Nursing homes, 2020 - pt. 1
Narrative, vs reality: The narrative seems... not only accurate, but understated
The Land Where Nobody Died (after spring 2020)
Last week, I encountered a provocative post by Jessica Hockett, questioning the narrative on nursing home deaths in New York (City, but in the context of Cuomo’s state administration response):
Hockett’s post primarily seeks to question a narrative that has been widely disseminated, if not crammed down our throats for three years; for me, it caused me to realize how little attention the facts behind the narrative have, in fact, received.
What particularly drew my attention were the numbers reported to New York state’s Health Department by 5-boroughs nursing homes (and long term care facilities) from late April, 2020, to present. These numbers quite aggressively understate deaths (even the state’s own government agrees1).
All told, for the nearly 10-month period from April 2020 to February 2021, [New York’s Health] Department failed to account for approximately 4,100 lives lost due to Covid-19 [in nursing homes]
Therefore, there are limitations on interpreting the Department’s own numbers. However, what is striking is that for the 5 boroughs (a.k.a. “New York City”), there were scarcely any deaths, and no waves after early 2020. Total deaths for all five boroughs, before and after June 2020:
For Queens, in an extremely crude visualization with uneven scale on the X-axis:
This stands in contrast to the state as a whole, which, despite being the most “left-heavy” of all the US, and therefore the most traditionally “seasonal” afterward, clearly still had some more “meeting the virus” to do after spring, 2020:
Why don’t NYC nursing homes report deaths after spring 2020?
The obvious answer is, for the opposite of whatever reason the rest of the (state and) country still does:
Rest of the country:
Infection rates extremely low in spring, 2020, as measured by antibodies.
NYC nursing homes
Infection rates nearly 100%, as shown by lack of future waves.
Indirect evidence from New Jersey corroborates this conclusion: Infection rates in nursing homes were close to total; and something around 16% of residents may have died in spring, 2020.2
Narrative (vs. Perspective) vs. Reality
The narrative:
Some states, particularly New York, sent “Covid-19 patients” out of hospitals and back into nursing homes. This prompted huge, crazy outbreaks and resulted in massive deaths. There were body bags piled up as tall as the Empire State building!
Perspective:
It was 2020. The news was trying to make a big deal over the virus that we had all panicked over several weeks ago. Yes, old people died in nursing homes, but this is what old people in nursing homes do. (Until a few days ago, this was my take on the whole question, which is why I never found this controversy very interesting.)
Reality:
Nursing homes in NYC and northern New Jersey experienced a triple-crisis of staff-vectored infections, staffing outages, and management non-communication to outside resources. Between 50 - 100% of residents were infected; staff outages might as well have been total, leaving residents abandoned; and no outside authorities were made aware of the problem until deaths were already inevitable.
“They took our nurse call buttons away. So now you hear residents calling out all night, ‘nurse, nurse…help me, help me...water, water.’”
— Glenn Osborne, Menlo Park veteran’s home resident, April 10, 20203
Gaps in narrative:
Although the scandal of New York’s sending recovering patients out of hospitals was monumental, in a way it served as a lightning rod to defuse attention from the nature and scope of the problem. First of all, it’s not clear that the policy was instrumental in nursing home outbreaks and deaths; second of all, and causative of the first, the nature and scope of infections and deaths in nursing homes seems to never have been adequately investigated.
In particular, New Jersey’s state government has faced no political consequences for early 2020 nursing home resident deaths, despite substantial local media coverage. Whereas Cuomo was (eventually) demonized and ostracized by the media, New Jersey’s geriatric governor and his administration remain unscathed:
On October 1, 2020, Murphy announced he would seek reelection, with Oliver as his running mate. He ran unopposed in the 2021 Democratic primary after two challengers were disqualified. He defeated Republican nominee Jack Ciattarelli in the general election, albeit by much closer of a margin than in 2017, with the reelection campaign mostly being harmed by the long duration of some of the state-level COVID-19 executive orders.4
As another reflection of the scandal’s lack of real scrutiny, the wikipedia page for “Impact of the COVID-19 pandemic on long-term care facilities” contains few mentions of events after spring, 20205 — despite the spectacle of Cuomo’s deposition, no one really has cared about the story of the crisis in care homes in spring 2020.
In the case of New Jersey, despite the stark lack of political consequence for the Murphy administration, the disaster of spring 2020 has been moderately well-dissected, by local media, the state’s contracted assessment with Manatt, and a seroprevalence study. This may make New Jersey a better source of primary evidence for what happened in 2020 than New York; at all events it is where I have focused my research.
In Pt. 2: The legal basis for visitor bans
If you derived value from this post, please drop a few coins in your fact-barista’s tip jar.
Office of the New York State Comptroller, “Report 2020-S-55”: Department of Health: Use, Collection, and Reporting of Infection Control Data (2022, March.) https://www.osc.state.ny.us/files/state-agencies/audits/pdf/sga-2022-20s55.pdf (pdf)
Reviewed in pt. 3.
Duhart, Bill. “34 deaths at veterans home concerns families as National Guard joins coronavirus fight.” (2020, April 10.) nj.com
Thanks for commenting on my post.
You're willing to make some assumptions I am not willing to make. First, that a newly-named virus suddenly started spreading in early 2020 and was the underlying or contributing cause of death for every person in NYC (and elsewhere) with covid-19 on the death certificate. What you see as evidence that the population of NH residents were sufficiently/wholly infected, I see as evidence that the natural course of a virus didn't cause 20K+ people to die there in 11 weeks.
NH residents aside, NYC has 8 million+ people - including hundreds of thousands that fit the profile of susceptibility to death-by-virus. All-cause mortality dropped to baseline and did not rise appreciably (beyond excess) until late December. That's the biggest tell, IMO, that this whole thing makes zero sense and is not the work of a novel virus. And yes, that extends to the tri-state area https://twitter.com/ProfessorAkston/status/1635771595787751424?s=20 Obviously, the more NH residents that died in spring 2020, the more of a pull-forward effect we'd see. So, it's not so much that "the virus" was done with NYC NH patients, it's that those statistically-scheduled to die later in the year were already dead, thanks to human interventions (which were worse in NYC, thanks for hospital protocols and panic than in the rest of the state).
I'm sure we all remember that the drop-to-baseline was hailed as NYC "defeating the virus". Thus, the book, the Emmy, the accolades for Cuomo.
When people look at NYC's outrageous spring 2020 ACM, they tend to say, "Well, that's because Cuomo sent covid+ patients back to nursing homes and killed everyone." My point in the Substack point is that the raw mortality data (specifically Place of Death) don't support that claim. Worse, we still have no idea who all those people who died in NYC hospitals were - including how many were nursing home residents that don't have covid on the death cert. Where is the de-identified death certificate data? Where is the outcry about the astounding hospital CFR (20% - 75%, depending on facility)?
As you note, there's been no accountability for Murphy or other Governors, who all had similar policies about NHs not rejecting admissions on the basis of covid status. (Policies that, by the way, were aligned with CMD and CDC guidance -- not the brainwork of the Governors.)
Covid+ residents were already in the nursing homes. Coming back from the hospital covid+ wasn't a big deal. Neglect, the decision to send people to hospitals in the first place, and the absence of 3rd- party witnesses (in NHs and hospitals alike) were a recipe for disaster. Didn't even need to excuse of a virus for those things to result in mortality.
Whatever people say about Cuomo covering up the numbers, CDC Wonder Place of Death data was always clear about the number of people who died at the nursing homes. The question was -- and is - how many died in the hospitals. NY is still not disclosing the data, and is still giving people the impression that NH residents and nursing homes themselves comprise the lion's share of excess in those weeks, which is false.
I think the grim truth is that NHs have been scapegoated for the non/maltreatment hospitals were following.
P.S. Here's my gauge of NJ's ratio of NH resident deaths at hospitals versus in nursing homes. County-level would be more revealing. https://twitter.com/EWoodhouse7/status/1629164921031098369?s=20
I've seen some of these posts around but I never payed any mind to them since it seemed to be stating something already well-known. I recall the whole Cuomo scandal and even talking to someone about the nursing home debacle months before the news came out (I think because people were "praising" Cuomo at the time for being "not Trump"). I recall several outlets picking it up including maybe Jimmy Dore and Breaking Points but then others did as well. I consider it partially political, but it also went as soon as it came.
I think the attention on Cuomo was exacerbated by the other scandals a la #MeToo, and quite frankly many outlets probably latched onto Cuomo because they couldn't bother to look at other states even though other states appeared to have followed this policy (monkey see monkey do I suppose).
So many things in 2020 seemed to have been the wrong thing to do. The question is figuring out whether it was all intentionally nefarious, intended to increase deaths to make the illness seem more severe and direct public discourse, or if plenty of mistakes were made as well. It seems that the narrative is leaning more towards a wholly nefarious/intentional driver, but I lean more towards a mix.