The case for reopening schools is compelling. We know that for children, the risk of dying of #COVID19 is lower than that of dying of influenza in normal years. And we have a lot of European experience at this point that schools can be reopened without damaging public health.
That doesn't mean we go back to pre-pandemic normalcy. We'll have to protect teachers and staff from infecting each other, just as in any other workplace, and provide virtual and microschool opportunities to students who can't attend traditional schools. freopp.org/reopening-amer…
If you want to understand what's going on with #COVID19 right now, the best place to look is Florida, because they do the best job of anyone in terms of data transparency. Note the different age distributions of cases, hospitalizations, & deaths in their regular report.
The full report is here: floridadisaster.org/globalassets/c…. The point is that not all hospitalizations are the same. If you're 85 and you've been hospitalized with #COVID19, the risk of death is 61%. If you're 35-44, the risk is 5%. If you're 25-34, 2%.
So, when you see reports about rising numbers of hospitalizations, it's critical to ask: what's the age distribution of the people being hospitalized? We talking about elderly or young people? Without that information, "hospitalizations" statistics are far less useful.
THREAD: You've probably heard of that 2000 @WHO study ranking health care systems in 191 countries. In it, the U.S. placed 37th, behind Oman (8), Colombia (22), Saudi Arabia (26), Morocco (29), and Costa Rica (36). It's frequently cited as to why the U.S. should go single-payer.
Well, this week @FREOPP is premiering the World Index of Healthcare Innovation, our answer to the @WHO rankings. We rank 31 high-income countries, and not just on universal coverage, but also science & technology, patient choice, and health outcomes. freopp.org/wihi/home
The @FREOPP World Index of Healthcare Innovation is in fact the first comparison of national health care systems to explicitly take science & technology and patient choice into account in its rankings. It should go without saying that these are important. freopp.org/wihi2020-505b1…
New @FREOPP: The share of U.S. #COVID19 deaths occurring in nursing homes & assisted living facilities has gone up to 43% in our latest scouring of state data. freopp.org/the-covid-19-n… That means that the share of June COVID deaths in long-term care facilities is even higher.
Remember that only 0.6% of Americans live in long-term care facilities, and yet they account for 43% of all #COVID19 deaths. In New Jersey, 11% of all nursing home & assisted living facility residents have died from COVID.
Here's how the map of LTC deaths as a share of LTC residents looked on June 1:
The most important #COVID19 statistic for thinking about our public policy response is that 43% of all U.S. deaths have taken place among 0.6% of the population: those who live in nursing homes and assisted living facilities. forbes.com/sites/theapoth…@Forbes
To those asking about NY: I do discuss, in the article, NY's massaging of the numbers by not counting deaths in hospitals of nursing home residents. Key question for comparing NY to other states is: how many (and which) other states do the same thing?
The first map is the key map in terms of understanding the problems with a one-size-fits-all lockdown approach. Any approach to reducing #COVID deaths that doesn't make long-term care facilities its first priority is, at this point, not serious.
Remember that only 1.8% of U.S. residents live in nursing homes or assisted living facilities, and yet these facilities have tallied 42% of all #COVID19 deaths.
I've updated the map a second time to reflect new information out of Ohio (h/t @patpaule). Ohio added nursing home & assisted living deaths before April 15 to their totals, which now means that in Ohio, LTC facility deaths are 70% of all #COVID19 fatalities.
@GovRonDeSantis@RichLowry@RonDeSantisFL So many great insights in the @RichLowry piece. DeSantis’s team actually prioritized sending PPE to nursing homes over sending PPE to hospitals, recognizing that nursing homes were seeding the outbreak that would lead to hospitalizations.
Another piece: Florida’s experience with natural disasters meant that it had a lot of reporting/data infrastructure in place already, including daily reports from nursing homes, assisted living facilities, and hospitals.
New @FREOPP: There is no request I get more often than to compare the risk of fatality from #COVID19 vs. the flu by age bracket. So I’ve put one together, assuming 150,000 deaths from COVID vs. the 2007-17 average from influenza & pneumonia combined. bit.ly/2LBmtll
@FREOPP Assuming 150k #COVID19 deaths (the IHME mid-range estimate today), children are at much lower risk of dying from COVID vs. influenza or pneumonia. For those over 25, the relative risk is higher of death from COVID. But the *absolute* risk doesn’t get high until age 65:
If you’re looking at the first chart I posted (the one with the blue bars), a longer bar is “good” (i.e., relatively low risk of COVID death vs. influenza or pneumonia). A shorter bar is “bad” (relatively higher risk of COVID death). But absolute risk is most important.
Great thread on a theme I've been hammering home in Congressional remarks and other forums this past week. People are *way* overestimating the willingness of 2 million Americans per day to get 6-inch nasal swabs sent up their nostrils to comply with a population testing regime.
And this 2 million number I'm using is not arbitrary. It's from a recent @HarvardEthics paper arguing that we should continue to lock down the economy until we deploy 2 million RT-PCR tests per day. ethics.harvard.edu/Covid-Roadmap
We should certainly test as many people as we can, with a special focus on high-risk populations (nursing homes, first responders, etc). But population-wide #COVID19 testing should not be the threshold for economic reopening. freopp.org/a-new-strategy…
Our updated map @FREOPP compiles deaths from both nursing homes and residential care homes as a share of COVID-19 deaths, as that is what states are reporting. 39% of all deaths are taking place at these facilities; 49% if you exclude New York state. bit.ly/2WBk7Ih
@FREOPP Hardest-hit states re nursing homes & residential care homes are MN, RI, NH, PA, NE, VA, WA, MA, OR (colored blue on the map). Underlying data is here: bit.ly/3bnPNG8
A lot of people are speculating that NY state’s numbers are so low because NY counts as a hospital death a nursing home resident who dies in a hospital. We haven’t confirmed that this reporting approach is unique to NY.
When can social distancing end? The key: we need widespread testing, probably at a scale that is greater than South Korea (6000 per 1MM residents vs. 150 for US). Greater because Korea is able to leverage those tests with GPS/smartphone tools we won’t/can’t deploy.
Korea takes the GPS data from an infected patient’s phone and notifies everyone who was physically near that patient of that fact, for example. We won’t do that. Hence we probably need at least double the penetration of testing (12k/1MM residents, or 4MM tests) to get there.
It would obviously help if we can focus testing in areas with serious outbreaks (NY, FL, New Orleans, Seattle).
According to @axios, Bernie Sanders plans to use the Senate reconciliation process to push through Medicare for All, Green New Deal, free college, etc., and have his VP overrule the parliamentarian if needed to get it done: bit.ly/2OT5CMQ
@axios This kind of stuff has made me skeptical of polls showing that Bernie has a general election lead over Trump. In a general election, the most irresponsible and unpopular aspects of Sanders’ agenda and history will be litigated. Much of it is being ignored in the primaries.