were the circumstances of how they contracted it.

    My 2 cents – they need to do this.

    It will do two important things:

    1. – it will inform the public as what behaviors are risky.. or more risky
    2. – it will inform the State and localities as to what restrictions are appropriate and necessary and which ones are not.

    Although in the long run – we already know that it’s close contact with others – what we don’t know or some pretend to not know is what kinds of activities actually do result in closer contact even if some say they don’t.

    For instance, can we have stadium sports AT ALL or is there a safe way to do it and if so – how?

    Ditto for K-12 and Higher Ed… DMV… and any other activities where people tend to congregate…

  2. A bit of a false equation. Yes there are big problems with nursing homes everywhere. Not just Virginia.?The national media has been filled with such stories. Why beat the drum constantly about a temporary beach closure? I am getting tired of it.

    • I agree. Over and over and over, some folks have tried to make this about Virginia and Northam.. and the truth is this is a national-scope problem and it has to do with how the Nursing Home Industry as a whole has operated AND it’s also about how Medicare and Medicaid have regulated.

      No one – not the Federal govt that regulates nor the Nursing home industry correctly anticipated the actual risk of the COVID19.

      Trying to target a particular guy or state as if they alone screwed up is not a fair argument… it’s just more partisan stuff.

    • No, in fact, there are not big problems with nursing homes everywhere.

      Nursing homes deaths vary widely as a percentage of all deaths in a state — from zero in places like Hawaii, Alaska, and the Dakotas — to 80% in Minnesota, 66% in Pennsylvania, 59% in Massachusetts, and 58% in Virginia. We have one of the highest nursing-home death rates in the country — according to that ultimate arbiter of the truth, the New York Times.

      • Why don’t you provide the map in the NYT showing the extent of the problem?

        Yes, there are variations but do they correlate to the population, amount of infection, etc.

        The article in the NYT basically says the problem is widespread .

        it also says this:

        In the absence of comprehensive data from some states and the federal government, The Times has been assembling its own database of coronavirus cases and deaths at long-term care facilities for older adults.

        Some states, including Colorado, Illinois, Maryland, Nevada, New Jersey and South Carolina, regularly release cumulative data on cases and deaths at specific facilities. California, Massachusetts, Michigan and Ohio, among others, provide some details on the number of cases — but not on deaths. Others report aggregate totals for their state but provide no information on where the infections or deaths have occurred. About a dozen report very little or nothing at all.”

        I would ask if you think you’re being fair and objective here.

        This is a little like saying that because NY has a lot of cases – that they’re doing something wrong.. It’s that old correlation thing again.

      • Yes, apparently there are no problems in Arizona nursing homes.

        • well that we know of:

          Arizona Gov. Ducey Ducey doubled down on his administration’s decision to withhold details about the spread of COVID-19 through nursing homes and assisted-living facilities.

          Ducey held a news conference Wednesday to announce changes to his stay-home orders to combat the pandemic, but the subsequent question-and-answer session became a combative exchange about the minimal information the state has released to the public.

          It began with Dr. Cara Christ, head of the state’s health department, suggesting the state would only release the names of long-term care facilities with COVID-19 cases if a judge ordered it.

          Ducey and Christ then faced a barrage of questions about how relatives could gauge the safety of loved ones in nursing homes. The conference abruptly ended minutes later, when Ducey announced, “That is the answer. That will have to satisfy for now.”

        • then apparently THIS is going on:

          Numerous states accused of manipulating or bungling COVID-19 data

          In Virginia, Texas and Vermont, for example, officials said they have been combining the results of viral tests, which show an active infection, with antibody tests, which show a past infection. Public health experts say that can make for impressive-looking testing totals but does not give a true picture of how the virus is spreading.

          In Florida, the data scientist who developed the state’s coronavirus dashboard, Rebekah Jones, said this week that she was fired for refusing to manipulate data “to drum up support for the plan to reopen.”

          In Georgia, one of the earliest states to ease up on lockdowns and assure the public it was safe to go out again, the Department of Public Health published a graph around May 11 that showed new COVID-19 cases declining over time in the most severely affected counties. The daily entries, however, were not arranged in chronological order but in descending order.

          For example, the May 7 totals came right before April 26, which was followed by May 3. A quick look at the graph made it appear as if the decline was smoother than it really was. The graph was taken down within about a day.

          Georgia state Rep. Jasmine Clark, a Democrat with a doctorate in microbiology, said the graph was a “prime example of malfeasance.”

          “Sadly it feels like there’s been an attempt to make the data fit the narrative, and that’s not how data works,” she said.

          Republican Gov. Brian Kemp’s office denied there was any attempt to deceive the public.

  3. Jim, you said, “It is imperative to identify the virus and quash it before it spreads.” Afraid it’s way too late for that with 19 LTC of the total 26 deaths yesterday. Action should have been taken in March when it might have made a difference.

    We haven’t seen much on the nursing home testing the National Guard started doing the first of May. Or maybe we have––in the daily increase of LTC facility outbreaks reported. Waiting to see the CDC reports on which nursing homes are involved.

  4. The deaths in nursing homes and assisted living centers from COVID-19 are tragic. Furthermore, more attention should have been paid to them by state and local health authorities from the beginning because of their obvious vulnerability.

    That being said, I think this effort to shift the focus of the danger from COVID-19 away from the general public and focus it on these facilities for older residents may be a mistake. According to the data cited above, 59% of all COVID-19 deaths occurred in long-term care facilities. That means 41% occurred outside of those facilities.

    It is not surprising that a greater proportion of the COVID-19 deaths occurred in long-care facilities. Most of these people have serious medical problems, notwithstanding COVID-19. In fact, in 2018, people 75 years old and older accounted for 54% of the deaths in Virginia from all causes, which is not that much lower than the proportion of COVID-19 deaths in long-term care facilities. We will not know until the year is over and the final data is available whether the percentage of all deaths of folks 75 and over who died from all causes increased, compared to previous years, indicating that COVID-19 took a heavier toll on this group, or whether the percentage of younger people dying increased.

    Finally, your post implies that coronavirus infections originated in the long-term care facilities (“It is imperative to identify the virus and quash it before it spreads.”) It is pretty obvious that the coronavirus is being brought into the long-term care facilities from the outside. That is another reason to try to limit its spread on the outside.

    • Sometimes there is a flavor not unlike the logic which says that if a lot of people die in hospitals – it’s obviously a problem with hospitals..

      People in LTC are, for want of a more eloquent or comforting phrase – dying. Hells Bells – we are ALL dying but for some of us – the last stages of that occur in LTC and hospitals.

      We need to step back a bit IMHO.

      No matter what we do for LTC – it won’t change the actual death rate. That’s inevitable. The question is did they die sooner than they might have and I have to say – my apologies to those I might offend – the quality of life in most nursing homes is not something to be savored.

    • I did not mean to imply that the infections originated in the long-term care facilities. Clearly, the virus came from the outside. But once it gets in, it is very difficult to control. A big part of any containment effort will entail setting up quasi-quarantine measures to prevent the virus from getting into institutions that have not yet been infected.

      • Yeah, difficult to eliminate it from places like nursing homes, and other types of institutions like, oh say, hospitals, or any place where expressions of bodily fluids can be expected… clinics and surgeries, too, perhaps.

  5. So far. Once the occupancy of the beach reaches the same people/hour/sqft of the nursing home…

  6. This is another industry that may see radical changes long term. You aren’t going to get unfiltered data on the nursing homes and other long term care facilities for the elderly because, as previously noted, Medicare, Medicaid, the Veterans Administration and other government payers basically fund them. Private pay is small. As others on this blog have pounded home, the government is also heavily involved in regulating all those facilities, and may be liable for its failures to keep them up to standards. Liability is the big concept. Then, if this crisis is followed by a wave of bankruptcies and closures in the industry, many happy middle class families will look back in fondness on merely having to care for their kids 24-7.

  7. “The absolutely critical and widely misunderstood point here is that ‘underlying conditions’ are THE only risk that virtually all fatal cases of COVID-19 had in common—not age,” Reynolds writes. “That misunderstanding arose because old people are far more likely to have one or more of these conditions (and because more old people die of this and almost every other fatal risk). But it’s about time to stop echoing the fallacy that this virus kills old people, rather than sick people.”

    • Comorbidity has always been the link between contraction and death.

    • These are excellent points. Coved-19, comprised of several strains, also acts in a way like two illnesses. One that is relatively mild, and often not outwardly discernible at all, in the great majority of infected people; and another that is severe and deadly with a relatively few people. We are making excellent progress in identifying those who are at real risk from Coved-19, by reason of age combined with certain comorbitities, and are beginning now to make significant progress in identifying those at risk severe illness, even death, irrespective of age. But much remains to do. It’s vitally important work that was inexcusably overlooked by the experts for far too long, with disastrous consequences.

  8. On WTOP radio, almost daily, the are giving generic stats about COVID and they say MD is “x”, DC is “y” and Virginia refuses the disclose the data. Most recently the topic was nursing home numbers.

    My ZipCode has a fair number of COVID cases, but we also have our fair share of senior/nursing homes. I wish I knew how many of our ~250 COVID cases in my ZipCode were in senior homes. Then I would know more about spread in the non-group-home community.

  9. The real “Boomergeddon?” Great book concept just too crapped up with stale right wing fiscal tightness? New work, Bacon!

  10. The CDC has a fairly comprehensive outline of how nursing homes can respond to COVID-19. It includes addressing mitigation of staffing shortages and optimizing PPE supplies.

    • They do and they also address specifically COVID19 but their advice to “isolate” in nursing homes that are not physically designed to do that is not easily done especially when the number of infections increases.. it would mean moving people around using the same personnel and one of the fundamental problems is the personnel and where they go when they are not at the nursing home.

      Here’s what I would be more persuaded by. If some nursing homes – where there is COVID19 in the local region – that do not have COVID19 or very little of it. And what they are doing to keep it from getting into the nursing home.

      I do not think implicating all the ones that have infections does much good other than venting…and feeding the “anti” mindsets.

      We need to focus on what is working and get the others to follow those practices rather than playing this blame game.

      This is not one or two nursing homes in one or two states. It’s WIDESPREAD and the simple fact is that nursing homes ARE heavily regulated… and yet whatever is being done is not working.

  11. Bacon. You avoid my point. Dealing with nursing home regulatory failures and the brief delay in opening beaches in Virginia Beach that you and Dougherty have whined so much about

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