Nursing Homes and Covid-19- the state affairs- thank you @JonLemire for taking time to discuss this topic @MSNBC @WayTooEarly a long 🧵 that I start with a picture from a NH in rural Michigan: yep, thats right- 14 staff out with covid-19 infections.
2/ A series of Graphs with situation today: data from @CDCgov illustrating cases by vaccine status-

clear decoupling among those w/ boosters vs not boosted

cases of vax but not boosted quite close to unvax-this is unadj data but reflective of highest efficacy of 3rd dose in NH
3/Next up-cases-data lag by about a week, but state data which maps to experience in many states-note Michigan data below followed by national trend-note low case counts this past year=vaccine.vaccine.vaccine
4/ Nursing Home Hospitalizations- also on the rise-harder to get granular data on % of hospitalizations from Nursing Home residents, but it is a growing share. Equally growing-->pressure to ACCEPT covid+ pts to NH but lack of hosp capacity/staff has forced hands of many states
5/Nursing Home Deaths-always the last to rise, but trends are NOT good, appear to be rising above #s seen in delta surge. Controversy exists over deaths to date in nursing homes (largely undercounted):…
6/Now on to even more bad news- cases and deaths amongst staff- almost 2500 deaths- this is probably the most under-reported statistic- also a couple of weeks old so actual # is higher. Majority of staff are female, over 50 and black. source:
7/ More on Deaths amongst Staff from CDC: below are unadjusted rates, but useful to see the uptick in trends- again, after lower rates earlier in year as part of delta surge. Some of these deaths are still delta to be sure.
8/why are hcw esp in nursing homes refusing the vaccine? not for the reasons you might think-top reason is:
1⃣vaccine cynicism- initially vax were rolled out too quickly, not enough data but now that viewpoint has morphed to sentiment they dont work/e.g see breakthrough rates
9/ More disturbing news: according to a survey profiled in this excellent @19thnews article in JULY 2021, only 1 in 4 nursing homes thought they can survive in a year (which is in about 6 months):…
10/ but lets go beyond statistics and maps:

I used to work inside of nursing homes/stopped bc I got pretty frustrated/easier to feel I could make a difference in the hospital/clinic setting

here is a glimpse of what it is like to be a nursing home resident now from @Altarum :
11/ here is what women who work in nursing homes tell me:
1⃣ they are so short staffed, they are just trying to make sure residents can get to the bathroom/get 3 meals
2⃣ average pay $14.82/hr -->not enough to pay bills
3⃣ they lack infection control/fear getting sick

and why so many nursing home residents still unboosted? majority of nursing homes have less than 50 beds, are small esp rural ones and lack pharmacy infrastructure to vax/ large retail pharm either not able to come in like they did earlier in pandemic or simply not enough
America has always had a problem with how our we treat our elderly (average age of resident: 85 yrs). we dont want to think about:

who will help turn us in bed to avoid bedsores

clean us after we urinate or defecate

who will feed us when we cant feed ourselves
so what can we do?

for starters, pass #BuildBackBetter which has significant funding for $1 billion in workforce/infection control improvements. So lets actually start there

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More from @kavitapmd

18 Feb 21
Thread on Variants- building on excellent work cited by @DrEricDing @CarlosdelRio7 @BhadeliaMD but I am trying to distill it for mere mortals (me+my mom) (1/n)

B117 (from UK):
1. in 42 states but really everywhere (see @CDCgov page here):…
B117 (2/n)
2. People infected have higher viral loads (likely making it more transmissible)…
3. has mutated in a bad way-evidence of the E484K mutation which is in the SA and Brazil variants-possibly making it even more problematic:…
B117 (3/n)
4. 73 people introduced variant into the US and NY was a hub (no surprise) but again this is an undercount most likely:…
5. here is a pattern of the travel from UK showing likely hubs of spread:
Read 10 tweets
16 Feb 21
Agree that COBRA subsidies will likely not survive the Byrd rule along with a number of other provisions like vaccine funding/discretionary spending; get familiar with Senate Parliamentarian Elizabeth MacDonough, first female in that job, named to the office by Sen Reid (1/n)
The Senate Parliamentarian imho is one of THE most powerful positions in the Congress-past Parliamentarians have been fired bc their rulings have rubbed 1 party or the other the wrong way-something we might see if her ruling does not sit well with Dems. (2/n)
What this will force depending on her assessment of whether provisions are extraneous (and honestly my rule of thumb for Byrd is whether the provisions seem discretionary vs mandatory or are considered outside of nl appropriations cite territory)is for Sanders/others (3/n)
Read 4 tweets
16 Feb 21
2/15: Federal Xchange open for a special enrollment period-in most states you have until May 15 to try and get health care-many will qualify for subsidies including millions being able to have fully subsidized health insurance. Important first step but more needs to be done (1/n)
Paul Starr describes what we are in as a policy trap-referring to the "creation of a costly, inefficient system of health insurance that satisfies enough individuals and powerful stakeholders to neutralize an effective constituency for change" h/t Dr. Mical Raz (2/n)
Employer sponsored insurance is the trap with costs disguised as premiums subsidized by taxpayers and lost wages. Yet we (incl me) are tethered to this and it is seen as a reward for hard work also furthering the notion of individual responsibility (3/n)
Read 6 tweets
23 Aug 20
Thread of how we got to the point where the President is accusing FDA of being part of the Deep State. And why its shameful that neither the Secretary of HHS/FDA Commissioner/Director of the NIH have not vocally and frequently defended their agencies. (1/4)
(2/4):Hydroxychloroquine:3/30-EUA for HCQ issued with questions raised by sr staff about political pressure to approve drug prematurely. 4/8-POTUS said "what do you have to lose?" followed by warnings by MDs about deadly cardiac effects. 6/15: EUA revoked 7/28-Trump defends HCQ
(3/4) 2 days ago: FDA v HHS on LDT (lab developed tests)-great thread by @ASlavitt on this, but HHS pulled FDA's authority to review LDT. Making this more confusing was 2/3/20 CDC test EUA which had significant issues along w sense that FDA approved poor performing COVID tests
Read 5 tweets
24 Jun 20
(1/5)Breakdown of some dynamics resulting in today's headlines around single day record of COVID cases (over 36k since 4/25. Drivers are multifactorial, but there are a few themes which are making this more difficult than we thought.
(2/5)1. Stay at home orders generally work, particularly when reinforced at national level; Curves were flattened and pressure to reopen too early won/no masks/inadequate testing/tracing/isolation support leading to community spread
(3/5) Additionally, data supports a higher number of young adults (as high as 60% of new cases in some regions)accounting for the numbers. But being young does not mean you are invincible; in TX/FL some hospitals reporting up to half hospitalized for COVID <50
Read 5 tweets

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