Canada fact of the day

Nursing homes account for 81 percent of the country’s covid-19 deaths, according to Theresa Tam, Canada’s chief public health officer, a far greater proportion than in the United States.

Here is the full story.

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I blame Cuomo

The human brain on the drug known as culture war.

I find it oddly gratifying to have my own personal yippie dog troll

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Brazil fact of the day: We beat Italy and Spain! I don't mean football!

well obviously not football

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American fact of the day
mister rogers was from canada

Fred Rogers is from Pennsylvania. His first TV show was produced by CBC in Canada, but it wasn't called "Mister Rogers' Neighborhood" -- that was the title of the show he started after moving back to Pittsburgh.

I'm afraid the US gets full credit for Fred Rogers and Mister Rogers' Neighborhood, even if Canada helped get his career going.

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Cuomo botched this in NYC. The important thing is to let the nursing homes protect their own.

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What fraction of the Canadian cases is he responsible for? In the US, it's 65%.

https://www.nytimes.com/2020/05/07/us/new-york-city-coronavirus-outbreak.html?action=click&module=Spotlight&pgtype=Homepage

It would not surprise me to find that many of the Canadian cases also stem from New York.

Prepare to be surprised...
https://www.forbes.com/sites/victoriaforster/2020/03/06/most-of-canadas-recent-new-cases-of-covid-19-are-linked-to-the-us/#5ec65a465886

We should have built a wall to keep out the people from that shithole country to the south. - A Canadian

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First the borders were drawn at the airports. Then the borders became the perimeters of each household so the unemployment rate increased. May be the borders should be the perimeters of the LTC homes and that might be the easiest and best border.

Yes, sad, they are a Petri dish and the problem got attention late instead of early. Too focused on the mechanics and optics of a national lockdown that didn’t help.

There is no way for you to prove lockdown didn't help. Just saying often enough doesn't make it true.

No, no, no- it is the lock down proponents that have to prove it worked. That the detractors are now being asked to prove it doesn't work basically is an admission by the proponents that it, in fact, didn't work.

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But if we did that, how would we fulfill our pathological desire to express our authority over the commoners via petty and arbitrary tyranny while also making them dependent on our bloated welfare state and punishing Orange Man and his supporters?

In which the crinkle of tinfoil is heard.

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Wow, I knew nursing homes were being hit disproportionally but I wouldn’t have guessed it was that bad. This does suggests though that Canada did a pretty good job at minimizing virus deaths in the general population, especially considering that overall per capita deaths in Canada are only about half of what they are in the US.

This also suggests an alternative theory for why Western countries have been hit substantially harder than non-Western countries: a much larger percentage of old people in Western countries live in nursing homes.

Any analysis that tries to talk about per-capita rates or severity ratios has to run the gauntlet of faulty and unavailable testing here.

Suffice to say, comparing states, let alone nations is a minefield.

Not to mention the range of approaches and timing of approaches.

Apples to apples data is probably years off, and the US will never really get decent data on some questions, due to the poor testing regime.

But the nursing homes are where the vulnerable are.
You seem to argue they did a pretty good job at protecting the not vulnerable.
nursing homes were the obvious place to protect. Focusing on something else was not particularly helpful.

In answer to Zaua, sorry

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Some places were pretty quick to shut down visitors, but I think many were slow to stop "circuit riders" of various sorts. By that I mean not just medical staff, and support, but also external service providers which could visit multiple senior centers in a week.

I mean, even when covid-19 was getting big in Las Angeles, we saw minibuses bringing elderly shoppers together to Costco. In a worst case scenario they were picking up seniors from multiple centers and distributing them again.

When the article talks about 80 nursing homes in a region all having deaths, I don't think it's likely they all gained infection independently.

I think the centers were too connected. Maybe the Canadian system in particular rotated staff too much.

This is accurate. Our largest province, Ontario, about a month ago banned staff from working in more than one nursing home. Probably too little too late, but we had workers travelling between clustered groups of vulnerable people...

They also got rid of a policy requiring nursing home to take new residents who had tested positive, which was just insane. Canada and Ontario have done a pretty good job overall, but the nursing home policies were crazy. D minus on that front.

Sorry, my last post is not a good summary. Here's the story:

https://www.theglobeandmail.com/canada/article-ontario-places-pause-on-transfers-from-hospitals-to-seniors/

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In partial apologia for Zaua's comment here, depends a bit on whether we are optimizing for deaths overall, or quality/disability adjusted life years. Care home residents tend to be very sick, even compared to a community age matched samples, or least have a very sick subpopulation within them that's probably receiving the brunt of this. But those people wouldn't have lived long and certainly not in good health. If we calculate by lost years of healthy life expectancy, the weighting is very different on care homes vs community spread among healthy middle-aged people.

That said, obviously, there is no inherent trade-off, and I would tend to agree that focusing on these all-or-nothing, politically divisive national lockdowns, which probably did not flatten the curve or limit community spread very much compared to personal responsibility and distancing advice, as a panacea seems in hindsight a bad move which distracted from this problem.

I don't think the general public had any awareness of how sick, on average, people in homes were and so how bad the infection-fatality rate would be in carehomes, even compared to an age matched community samples (where it's like 10%, but it must be a few times that at least, in care homes residents). The popular image is very much people who are as healthy as their age matched fellows in the general community, probably because out of sight and out of mind, but it's really not the case.

It’s a novel virus. There’s no need to give up easily on these people and think oh well, they’re just too fragile anyway.
The nursing home environment promotes contagion. It’s also flu and pneumonia in normal years.
The methods to fight the pandemic matter to the final result. In Italy they shoved anyone with symptoms into the hospital. This infected ambulance drivers, health care workers and more people.
This idea of a national lockdown but there’s no attention paid to the 50x or 100x more vulnerable is not sensible

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Canada's overall death rate is also lower than in the US. it's not that MORE nursing home patients are dying it's that fewer middle-aged adults are dying.

No. They did the standard lockdown but didn’t get the standard result. All countries with a similar lockdown had problems with nursing homes. On the US east coast it was up to 50% deaths from nursing homes . In Europe it was 30 to 60%
https://amp.theguardian.com/world/2020/apr/13/half-of-coronavirus-deaths-happen-in-care-homes-data-from-eu-suggests

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Canada did worse than 35 of the 50 US states so far.

That doesn't tell me anything. Is Canada worse or better?

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Cherry picking. How did New Mexico do compared to Saskachewan?

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"Nursing homes account for 81 percent of the country’s covid-19 deaths, according to Theresa Tam, Canada’s chief public health officer, a far greater proportion than in the United States."

I suspect that if you remove the deaths in the New York metro area from the figures, the percentage in the US would probably be around 60 to 70%. Outside of New York and New Jersey, the numbers seem to indicate that the majority of deaths are occurring among nursing home residents. Pennsylvania, for example: https://triblive.com/news/pennsylvania/pennsylvania-reports-61-more-covid-19-deaths-989-more-cases-69-of-deaths-linked-to-nursing-homes/

As in many things, New York City is an outlier in North America.

New York isn't including nursing home residents who died at the hospital in their numbers, unlike other states (https://time.com/5832141/new-york-nursing-home-death-toll/):

"But just how many nursing home residents have died of COVID-19 remains uncertain despite the state’s latest disclosure, as the list doesn’t include deaths of nursing home residents at hospitals or any details about the number of COVID-19 cases at individual nursing homes."

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UK was high as well. This is a nosocomial disease. Countries that protected their elderly and sick did not have an epidemic. Example: Japan.

Or, countries that are more willing to report nursing home deaths as covid19, have a higher rate of covid19 deaths (Belgium, UK etc). Maybe the miracle of Japan is just that they don't report nursing home deaths as covid19.

Still would see it in excess death figures and I think we don't?

Since we see not-explosions most everywhere explosions were predicted, Japan is probably just a case of early advice, and the population taking the threat seriously* being very effective to lead to social distancing, and then social distancing (plus some masks) being very effective.

It may have ironic consequences if lockdowns have created pent up demand, and encouraged some to engage in social "closening" as an act of rebellion or protest, while diluting this basic message.

*No NYT-likes claiming Corona concerns are less important than minimising any anti-Chinese backlash (which matters a lot when all the elite class read the NYT), no business that pushes media and lobbies to try to avoid losing pennies of lower footfall and doesn't see the much larger sums lost in true epidemic...

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At first, I read the sentence as being critical of the US, especially since it appeared in the Washington Post. I thought the point was that deaths in the US weren't limited to the elderly in nursing homes. After reading the article, I think the sentence was meant to be critical of Canada's poor job in protecting nursing homes.

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Imagine how many lives could have been saved if only we had encased the olds in bubble wrap when we had the chance instead of wasting resources chasing college kids out of parks and off of beaches. Our regulatory state capacity libertarianism is failing us!

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If such a large proportion of deaths are among nursing home residents, how, concretely, could we protect them?

Lots of PPE for workers and vendors? No visitors? Lots of testing of workers and residents? Retrofitting HVAC systems with special filters? Masks for residents and social distancing among them?

Sooner or later the lockdowns will end, in which case the virus should spread pretty steadily through the general population. It would be good to have a plan to protect the most vulnerable that amounts to more than a hope and a prayer.

A few simple things.

Not have staff go from facility to facility. The severity in Canada can almost be plotted on when this was implemented. BC very early on, Ontario very late.

Tracking staff. In BC almost all the cases in care homes were brought in by workers either themselves returning from travel or someone in their entourage.

Protocols and information dissemination. The care homes had clear protocols and active communication in BC. They knew what to do.

In case of infection some kind of response. In BC if there is an infection in the care home, action is taken by the health authorities to limit the spread.

No visitors.

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In the UK care homes officially account to about 45% of all deaths, in Scotland - also around 45%.

In Spain - 67% (!!).

This is probably the biggest lesson for us from 2020 - how appalling standards of care and hygiene are in nursing homes in 21 century.

And lets not forget centres of contagion - hospitals. How this is even possibel that so many medical staff got infected.

In Russia for example due to absence of care homes, main centres of decease are hospitals.

Why would this be news? There have been literally decades of news reports of horrible conditions in nursing homes in the US, and poor hygiene at hospitals was such a big problem at US hospitals that an important part of Obama’s Affordable Care Act was putting in place a payment system to punish (or reward) hospitals based on hospital acquired infections.

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I think the real issue is that people in nursing homes are by definition at the end of their lives. They are in such bad condition that they can no longer stay at home. I doubt anybody ever chooses to go to a nursing home. So combine poor health with not wanting to be there in the first place, and yeah, any particular virus is going to be a problem. This one happens to be highly contagious. I think other, more familiar viruses would be just as bad if they were more contagious. In some respects this is all caused by the miracle of life-extending drugs. A few decades ago people wouldn't live long enough to get to a nursing home.

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Differential hit in care homes between countries is probably one of the ongoing issues with calculating population general IFR even from a relatively large scale healthy sample. Spain's recent serology suggested 1.1%, but that probably de-trends down once adjusted for the proportion of deaths in care homes (67%) and care home residents in general population.

(Not that this would seem to matter too much for policy at this stage, unfortunately it's likely close enough to IFR = 1% that this is workable enough to use?).

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To be clear, a significant percentage of the dead are staff at the nursing homes. Casual and infrequent contact is a low risk; close and frequent contact is a high risk. Designing effective public policy without an understanding of the risk is like asking a blind man to describe the Mona Lisa.

That would be helpful to see your numbers on this. Considering the caregivers tend to be in their 20s and 30s and the clients are in their 80s and 90s, I have a really hard time thinking your "significant" number is very high. Makes no sense.

Related - https://www.bbc.co.uk/news/health-52616080

2x as likely as general working age, but...

-Care workers possibly likely to be older than general working age pop
-2x zero (or a very low number) is still zero (or a very low number)
-deaths among medics same as gpop in UK... casts significant doubt on exposure/load based theories btw
- infection rates in care homes probably higher than community, death rates not necessarily higher than age matched group with same level of infection

So all in all i'd guess ray is wrong and won't have much evidence (but what's new about that?).

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Here's an idea: read Cowen's link.

Says only that a high proportion of staff at outbreak facilities are sick, which probably means infected, not even hospitalised, not dead. Which would highly unlikely given everything we know about the mortality profile of disease.

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Quality of facility, staff and overall care vary more widely in nursing homes than in hospitals. In the US some are poorly staffed both in numbers and quality of staff. Many of them had almost no PPE available. In some nursing homes the staff just refused to come to work. If we had a couple of years to prepare and were willing to spend a lot of money we might have been able to make our nursing homes much safer. Since we didnt have that time, and we would not have been willing to spend money ahead of time for something that was only going to happen once every 100 years, the next best option was to keep the infection rate lower in the general community.

Steve

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This does rather seem to skip a step.

1. a high proportion of the dead are in nursing homes.
2. a high proportion of dead are elderly
3. ....

The real problem is that the elderly are not more likely to get the disease than the average person, but that our response to covid (and the nursing home infrastructure in Canada) seemed almost designed to ensure that the elderly *in nursing homes* were disproportionately *infected* with the disease.

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the harvard sociologists are underrating the potential for non geriatric covid 19 morbidity & mortality

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I also intepret the data as saying Canada is doing a great job. If-you want to minimize the number of lost life-years , then the more skewed the age distribution is towards the very old, the fewer total lost life years you are going to have. The elderly in nursing homes weren't going to live much longer anyway.

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It's 70% in Ohio. But don't worry, our governor came out with new rules today about batting cages!

https://www.beaconjournal.com/news/20200521/coronavirus-nursing-home-deaths--account-for-70-of-all-covid-19-deaths-in-ohio

https://twitter.com/GovMikeDeWine/status/1263532677061369856

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Our online payment gateway is an independent platform for providing safe and secure payment processing for PSP /ISO and merchants.

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