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
Looking at a local media article from the UK in April '20, one home lost 20% residents in an outbreak and another lost 10%
https://www.liverpoolecho.co.uk/news/liverpool-news/government-said-very-unlikely-care-18100436
So the number of 16% from New Jersey seems quite possible. ISTR I saw an article that said NY simply failed to classify a large number of nursing home resident deaths, possibly as the deaths took place in hospital.
OTOH the Diamond Princess outbreak in early '20 showed that mortality for the over 70s was around 7-9%, but the overall mortality still quite low compared to the early estimate out of China (though the former was ignored and the latter used in the UK to justify lockdowns)
https://cmmid.github.io/topics/covid19/diamond_cruise_cfr_estimates.html
So the narrative is sending “hot” patients back to nursing homes after a positive test contributed to high nursing home deaths. The reality is up to 100% of residents were infected and 16% died.
It seems the reality supports the narrative.
I’d like to see a source for how many were actually infected though.
I’d also like to see all cause mortality in nursing homes in this period compared to a 3 year average. I suspect there may have been deaths due to delays in sending residents out for emergency care to treat their other issues, and deaths due to lack of care resulting from staff shortages