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)
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
Does this correlate with all-cause mortality? At the moment I don't intend to look at the question. I mean if you literally send Mongols to raid nursing homes, would that increase ACM? It's not clear. But there would still be a lot of murders.
Excellent points; analyzing the data arising from this pandemic has been tortorous for many reasons, and despite that reality, most observers eagerly jumped to a preferred conclusion while simultaneously dropping any consideration that other elements might have played a part.
This frantic urge to grasp onto a single paradigm is antithetical to free speech, science, economics, geopolitics and history (not to mention epidemiology), but hyper focusing is typical when faced with existential uncertainty.
The NE nursing home outbreak dynamics are a good microcosm of the larger confusion about the origin of the pandemic; the lack of specific information allows for almost ANY potential explanation to be persuasive, and the Uber-stressed populace makes for fertile ground for psychological " immune imprinting'" (ie a tendency to latch on to the first potential explanation that one encounters, which leads to pathological resistance to further paradigm shifts, whether needed or not).
Given the quantity and scope of the unanswered questions that remain, it is painfully ironic that the term "scooby doo" has been used as a metaphor to describe those who cannot see the logic of the pandemic as nothing but an illusion. If anything, the formulaic endings are a reminder that we should never roll the credits BEFORE removing the mask.
Why?
Because we don't know how many episodes we have left to learn these lessons - and we can't afford re-runs.
Right - it's fertile grounds for jumping to conclusions. The problem is that the next step - ok, what does my conclusion about these deaths here predict I should see elsewhere - doesn't happen. If it was just disruption of care, the deaths would be everywhere. If it was depriving people of "three pills," you would be able to look at reports of deaths and see they didn't get antibiotics (but they all did). And etc. A mixed model is going to be best. Disruption plus virus plus mistreatment.
I admire your consistent adherence to critical analysis, even though I've disagreed with several of your perspectives over time. In every case, your observations required me to conduct further due diligence or consider the same evidence from the perspective of someone else.
I've been proud, as a non-scientist, of being able to put in enough work to credibly interact with my fellow DRASTIC members, or investigators, or RFK, etc on this topic (and soon to testify under oath). It has taught me a lot about scientists, however.
You're one of the most open-minded people I've seen throughout this process, and by that I mean most wiling to allow the evidence to guide your perspective above all else.
I think it would be fruitful to connect, as I can certainly provide some context on current events/findings, and vice versa.
The flaw in your logic here is that the same level and kind of "disruption of care" and "treatment"/non-treatment occurred everywhere - which it did not.
My advice to you is to learn how to query CDC WONDER.
Well - I know how to query WONDER, but it's not a crystal ball. That said, what I have used WONDER for is to support the case that the virus caused both sustained and wave-associated elevations in deaths coded for circulatory system, so it's not immediately clear what I am missing from WONDER.
I'm mostly trying to perform an analysis with the nursing home deaths that builds on my previous work, I'm not trying to debate or defend my whole gestalt at the moment, nor detract from yours, and as a consequence I haven't given all your points the attention they would require *if* that were my current goal.
Disruption of nursing home visits is a universal disruption of care, so there were lots of place where the same "agent" did not cause the same "disease" (NY/NJ level spring death waves), so the point is simply that other stuff is needed. This isn't a wild conclusion.
Mistreatment was sporadic and the facts are poorly recorded. My point is just that most theories of "they just did X and regular pneumonia became deadly" can be refuted by showing people died without X.
For the very greatest part, just give ordinary people clear, relevant, transparent and timely information, and let them figure out the nuances for themselves.
Do not heavily rely on 'too big to fail' bureacracy with the typical top down one size fits all; their output is often a study in groupthink, deferent relationships, and self interested salesmanship.
I agree with this, though I don't mind owning "let it rip" - it is my opinion of what should have been done. We are humans, this is life, sometimes we will get sick, it isn't supposed to be any other way.
Those two places had minimal lockdowns. Masking has been shown to have negligible effects. Vaxx efficacy...? not much, probably. I guess there are still quibbles.
I guess you could look at Bulgaria or sub-Saharan Africa. Harder to do apples-to-apples. But many rural places in the US and elsewhere (India?) basically had none of those three variables, and didn't seem to suffer much for it.
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.
It would seem that John Beaudoin's work on the Massachusetts death certificates could be key in this context. My impression was that he ascribes very little if any of what was classified as covid mortality to actual covid
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.
The most notable other states are Michigan and California. However, they did not have as much community spread, and so not as many worker-vectored nursing home outbreaks. The likely difference was that B.1 already had a foothold in NY/NJ imo.
It's always a mix. But it's important to recognize that it's a structured mix. It's not random.
In "Hanlon's Razor" terms, sufficiently clever, well-placed, and well-organized malice on the part of a small minority of actors can instrumentalize the incompetence or stupidity or mere moral disorientation of a majority of highly conscientious but largely unaccountable mid-level actors. And then the malicious "drivers" get plausible deniability, a la "mistakes were made".
This is such an old pattern, it's been refined to an art. I would argue that many of our institutions have been gradually restructured to facilitate these kind of operations. Healthcare and journalism, certainly.
"I would argue that many of our institutions have been gradually restructured to facilitate these kind of operations. Healthcare and journalism, certainly."
If not all of corporate America. Just a conformity cult.
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
That’s not what DP shows, for anyone who has actually examined it. PANDA will be posting an article about that soon
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
Part 2 was going to review evidence from a seroprevalence study; that will now be Part 3. But you can preview the math at the "New Jersey estimated IFR" sheet if you want https://docs.google.com/spreadsheets/d/1PyCFqcu9QjMEuifnBGnrc6RHhMtzXCigMEKKuFT29Ms/edit?usp=sharing
Does this correlate with all-cause mortality? At the moment I don't intend to look at the question. I mean if you literally send Mongols to raid nursing homes, would that increase ACM? It's not clear. But there would still be a lot of murders.
Excellent points; analyzing the data arising from this pandemic has been tortorous for many reasons, and despite that reality, most observers eagerly jumped to a preferred conclusion while simultaneously dropping any consideration that other elements might have played a part.
This frantic urge to grasp onto a single paradigm is antithetical to free speech, science, economics, geopolitics and history (not to mention epidemiology), but hyper focusing is typical when faced with existential uncertainty.
The NE nursing home outbreak dynamics are a good microcosm of the larger confusion about the origin of the pandemic; the lack of specific information allows for almost ANY potential explanation to be persuasive, and the Uber-stressed populace makes for fertile ground for psychological " immune imprinting'" (ie a tendency to latch on to the first potential explanation that one encounters, which leads to pathological resistance to further paradigm shifts, whether needed or not).
Given the quantity and scope of the unanswered questions that remain, it is painfully ironic that the term "scooby doo" has been used as a metaphor to describe those who cannot see the logic of the pandemic as nothing but an illusion. If anything, the formulaic endings are a reminder that we should never roll the credits BEFORE removing the mask.
Why?
Because we don't know how many episodes we have left to learn these lessons - and we can't afford re-runs.
Right - it's fertile grounds for jumping to conclusions. The problem is that the next step - ok, what does my conclusion about these deaths here predict I should see elsewhere - doesn't happen. If it was just disruption of care, the deaths would be everywhere. If it was depriving people of "three pills," you would be able to look at reports of deaths and see they didn't get antibiotics (but they all did). And etc. A mixed model is going to be best. Disruption plus virus plus mistreatment.
I admire your consistent adherence to critical analysis, even though I've disagreed with several of your perspectives over time. In every case, your observations required me to conduct further due diligence or consider the same evidence from the perspective of someone else.
I've been proud, as a non-scientist, of being able to put in enough work to credibly interact with my fellow DRASTIC members, or investigators, or RFK, etc on this topic (and soon to testify under oath). It has taught me a lot about scientists, however.
You're one of the most open-minded people I've seen throughout this process, and by that I mean most wiling to allow the evidence to guide your perspective above all else.
I think it would be fruitful to connect, as I can certainly provide some context on current events/findings, and vice versa.
Chrixey@protonmail.com
PS - I can also provide some context on DEFUSE, having been the person to whom the documents were given.
The flaw in your logic here is that the same level and kind of "disruption of care" and "treatment"/non-treatment occurred everywhere - which it did not.
My advice to you is to learn how to query CDC WONDER.
Well - I know how to query WONDER, but it's not a crystal ball. That said, what I have used WONDER for is to support the case that the virus caused both sustained and wave-associated elevations in deaths coded for circulatory system, so it's not immediately clear what I am missing from WONDER.
I'm mostly trying to perform an analysis with the nursing home deaths that builds on my previous work, I'm not trying to debate or defend my whole gestalt at the moment, nor detract from yours, and as a consequence I haven't given all your points the attention they would require *if* that were my current goal.
Disruption of nursing home visits is a universal disruption of care, so there were lots of place where the same "agent" did not cause the same "disease" (NY/NJ level spring death waves), so the point is simply that other stuff is needed. This isn't a wild conclusion.
Mistreatment was sporadic and the facts are poorly recorded. My point is just that most theories of "they just did X and regular pneumonia became deadly" can be refuted by showing people died without X.
You're right - it's not a crystal ball, because it doesn't show the future. It shows the past.
You're missing county level by Place of Death (hospital inpatient, hospital Outpatient/ED, Decedent's Home, etc.).
There's a good amount of real-time documentation of what was going on in hospitals. https://twitter.com/EWoodhouse7/status/1631509533565628417?s=20 Nursing homes, less so.
But again, my contention is that many of the NH resident deaths in spring 2020 occurred in hospitals, not in NH facilities.
Begs the question, is this what it would have looked like if we'd let it...rip?
'Letting it rip' is more of a Fauci court and media promulgated false dichotomy.
Please explain
For the very greatest part, just give ordinary people clear, relevant, transparent and timely information, and let them figure out the nuances for themselves.
Do not heavily rely on 'too big to fail' bureacracy with the typical top down one size fits all; their output is often a study in groupthink, deferent relationships, and self interested salesmanship.
I agree with this, though I don't mind owning "let it rip" - it is my opinion of what should have been done. We are humans, this is life, sometimes we will get sick, it isn't supposed to be any other way.
IMO, it was already in circulation, “ripping” for many months (if not years) doing not much of anything
Florida? Sweden?
I mean, let if we had let it rip sans lockdowns, masking, and vaccinations.
Those two places had minimal lockdowns. Masking has been shown to have negligible effects. Vaxx efficacy...? not much, probably. I guess there are still quibbles.
I guess you could look at Bulgaria or sub-Saharan Africa. Harder to do apples-to-apples. But many rural places in the US and elsewhere (India?) basically had none of those three variables, and didn't seem to suffer much for it.
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
It would seem that John Beaudoin's work on the Massachusetts death certificates could be key in this context. My impression was that he ascribes very little if any of what was classified as covid mortality to actual covid
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.
The most notable other states are Michigan and California. However, they did not have as much community spread, and so not as many worker-vectored nursing home outbreaks. The likely difference was that B.1 already had a foothold in NY/NJ imo.
Most notable states in terms of...?
Also, it would be helpful if you became familiar with how to use CDC WONDER.
County level and place of death are key to mortality analysis.
It's always a mix. But it's important to recognize that it's a structured mix. It's not random.
In "Hanlon's Razor" terms, sufficiently clever, well-placed, and well-organized malice on the part of a small minority of actors can instrumentalize the incompetence or stupidity or mere moral disorientation of a majority of highly conscientious but largely unaccountable mid-level actors. And then the malicious "drivers" get plausible deniability, a la "mistakes were made".
This is such an old pattern, it's been refined to an art. I would argue that many of our institutions have been gradually restructured to facilitate these kind of operations. Healthcare and journalism, certainly.
"I would argue that many of our institutions have been gradually restructured to facilitate these kind of operations. Healthcare and journalism, certainly."
If not all of corporate America. Just a conformity cult.