In early May, I wrote about how poorly the U.S. had protected its elderly, particularly in nursing homes, which it could have done easily and cheaply, slicing the pandemic's death toll in half. A clearer picture of that failure emerged this week... (1/x) nymag.com/intelligencer/…
In Politico, a great piece by @MaggieSeverns looked at one set of nursing homes where things were done right: those run by the California Department of Veterans Affairs. politico.com/news/2020/08/1…
"An average nursing home patient in California is 31 times more likely to die from the coronavirus than a resident of a CalVet home," she wrote—31 times more likely. Meaning the common-sense procedures and protocols of the CalVet homes reduced lethality 31-fold.
This is an especially dramatic effect considering how terrifyingly high lethality rates have been for those in nursing homes, especially those in their 80s and 90s, whose risk of death is perhaps one hundred times as high as someone in their 40s.
At the eight Calvet homes, @MaggieSeverns writes, "among 2,100 residents, half of whom require round-the-clock care, including hospice patients and Korean and Vietnam war veterans with complicated health conditions, only two have died of the coronavirus."
Perhaps even more eye-opening than the CalVet success in preventing deaths from COVID-19 is their success in preventing any infections at all—an almost total quarantine success of the most vulnerable. In total, there have been eight cases in the eight homes.
As soon as the first data from China, we knew how dramatic the age skew of COVID-19 mortality was. But we did hardly anything at all to protect those who we knew would be most vulnerable.
Why? Some said it was too expensive, though it would have been much cheaper to supply PPE and mass-testing capacity to this small fraction of the country's population than to the country as a whole.
(And political objections to medical surveillance would have likely been much less pronounced, given those in nursing homes are already living with medical surveillance.)
Some believed it was impossible, or impossibly cruel, to try to cocoon nursing homes, but the CalVet success shows, at least, that it was not difficult, at all.
All it took was "a rigorous program of testing, contact tracing and encouraging employees who think they may have Covid-19 to stay home from work."
Notably, CalVet didn't seek waivers to allow it to under-staff its facilities during the pandemic, as many other homes in California did, instead simply doing what was necessary to ensure that the fully staffed facility was also fully safe.
This stands in stark contrast to the experience of nursing homes in the country's hardest-hit state, New York.
Here, Governor Cuomo not only extended liability protections for nursing homes (essentially encouraging them to cut corners) but in fact prohibited homes from testing patients being discharged from the state's hospitals before re-admission, seeding homes with the virus.
The result has been 6,600 nursing home deaths in the state. (x/x)
