Covid-19 in nursing homes- fatalities seem high

[jim mcnamara]

https://www.kob.com/albuquerque-news/nmdoh-nearly-50-nursing-home-patients-have-died-from-covid-19-in-new-mexico/5715015/
New Mexico(USA) as of 29 April had 48 deaths out of 166 positive tests. All were nursing home patients, and a majority of the fatalities are clustered in two nursing home facilities. They account for 48 of 169 fatalities statewide (~28%) as of April 29.

Washington state has had a similar problem.

Correct me, I think Sweden had some fatality clusters in nursing homes as well. Maybe @DennisN would know.

Anyone seen local data on the observation of other clusters of nursing home fatalities? Or whatever those facilities are called - if they exist.

 

[Vanadium 50]

60% of the Massachusetts fatalities are in nursing homes. Extrapolating from CFR's, that means 95 +/- 10% of the residents have been infected.

NY and NJ numbers are only a little better: around 85%.

 

[Vanadium 50]

In Massachusetts, your odds of dying inside a nursing home are 270x higher than outside.

 

[Mondayman]

Last week the Public Health Agency of Canada said that Covid-19 outbreaks at long-term senior care homes are responsible for 82% of the Covid-19 related deaths in Canada.

 

[PeroK]

In the UK a significant majority of deaths have been in the over 65 and mainly over 75 age group with nearly half over 85. From the Office of National Statistics:

The majority of deaths involving COVID-19 have been among people aged 65 years and over (29,495 out of 33,408), with 45% (13,214) of these occurring in the over-85 age group.

https://www.ons.gov.uk/peoplepopula...articles/coronaviruscovid19roundup/2020-03-26

 

[DennisN]

Correct me, I think Sweden had some fatality clusters in nursing homes as well.

Oh yes.

I don't know the current numbers or percentage, but a month ago our Public Health Agency reported that about a third of Sweden's deaths were people in nursing homes. In Stockholm county the number was about 50%. For source, see this post.

And in this post I posted a recent short interview with Anders Wallensten from the Swedish Health Agency (FOHM) regarding the high number of deaths in nursing homes in Sweden (translated to English).

 

[jim mcnamara]

@PeroK - does NHS report fatalities. categorized so that it is possible to see the effect on nursing home populations?

 

[russ_watters]

New Mexico(USA) as of 29 April had 48 deaths out of 166 positive tests. All were nursing home patients...

Separating that into two sentences makes it read differently than what it is. I think it should be New Mexico(USA) as of 29 April had 48 deaths out of 166 positive tests in nursing homes.

And it makes your question unclear. Are you asking about:

• Death rate in nursing homes per case?
• Death rate in nursing homes vs rest of state?

Others have answered the latter - seems typical - but for the former, the high death rate is likely due to lack of testing. Once the virus has torn through a nursing home, there's no longer much point in testing, especially if there is a shortage of test kits. It also may be some selection bias in that people in nursing homes tend to be in poorer health than average. The opposite of the cruise ship selection bias.

[opinion] Nursing homes tend to be poorly run storage facilities where old people go to be forgotten while they wait to die. Most, particularly those that serve the poor, are just awful. I've heard many stories in the news and anecdotal from my parents' friends about how limited/poor the response has been. Things like continuing communal dining and activities for way too long into the crisis probably caused a significant amount of deaths. They've also gone into public relations damage control mode, where often relatives of the infected are kept in the dark. It's a disgrace.

Bias trigger: my parents were supposed to move into one last month. [/opinion]

 

[PeroK]

@PeroK - does NHS report fatalities. categorized so that it is possible to see the effect on nursing home populations?

I don't know, I'm afraid.

 

[jim mcnamara]

@russ_watters Yes. I was not clear. But some places obfuscate intentionally or unintentionally mortality data.
Pennsylvania apparently has problems like that. Sweden did some things that caused repeated spikes in deaths.

People local to the issues often know how to get around the problems or at least explain them. Example:
Maybe you can explain Pennsylvania reporting. Maybe I am wrong and reporting is perfect there. So help us out

I think the cause of the high mortality in communal homes is obvious a priori. But I used to teach a section on epidemics and infection control - long ago. Unsurprisingly it has not changed much from 1918. Including a mishmash of proposed solutions usually at the political level. Most docs get it.

This is one take on infection control and social distancing in 1918:

C/o Washington Post -> wikimedia

 

[russ_watters]

@russ_watters Yes. I was not clear. But some places obfuscate intentionally or unintentionally mortality data. Pennsylvania apparently has problems like that...

People local to the issues often know how to get around the problems or at least explain them. Example:
Maybe you can explain Pennsylvania reporting. Maybe I am wrong and reporting is perfect there. So help us out

I had some discussion of that issue with someone else in the other thread, and have an update I hadn't yet shared, from a news article on the subject. There's three separate issues that I'm aware of:

1. Privacy protections vary from state to state, and in PA they are more stringent than average, so the data is less detailed. So, for example, we don't know what meat packing plants or nursing homes have had outbreaks because that's protected information. But reporters have gone digging and gotten tips and we have a good idea that we're having the same problems other states are.
2. The ineptitude issue is real. And maybe that's harsh, because unless there is a system in place for sharing this data, then people had to add it to their job/department's function during the crisis. So the data is chaotic in large part because different health departments/agencies are literally sharing spreadsheets back and forth at irregular intervals, in different formats. It feels like it should be easy, but it's not.
3. The testing really is still sporadic, particularly on an institutional level. My county's highest one day infection count came 2 weeks after the "real" peak; it was the day the test results for the entire county's prison population came back.

More detail on the second issue here;
https://www.inquirer.com/health/cor...adelphia-coronavirus-death-toll-20200502.html

 

[mcastillo356]

Same rate of deaths in Spain, focused at Barcelona and Madrid nurse homes.

 

[Vanadium 50]

Nursing homes tend to be poorly run storage facilities where old people go to be forgotten while they wait to die.

Some are definitely like that. Some are not. It is unquestionably better to have money - I recommend taking every 20-something not maxing out his or her 401K to visit both kinds.

The nursing home situation in NYC and NJ is pretty easy to understand. Until 3 days ago, they were required to take in Covid patients. (While they are no longer required to do so, it matters little, because the infection rate is near maximum). This was in response to predictions of millions of deaths and an overwhelming of the entire health system. Since these predictions were off by ~20, if you multiply NY state's rates by 20 you get 6M cases and 400,000 dead. In that environment, they would need every bed.

Of course we know now that 2 million was never going to happen, and this was a very bad decision.

 

[jack action]

This is the one thing I don't understand about what is done against COVID-19: Why bother confining everyone if we don't protect the weak ones?

In another thread, I wrote on Mar 31, 2020:

I'm not saying that we shouldn't care for the weaker members of our society. But I think isolating them is a lot smarter than isolating the rest of the community - that can easily handle the pathogen - essentially putting living on hold. We can isolate them for as long as it is necessary, but how long can the majority stop living?

Governments could have invested so much less money into the isolation of these nursing homes (+ maybe creating some temporary ones for vulnerable people currently living outside those homes) than they did for confining everyone (paying people doing nothing). In addition, they wouldn't have stopped the economy, i.e. keeping the flow of money to help protecting those people. For the rest of us, it would have felt like the flu.

Isn't confining everyone supposed to be done to protect the ones with a weak immune system? These devastating results indicate to me that the measures used failed badly and all of this was done for nothing: they're dead anyway because they weren't protected adequately; as much as the rest of the population is protected way too much.

This is the basic stuff we do for pigs, why weren't we doing something similar for nursing homes?

​

 

[Vanadium 50]

Isn't confining everyone supposed to be done to protect the ones with a weak immune system?

It's not clear what the goal is. "Flatten the curve" PSAs are still running, but we are well past that.

We need to look back at the situation in mid-to-late March when the edict was made. At the time, 2.2M deaths was the number being bandied about, and people skeptical of that number were labeled "Covid deniers" (But a few weeks before that, the message was "don't worry, be happy"). At that level - about 20x worse than we will ultimately see - the NYC hospital system will be a could hundred thousand beds short. So nursing home beds were an important resource to deal with this wave.

You are right that a better strategy would have been to turn our nursing homes to fortresses. The purpose of isolation is to keep the infected and uninfected populations away from each other, but we have spent a tremendous amount of effort keeping uninfected people away from other uninfected peopled while at the same time failing to keep infected people away from the most vulnerable.

 

[russ_watters]

It's not clear what the goal is. "Flatten the curve" PSAs are still running, but we are well past that.
[snip]
The purpose of isolation is to keep the infected and uninfected populations away from each other, but we have spent a tremendous amount of effort keeping uninfected people away from other uninfected people...

"Social Distancing"(isolation) is a tool and "Flattening the Curve" is a goal -- they are different things, so I don't think it matters for this discussion that "Flattening the Curve" was poorly defined. The purpose of social distancing on a nuts and bolts level was to keep people of uncertain infection status away from other people of uncertain infection status at a time when testing was woefully inadequate and contact tracing futile*.

That said:

...the NYC hospital system will be a could hundred thousand beds short. So nursing home beds were an important resource to deal with this wave.

You are right that a better strategy would have been to turn our nursing homes to fortresses.

In what universe would the idea of purposely putting known infected people into populations of uninfected people be a logically sound idea, especially in light of the nuts-and-bolts function of social distancing? It's basically the exact opposite of what you're after. Is it "well, at least they're already in a hospital?" Leaving 10% (guess) of nursing home beds unfilled while hospitals are overwhelmed is a lot better than adding 10% sick and creating another 60% sick in the nursing homes.

What a spectacularly stupid idea.

*I still think manual contact tracing is futile due to the incubation period.

 

[Vanadium 50]

In what universe would the idea of purposely putting known infected people into populations of uninfected people be a logically sound idea, especially in light of the nuts-and-bolts function of social distancing?

You'll have to ask the decision-makers that. But I wonder if it is an over-reliance on models and an under-reliance on critical thinking: "Our models show a lot of beds opening up 2-3 weeks after sending patients to nursing homes. Yay!"

 

[Evo]

Nursing homes aren't hospitals, most are nothing more than places with beds and cleaning people, maybe one nurse. My father's mother was in one due to being a quadraplegic and only survived as many years as she did (died at age 94) due to my mother going there twice daily to feed, clean and turn her. The workers were worthless, and it wasn't cheap. My parents moved her several times due to unsanitary conditions.

Of course the more you spend the higher level of care you get, but these places wouldn't be the ones getting the patients forced on them.

Also, I have an issue with "65" being considered an age at which people are at high risk and should be written off. You can't even retire at 65 anymore and they're talking about raising the retirement age again. I don't know where this magic "65" number is coming from. I personally know someone who is 65 and was told they had the Coronavirus and had virtually no symptoms aside from some nausea, diarrhea the week before and a fever of 102-103F for a few days the following week, yet much younger, stronger people have been hospitalized and even died.

 

[bhobba]

But I wonder if it is an over-reliance on models and an under-reliance on critical thinking: "Our models show a lot of beds opening up 2-3 weeks after sending patients to nursing homes. Yay!"

You think so? Here in Aus the latest scandal is a nurse of all people that went to work in a nursing home while waiting for results of a Covid test. After taking the test you sign a form you will self isolate until the results come back:
https://www.abc.net.au/news/2020-05-18/rockhampton-nurse-coronavirus-positive-investigation/12257130

And then we have the premier of our state, that calls itself the smart state, when interviewed about the response, having to be told what an asymptomatic case was, and then saying - I will look into it. Lack of critical thinking - sure - but likely well beyond that into the realms of stupidity and a total absence of basic scientific knowledge. Our premier is no dummy - she is a very well qualified lawyer. Interestingly she bought in a law saying you must do English (it's a combination of English Literature and Communication) or English Literature in grade 11 and 12 because of its critical importance - before you just had to do a short course demonstrating proficiency at about grade 10 level. I would like to debate her on that one eg England only requires English O levels, which is equivalent to our grade 10, to get into universities over there. IMHO critical thinking and research/communication skills are much more important.

Thanks
Bill

 

[bhobba]

This is the one thing I don't understand about what is done against COVID-19: Why bother confining everyone if we don't protect the weak ones?

That one has been bought up many times. Near as I can figure it, administratively it would be a nightmare, and even though the majority of deaths is in the at risk population, like the flu, a small number of seemingly very healthy people still die. You would not put the vulnerable into nursing homes - they would be better dispersed throughout the community because nursing homes are like a ticking time bomb. Those already there you can't do much about, but certainly those in the community are best left there. Then in order that they remain isolated you will need an army of people to bring them food, take them to doctors appointments etc. I am in that group and there is some support available along those lines - but nowhere near enough. For example we have what is called meals on wheels - but guess what - they do not operate on weekends. The whole situation is disjointed like that and it would need a complete overhaul. A lot more trained staff would be necessary. It could be done of course, but it would be a lot of work. What in Aus we are now doing seems to be working OK, but is expensive. I think at least here in Aus there is a view of why tinker with what is working. Still we need to be very carefull about ensuring nursing homes are safe.

Thanks
Bill

 

[russ_watters]

Brought in from the other thread:

But let's look at the situation in the Four States listed above and nursing homes. The vulnerability of the elderly to Covid was well-established. The fact that individuals had Covid was known. And yet these people were deliberately moved into nursing homes. Around half the deaths in the Four States were in nursing homes.

My state wasn't on your list, but is adjacent to the Four States and also had high fraction of its deaths in nursing homes. I'm not sure if that was the policy here, but I don't think so.

I remain dumbfounded by the stupidity of the policy, but at least today it is reversed: prior to being moved into such a facility, a negative test is required. My parents just moved into theirs a couple of weeks ago -- I'm still nervous about it, despite the improvement in the situation.

 

[Vanadium 50]

I picked four states by sorting by death rate and adding states until I had a 50-50 split. The next ones are Rhode Island and DC. (The first non-contiguous entry)

 

[Vanadium 50]

And the nursing home rates are truly horrific. If you take the deaths in these states, and divide by the mortality rate for the age distribution in nursing homes you get an infection rate close to 100%.

 

[mcastillo356]

In Spain the word is chaos: a state of total confusion with no order. No quorum about covid-caused deceases in old people's homes; what person, or persons, decided not to carry to hospitals the covid-affected old people.

 

[OmCheeto]

I find it interesting that so few old people live in nursing homes.

ref: https://www.census.gov/prod/cen2010/reports/c2010sr-03.pdf

I'll have to research this further, to see how this skews the statistics.

 

[Vanadium 50]

how this skews the statistics.

How can it skew the statistics? The data is what it is.

Now, if you want to use this data to predict some other quantity, you need to correct for various factors. But you would have had to do that anyway.

 

[mcastillo356]

As I see, he/she, means, with the word "skew"; what he/she seeks is to use these others words: nuance, contribute, complement, enrich... Or simply add, attach.

 

[Vanadium 50]

Again, I don't see how his surprise at the data is anything more than surprise at the data. (An experience I know well).

 

[mcastillo356]

I find it interesting that so few old people live in nursing homes.
I'll have to research this further, to see how this skews the statistics.

OmCheeto, interested in your words. Skew?

 

[russ_watters]

OmCheeto, interested in your words. Skew?

He probably just means "affect". Like; we discussed how nursing homes are death traps for COVID (particularly in states that purposely sent infected people to them), but since a large majority of the elderly don't live in nursing homes, how does that affect the death rates? Are the nursing homes housing the least healthy? Also, it isn't clear to me how those statistics define "nursing home", and if multi-level continuing care centers such as the one my parents just moved to are categorized differently. I would think so.

 

[mcastillo356]

Hi russ, I think OmCheeto is trying say... I don't know. It's him who has to explain his opinion. He has only pointed out one fact about the elderly. Let's wait for his explanation.

 

[Vanadium 50]

Are the nursing homes housing the least healthy? Also, it isn't clear to me how those statistics define "nursing home",

There is a continuum from "community for active seniors" through "assisted living" and "nursing home" and finally "hospice". I suspect there is not a universal line one can draw around any of these.

 

[Vanadium 50]

After some thought I suspect that this is done by licenses - it's well defined, but not defined the same way everywhere. Probably 50 different definitions in the US.

 

[OmCheeto]

How can it skew the statistics? The data is what it is.
...

Good point. Perhaps what I meant to say was; "I'll have to research this further, to see how this skews my perception of the situation."

 

[mcastillo356]

skew: to cause something to be not straight or exact; to twist or distort.
e.g.: These last minute changes have skewed the company's results

Good point. Perhaps what I meant to say was; "I'll have to research this further, to see how this skews my perception of the situation."

My point of view: the infection fatality rate is the rate of fatality per infection; it's a concept, a fact, that is straight, exact per se, by or of itself. Skew is to cause something to be not straight.
Nobody's perception should be affected by maths. Maths shows us, in this case, a fact. Hence, any elderly ifr is straight wherever elderly is at. Hope to have been reasonable. Greetings, anyhow, to those trapped at nursing homes, or elderly who are not at home, but some other strange place. Woldwide.