Fairfax County fact of the day

Fairfax County Health Department responded to my request for nursing home/longterm care facility deaths from COVID-19. As of May 22, there have been 249 coronavirus deaths in these facilities. That’s ***75 percent*** of all Fairfax County deaths from coronavirus as of today (330)

Here is the link, via Alex T.  For epidemiology, shouldn’t those numbers be in a separate model altogether?

Also, it would be very interesting to test the performance of the private sector vs. public sector institutions here.

Comments

I would prefer my county have had no deaths at all.

No deaths would have been difficult to achieve, but based on what other countries have managed under 1,000 seems reasonable.

So you tanked the economy, possibly for years to come, and screwed over the younger generation to save demented nursing home patients whom probably had life expectancy <5?

Fuck you Boomers, you cannot die fast enough. You will go down in history as the worst, most selfish generation in history.

The dude claiming his life is worth more than those we lock up in homes after they raised us is calling someone selfish, haha.

It's often the guys who complain about spending "other people's money." Now they demonstrate their commitment to higher values with "kill grandma."

Or they are paid Russian, Iranian, or Chinese trolls. Granted though that this is like shooting fish in a barrel, which is why it is so easy for foreigners without cultural competence to fake.

I kind of figure MR would be below the Real Authentic Russian Troll (TM) radar. But..

https://www.forbes.com/sites/andrewsolender/2020/05/22/bot-army-behind-reopen-america-push-on-social-media-study-finds/

Something weird is going on.

Twitter has bots.

Someone call Alex Jones

Are you a bot?

Why do you consistently align with the "decline of America it's completely normal?"

So much American exceptionalism here with jingoistic talking points: If you criticize the US, you must be a...sounds like some 2003 neocon BS.

Race relations and the generational divide has never been a problem in the US until Russian Trolls.

I also remember Iraq, Syria, Libya, Vietnam, Venezuela, Russiagate, and many other hyped up junk.

As boomers like to say (or at least do), f*ck them kids. But I welcome a 2nd opinion from the harmful MSM monoculture that brainwashes our at risk and real time mentally decaying boomer population - ie Biden (and Trump to an extent).

Mueller needs to investigate this too!

“They called me mad. They called me insane. They called me looney. They were right!”

suspect
cnn.com is where americans get most of their russian &fbi misinformation

Real talk: if Biden does lose, which there is a distinct possibility with the familiar, 'don't vote for me, since I'm entitled to win' strategy, I guess there will be external bogey man to blame, and it will NOT take the form of self-introspection (again).

Baby boomers are not quite 80 years old yet.

That's who the virus likes to kill.

Oh dear, nursing homes. Canada, 81%, Minnesota, too, just as bad (a well-run Viking state?).
A few years ago I had a little assignment re nursing homes. People do best (mortality adjusted for existing conditions) in the religious non-profits. Next best is the non-religious non-profits. After them are the homes run by publicly traded companies, and highest mortality is in homes owned by private equity funds. The mortality outcomes parallel their use of sedating drugs -- the religious nonprofits use the least. When PE firms take over nursing homes, they lower staffing ratios and average wages.
Mortality is lower in nursing homes generally during recessions, and higher during booms.
There was a big flurry of publicly traded nursing homes being taken over "private" by the PE funds in the oughts. It seems one motivation was to separate the operating company from the real estate, isolating the real estate from operating liability.
FHA insures mortgages for nursing homes, (232 and 232b programs) but requires the homes to carry high levels of liability insurance. The insurance companies impose standards. Why is FHA involved? It seems their influence is salutory. The "customers" are frail and uninformed. If your nursing home has a mortgage, but no FHA insurance, worry.
Surely by, oh, next week or so some group of energetic researchers will have a paper on coronavirus deaths by the nature of ownership interest.
There is a very elegant "old folks home" next to Stanford, now called the Vi. Originally it was built by the Hyatt hotel chain. It is not a “rental” model, but “buy-in”. It is full of stanford faculty and other affluent, well-educated people. It was taken over by private equity, who promptly paid themselves a huge dividend out of the reserves. Litigation is ongoing. The residents were shocked. Two members of the organization, one nobel laureate economist and another hi-falutin, had reviewed the contract and pronounced it ok. Maybe if you want a contract evaluated, a contract lawyer is better than an economist, no matter how high prestige. The same PE outfit has litigation going on the same issue all over the US.
Not all nursing homes have had such bad outcomes with the Virus. The California VA homes, run by an old military doc, are a bright spot. Why only the LA Times reports this?
https://www.latimes.com/california/story/2020-05-10/coronavirus-california-veterans-safe-homes
And Hong Kong has done well also, also due to leadership with pandemic experience.
https://www.theguardian.com/world/2020/may/19/mps-hear-why-hong-kong-had-no-covid-19-care-home-deaths

"... the most selfish generation in history."

Yeah, that's true about most of my peers. They also screwed THEIR kids lives so badly that none of their children want to live anywhere near them.

For some reason, though, all of our children - and our grandkids - live near-by.

Perhaps you can ask the dead broke - now mega millionaires - Clinton's about their parenting methods.

You're one of the good ones. It's those other Boomers that are destroying the country.

I'm not a boomer, but I'll say when the boomers were 20 and 30 years old they worked hard and mostly did the right things and pushed the country forward.

Today's millennial, however, are unbelievably selfish and the very definition of "me me me" while doing nothing to move the country forward and wanting everything for free.

Wind the clock forward 50 years on millennials and they will most certainly be 100X worse than the boomers. You can bet on it.

When the boomers when younger they established the culture of divorce, out of wedlock childbirth, and drug use that still are among the biggest problems in the country. They certainly didn’t do the right things. And please note I say this an atheist and person who frequently votes for democrats, so this isn’t some sort of argument about not following biblical norms.

Fair point, but the % of boomers that lived by the points you describe was a solid minority--maybe 10%. Let's call those permissive values a "me first" mindset--if it feels right, you do it.

I'm guessing the millennials today are upset at the "me first" boomers and not the silent majority types that worked hard and raised families.

If 10% of the boomer generation is of the "me first" mindset, today's millennials are probably 60-80% of the same "me first" mindset they abhor in their elders.

When boomers were 20 and 30 years old they lazed into an easy union job and got houses. College degrees were rare then, the geopolitical worked in their favor. Millennials at the same age got stuck with six figure student loan debt, sky high real estate, and must compete against the Chinese and Indian globalized labor force. All this while being forced to pay for the 2008 bailouts and again forced to close their businesses to save nursing home boomers.

Of course they will be 100X worse off. Likely an order of magnitude higher.

> Millennials at the same age got stuck with six figure student loan debt, sky high real estate, and must compete against the Chinese and Indian globalized labor force.

They didn't HAVE to take on the 6-figure student debt. You can easily live at home and attend a state school on a $12/hour fast food salary and graduate with zero debt.

The average house size in 1950 was 950 square feet. In 1960 it was 1100. In the 70's it was 1350. And by the 2000's, it was 2320. You can find a 1000 square foot house in Witchita, KS for under $90K. Zillow has dozens. You can buy the home your dad likely grew up if you earn about $17/hour. That's hardly a disaster.

And I'm not sure the Chinese and Indian workers are that big of a threat unless you had aspired to work in a factory with very little automation. Nobody in China is taking a $30/hour job from a US worker. Yes, they have taken the $8-10/hour factory jobs. But like picking lettuce, our young people have already decided they won't do those jobs no matter what.

When boomers were 20 and 30 years old they lazed into an easy union job and got houses.

What nonsense are you talking about?

We Silent Generation in the flyover states graduated from college into the Rust Belt.

Outrageous inflation.

My SIL who is 5 years older had a 13% balloon mortgage and lost her home. We had a 13% unsecured loan in ‘90. Our first home mortgage was 7.75% and we were happy.

My grandmother had a 16% CD.

Your anger is clouding the reality for millions of us.

As a baby boomer here are my stats and rambling thoughts: Grew up with loving parents, they made it up to the 10th grade. Father enlisted before WW2 started and fortunately was stationed at the Panama Canal. They provided a stable home and foundation for my brother and sister that I am very ever thankful. Anyways I started college at a Junior College like a lot in those days, then graduated with Econ and Math degrees, followed by a MA in Econ, which was not the smartest thing to do. Paid all of my college expenses with summer and school jobs. Then got a job for 40 or so years also married, house and family. A lot of my generation did that, others started out in Vietnam (LBJ's war) and came back dead or wounded for life. On the plus side my generation mostly did not have to deal with globalization (greatest piece of BS passed on by Nobel prize economist) that destroyed many middle income jobs, only had to worry about the cold war. We still had some semblance of a traditional home life, which is not to be denigrated. But no one ever wanted to deal with the cost of aging, Medicare, Social Security etc. Planning for the future was not my Baby Boomer's generations goal. So the millennials has to pay for these programs and globalization that robs American jobs. Also the slow destruction of the American Culture that very few want to admit, that will have dire consequences, if not attenuated. Actually feel sorry for what millennials have to deal with. So in closing the Baby Boomers, or those that avoided Vietnam, benefited from the greatest generation, we did work, but did not save. So we are passing on the cost of our living our golden years to the millennials. BTW when I ask you Millennials for help on my I Phone don't be so smug, you didn't have to schedule a time to run a computer program at 3 am. So in some ways your life is better.

This whole generational warfare business is incredibly small-minded. If nothing else, do you at least respect soldiers, cops and firefighters? If so, the non-millenials in these occupations are all old enough to start getting bad backs and knees and being unable to run up a few flights of stairs without getting out of breath. Who did you think did these jobs in the year 2020?

Boomer soldier, cop, firefighter: Enough pensions to bankrupt city/state/nation

Millennial soldier, cop, firefighter: What's a pension?

> Boomer soldier, cop, firefighter: Enough pensions to bankrupt city/state/nation

It was a small minority of boomers, overwhelmingly blue-city boomers, that got those things.

Everyone else knew it wasn't right to demand a 6 figure pension for jobs that could be learned in a few days.

Not many Boomer cops and firefighters (the youngest of whom are in the their mid-50s) are running up flights of stairs, and if they are still working rather than collecting fat government pensions, they are senior managers sitting at their desks.

Young Gun Summer

I'm not sure what you mean by "private sector" versus "public sector" institutions. Do you mean privately owned versus not-for-profit facilities? If you are asking me, the one distinction that may matter is whether the facilities accept Medicare patients. And that is because I suspect that the reason that many facilities accepted the COVID patients is because the vast majority of facilities (both privately owned and not-for-profit) accept Medicare patients discharged from hospitals. And that in turn is because these Medicare patients are usually quite profitable. Just FYI, and not sure this helps.

Medicare only pays for short term care (90 or 120 days) in Skilled Nursing facilities. Medicare does not pay for long term custodial care, assisted living, or memory care. The facilities are not profitable - see they recurring failures of the operators over the last few years.

Medicaid pays (not much) for custodial care for indigent patients. Minimum staff and facilities. Again, not very profitable.

The term Nursing Home is very generic, and can apply inconsistently to a range of elder care facilities. Some facilities have beds paid by both private and public sources, and some even provide both skilled and non skilled care. Lots of confusion in how the data is presented.

Well put. And even within a category, there's a range of amenities and costs, at least for long-term care. It's like looking for "an apartment"; you want to shop around and take a tour before you decide if you want to live there, or have your parent live there.

Accepting Medicare plus Medicaid is a matter of having 10 people filling a facility or 100 people.

If profit means paying customer, then Medicare is "profitable".

If profit is the revenue not paid to workers, Medicare is not very profitable. Medicare economic profits are transitory at best, with Congress and State legislators good at digging into books and cutting payments to limit economic profits as well as "management" employment rents.

The last profit opportunity was intermediate care rules in the 90s to cut the cost of rehab by moving patients out of $1000 a day hospital rooms to $500 a day facilities. After Medicare billing grew much faster than projected, the payment were cut to $400 in line with "nursing homes". Dollar figures illustrative based on my sister's explanation if her employer's rapid growth, then bankruptcy restructuring. She worked doing data analysis for the rising star managers running first the new industry Congress created to cut costs, then the restructuring after Congress fixed their failure to see how profitable cost cutting is. She's now working for the unprofitable corporation that is able to pay workers, service debt, pay high cost manager comp for a much smaller number, plus pay market returns to shareholders, from mostly government payments with some private payments.

They got rid of facilities in States with high Medicaid populations and rock bottom Medicaid fee schedules.

At least, an epidemiologist would connect the dots between these two observations.

May 24 - As of May 22, there have been 249 coronavirus deaths in these facilities. That’s ***75 percent*** of all Fairfax County deaths from coronavirus as of today (330)

May 21 - Latinos make up 16.8% of the county’s population, but account for 62.7% of the diagnosed Covid-19 cases. And if you assume that perhaps lower-income Latinos are less willing or able to go to a doctor, the true percentage of the Latino cases may be higher yet.

This being the sort of connection that only a low GRE scoring public health expert would be using a comprehensive model for, instead of using separate models altogether.

In my state, there were competing pressures regarding nursing home discharges. The initial models showed hospitals potentially getting overwhelmed, so in the exponential rise phase there was a lot of pressure and messaging to get patients out of the hospital and to clear beds for the anticipated surge. This meant cancelling clinic and elective surgeries to save PPE, staff, and hospital space.

A big driver of avoidable excess hospitalization is patients "bed blocking" waiting for placement into a nursing home. Some of them were covid positive (recovered but still "potentially" transmissible or persistently PCR positive) while others were covid negative. Understandably, nursing homes across the board in my state put up a big roadblock by refusing to accept these patients. We were desperate to free up hospital space. Eventually, at a high enough price one nursing home converted an entire wing to cater for convalescing covid+ patients, isolating them and the staff working there.

"Eventually, at a high enough price": thank God, a rational use of the price mechanism.

So the models regarding hospital capacity were not just wrong but disastrous, potentially causing most of the deaths in the US this far. What a ghastly failure of expertise.

The crony champion of artificial scarcity, the medical industry, is back at it again helping to ruin America. They deserve to get steamrolled by Medicare for All.

how the heck did you come to the non satirical conclusion that
"models regarding hospital capacity were not just wrong but disastrous, potentially causing most of the deaths in the US this far?

I think he meant the "hospital capacity models" overestimated the need for available beds for Covid, and so forced out existing Covid patients back into the nursing homes which became the main Covid death-traps.

lets jab a razor in the "models" for the moment.
the whole point of the national quarantine was to separate
the infected from the most vulnerable. with the medical information available 2 months ago, sending infected patients to uninfected nursing homes was a bigly avoidable mistake.

It's easy to look in hindsight, but the thinking at the height of the pandemic is that it's better to be prepared than not to be. Furthermore, we ended up with a safer discharge plan than most states by converting entire blocks of nursing homes to a covid specific wing and isolating them from non-covid patients in the same facility. Ideally there would be state-driven efforts to turn nursing homes into pure covid convalescent/isolation places, at least for the duration of the pandemic.

A proper model would take account of lots of different inhomogeneities in the population. Nursing homes are an extreme inhomogeneity because "distancing" is difficult between patients and impossible between patients and staff. But they're not truly separate, which is precisely the problem.

A superabundance of (properly used) PPE would have helped greatly, but that would probably have required government to do something useful instead of just playing Nurse Ratched by barking virtue-signaling orders to maximize psychological suffering in order to conspicuously display "sacrifice" "together".

Even in our litigious society, it's hard to imagine that the required enormous and constantly-expiring inventories of PPE would have been maintained spontaneously and privately over decades, for a then-hypothetical scenario. Heck, simple surgical-style masks of the sort that people wear on the train in Japan in a normal flu season are around 50 cents each there, but *still* not widely available here. Never mind complex PPE.

Of course it's also hard to imagine government doing anything useful instead of flailing around - as with the not-invented-here syndrome that badly delayed the start of testing. Bureaucrats much prefer to sit around idly and self-importantly.

And so it goes.

Maybe we could pay some staff to stay living isolated in the nursing homes for a couple of months?

have paid*, I mean, while the low-risk group built herd immunity.

Douthat's column today is about "new world order paranoia", which has been given "new life by the response to the coronavirus, which is being cast as a pretext for some sort of one-worlder takeover — with Bill Gates and Anthony Fauci held up as potential masterminds, “test and trace” as a scheme for permanent surveillance." For the less conspiracy minded but equally demented, "the pandemic lockdowns are an expression of late-stage liberal cosmopolitanism, of the liberal technocrat’s obsession with physical health and state control." For the more evangelically oriented, like Douthat, "late-stage liberalism is obsessed with health and state supervision for the purposes of personal liberation, pleasure-seeking, tourism and commerce. In other words, hedonism. I'm not all that familiar with what goes on in nursing home/longterm care facilities, but I doubt it's hedonism. If somebody has to suffer for the sins of late-stage liberalism, why the poor bastards in those places. Cowen's comment ("it would be very interesting to test the performance of the private sector vs. public sector institutions") seems to suggest that the sin isn't hedonism but creeping socialism in late-stage liberalism.

One joke goes that Gates created the coronavirus so that we *all* have bad haircuts.

But seriously, I don't think this means hedonism:

"In reality, late-stage liberalism is obsessed with health and state supervision for the purposes of personal liberation, pleasure-seeking, tourism and commerce."

It can mean just good old pursuit of happiness.

Huge yikes

Yikes is right - " state supervision for the purposes of personal liberation" Penitentiaries house the freest of all of us.

So it did not occur to either of you that a properly run CDC would be better for our pursuit of happiness?

Is that why you prefer to criticize the CDC, rather than demand better In This Moment?

Yet again,

https://www.amazon.com/dp/1324002646/

I'm with you on a properly run CDC, but that's a far cry from state supervision. You could argue that the CDC has been too involved with state supervision at the expense of being properly run.

Right, but "state supervision" is often just headlights on card.

It's not the CDC that is responsible for the nursing home fiasco. Why aren't you demanding that Cuomo and Newsom do better to Meet This Moment?

“They called me mad. They called me insane. They called me looney. They were right!”

maybe academics are myopic.
nobody spotted any of rices tells?
try free eye test no.3
spot douthits psycobabble

Not sure why you threw shade at him. CA is doing quite well with this thing.

Well, it was said "freedom is just another word for nothing left to lose".

Fortunately, Douthat's view is not that lockdowns are "an expression of late-stage liberal cosmopolitanism." He ascribes that view to R.R. Reno, who asserted in a tweet that he apparently (and wisely) decided to delete that it is an act of "cowardice" to engage in social distancing and mask-wearing in public in order to minimize the possibility of asymptomatic transmission to others. Reno (temporarily?) went off the deep end but I'm relieved to see Douthat not debasing himself in hypocrisy.

suspect douthat fraughted
When he misdiagnosed healthy scepticism of the elite with "new world order paranoia"
harvard sociologists live/love to make
fake psychiatric diagnoses

Willie Sutton supposedly said he robbed banks because "that's where the money is". Well, covid-19 deaths cluster in nursing homes because that's where the old people are. Duh.

We don't need a different model, we need to study commonalities of super-spreading behavior. My theory is super spreaders are People Who Shout: healthcare workers greeting hard-of-hearing seniors, a young Korean man circulating in noisy bars, an infected family member trying to be heard at a birthday party. Maybe the best advice the CDC could give is "don't raise your voice until we have a vaccine".

Someone seems quite eager to demonstrate why economists should not be doing epidemiology or modelling pandemics. Hassett was more than bad enough.

Hassett’s “model” is a stock Excel function

Nate Silver, a professional builder of quantitative models, immediately (and, as it turns out, presciently) guessed/joked that the story of Hassett’s model was that he plugged some numbers into an Excel file and then had the computer draw lines until he got an optimistic forecast.

I would bet $538 that the White House's "cubic model" is literally just an MS-EXCEL trendline with a third-degree (cubic) polynomial. https://t.co/TvrHm25dB6 — Nate Silver (@NateSilver538) May 5, 2020

vox.com/2020/5/8/21250641/kevin-hassett-cubic-model-smoothing

I have no idea which model was the best, but I do know the optimistic forecasts have fared much better than the pessimistic ones.

Hassett's model prediction according to that Vox link - “people with knowledge of that model say it shows deaths dropping precipitously in May — and essentially going to zero by May 15." About 11,000 Americans have died from covid19 since May 15, and the current average seems to be around a 1000 dead Americans per day over the past week.

And since the beginning of April, the American death toll per week has been greater than Richard Epstein's prediction of of 5000 total dead Americans.

Modeling something with variables that are affected by behavior changed through the model will always produce a range, from a worst case scenario and a best case scenario, both unlikely to occur. Which, to a major extent, is the purpose of such modeling - to attempt find the best courses of action to achieve the best result within the circumstances that the model is intended to reflect.

Hassett's and Epstein's models were wrong in a way that did not lead to a better result in any sense.

This might trigger a few here: "President Trump was skeptical of both those numbers, particularly the WHO’s estimate: “Well, I think the 3.4 percent is really a false number,” Trump told Sean Hannity. “Now, and this is just my hunch, and — but based on a lot of conversations with a lot of people that do this. Because a lot of people will have this and it’s very mild. They’ll get better very rapidly. They don’t even see a doctor. They don’t even call a doctor. I think that that number is very high. I think the number, personally, I would say the number is way under 1 percent.”

Several studies have suggested that Trump was right. But, now here’s what the CDC is saying about the fatality rate the coronavirus:

0-49 years old: .05%
50-64 years old: .2%
65+ years old: 1.3%
Overall ages: .4%"

The real number, from what it looks like today, was off by 9x.

https://pjmedia.com/news-and-politics/matt-margolis/2020/05/22/the-cdc-just-gave-us-the-biggest-reason-to-end-the-coronavirus-lockdowns-n417178

Hassett's model is off by every Americsan that has died since May 15 of covid19, and all those Americans that will die in the foreseeable future.

Epstein's corrected model is off by 20x - and growing.

In both cases, those two men were worse than Trump at predicting the course of the pandemic.

Not easy to model, but Hassert is off by 12% (to date) and the CDC will be off roughly by 90%. Not sure how Hassert's the one losing this fight.

This is a catastrophic failure in the public health administrations.

Lots of things to go wrong here. Start with a vulnerable population. The cases in British Columbia care homes were started by workers returning from travel. The situation was made worse by workers moving from facility to facility.

I found out the other day the strategy in my area, which wasn't put into effect because we didn't have any cases.

There was a facility set up with the ability to do infection control within. Anyone with symptoms were moved to that care home, then tested. If they were clear, they were moved back into care homes.

This starts with the reasonable assumption that most places would be incapable of dealing with an infection, which seems to have been proven beyond a reasonable doubt.

Other things were put in place to prevent problems; staff testing, no visitors, and a pretty strict infection control within the facility for staff. These are private and public facilities.

I suspect that the focus on primary care facilities drove the failure of elderly care homes.

"The situation was made worse by workers moving from facility to facility."

I've thought about this as well. I think it is the most tragically unanticipated complication to the whole thing. Even people trying to do good things, visit to play music, or visit with the dog, will visit multiple sites in a month.

Let’s put them in a separate model... we can call it the purge. We will count them as worth far less than more productive humans, like all the unborn children we murder so we can continue to go out drinking on the weekends.

It’s quite a sentiment to be like, whew... 75% of the deaths are just our grandparents we tuck away in homes so we don’t have to take care of them.

My thought this morning is that many people must have really bad family relationships.

I mean seriously, to have no one above 60 or 70 that you value?

The average person who dies from the Wuhan Flu is 82 years old.

Your response to this is throw millions of 20-year-olds out of work.

Now you want to claim that "the problem" is poor family relationships.

Go eff yourself, you blistering moron.

To show them how much we care, let’s send Covid patients back to the nursing homes to kill tens of thousands of them.

Then we’ll lockdown the rest of the economy while we do it

You do realize that all of these deaths of elderly people are occurring during shelter in place orders for everyone? So making separate models taking into account the large relative risk for the elderly is an attempt to get policy makers and politicians to actually do something to protect the elderly, in opposition to the crappy job we have been doing so far.

For example, how many states secured or setup facilities to quarantine nursing home residents with a positive Covid test or symptoms away from the other nursing home patients? How many setup testing regimes to frequently test nursing home workers? How many secured ample supplies of PPE for nursing home workers?

Conserve supply for nursing home workers? Madness! All PPE must go to doctors and medical professionals. All of it. Non-negotiable. They are our heroes. Once doctors are satisfied with PPE we can start talking about nursing homes. (just kidding)

But if we wait and do a few more studies to be sure we have it right, I think the problem will have resolved itself.

I suspect we're going to see a lot more of this sort of dissociation. As it becomes clearer that the lockdown modelers' insistence on clearing the hospitals killed a lot of people in nursing homes, it's going to be ever more important to invent fictitious grandma-haters to take the blame.

Who takes the blame for the suicides?

Nursing home deaths *should* be counted differently in terms of life-years lost. The best study I could find of time spent in nursing homes says that the median time to death is 5 months. If this is true, then nursing home deaths are still a sad event, but it doesn't make sense to drastically restructure society to, on average, slightly postpone them.

http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2945440&blobtype=pdf

75% of the deaths are just our grandparents we tuck away in homes so we don’t have to take care of them.

That's exactly what it is. If this primarily affected the young would Mom and Dad be outraged that little Timmy picked up some disease in daycare rather than simply bring him home to live as normal people have done for millennia? There are still a few survivors of the mid-twentieth century polio epidemic around. Anybody bothered to ask their opinion on this whole thing?

The entire world is focused on Fairfax County, thank god for these updates.

The county is this close to shutting down the schools for another year and further wrecking my kids education, in service to a failed construct that's been killing old people anyway. I appreciate the updates.

You want schools open during a raging SARS epidemic?

Wrecked education? You can’t teach your own kids? Sad.

I suspect it has nothing to do with a global perspective but that Fairfax county if home to the author.

Still better than condescending writing about Charlestown. Did you know that there are even people with high GRE scores living there too?

Gonna need some proof there, big guy.

I have been writing on this topic for the last month. Two quick comments. We need to identify the various types of nursing homes since the media refers to them in aggregate and their populations are quite different. Here is a link to that discussion, https://www.acsh.org/news/2020/05/13/let’s-talk-about-nursing-homes-and-covid-19-14783
There was in New York no significant difference in mortality based upon ownership or even Medicare's rating system as detailed in this article, https://www.acsh.org/news/2020/04/27/covid-19-and-nursing-home-deaths-what-do-we-actually-know-14746

Hey new yorktimes.com! wakey wakey!
-last week judge sullivan ( General Flynns Judge) hired another judge,
this week judge Sullivan hired an attorney!
& the fbi is doing an internal review

Looking at the VDH COVID-19 page for outbreaks. Seems a bit more than 95% of the deaths so far have been in long term care facilities.

https://www.vdh.virginia.gov/coronavirus/ then click on the outbreaks menu option.

However, I think the focus on these types of questions really don't get us to answers we really want to have. I would cast that in the metaphor of a risk meter for living -- just how much is this virus moving that needle.

These current discussions all seem to be more along the lines of thinking the needle is pegged at 100% and needs to be moved to 0%.

The Toronto Star has looked at the difference between profit models in LTC in Toronto, and for-profit comes out looking much worse. https://www.thestar.com/business/2020/05/16/for-profit-nursing-homes-have-had-far-worse-covid-19-outcomes-than-public-facilities-and-three-of-the-largest-paid-out-15-billion-to-shareholders.html

A few questions.
Is it fair to inquire about the financial impact of long term facility deaths on state budgets? Is there a medical cost saving in some states? Is there a positive long term economic impact for lower death rate states like Florida?
Putting aside any attribution of motives or causality, do economists want to draw conclusions from pure financial stats?
What profession would normally engage in such an inquiry? And what conclusions are reasonable from such a study? Do political leaders ever act or fail to act based on motives unknown to themselves?

Hong Kong which has a population a little smaller than New York and much larger than Fairfax County and a border with China did not have a single nursing home death.
Perhaps we should have asked successful countries how to do it. It’s not a state secret and I am sure they would have been willing to help.

"it would be very interesting to test the performance of the private sector vs. public sector institutions here."

New Hampshire is one of the worst his states adjusted for population.

"Some New Hampshire nursing homes have been hit particularly hard. At Hanover Hill in Manchester, 18 deaths have been linked to COVID-19 — more than any other facility in the state — while 68 residents and 52 staff have been infected. At Pleasant Valley Nursing Center in Derry, 92 residents and 38 staff have been infected, with five deaths."

Number 1 in deaths at 18:

Owned and operated by the Lee family for 50 years.
Theodore J. Lee, President

Ted Lee’s entire professional career has been devoted to the development and management of innovative, quality health care services to clients of Hanover Hill. He came to the company upon graduating from Denver University in the role of Assistant Administrator. Subsequently, he served as Hanover Hill’s Vice President as well as its Administrator. He has been President of Hanover Hill since 1986.

Second with 5 deaths:

Pleasant Valley Nursing Center in Derry, NH, has a short-term rehabilitation rating of Average and a long term care rating of Average. It is a medium facility with 112 beds and has for-profit, corporate ownership. Pleasant Valley Nursing Center is not a part of a continuing care retirement community. It participates in Medicare and Medicaid.

Two other facilities were notable early on, but State officials didn't name them. But the fifth institution providing care to the disabled was mentioned with the governor sending in aid:

"Crotched Mountain Foundation is dedicated to serving individuals with disabilities and their families, embracing personal choice and development, and building communities of mutual support.

Once Gregg established the children’s camp, he met Ezra Jones, MD, who was working to rehabilitate World War I veterans with war injuries. Jones was the first orthopedic doctor in New Hampshire. Together, they founded the New Hampshire Society for Crippled Children in 1936. The Society publicized the need for more extensive treatment programs for people with disabilities, lobbied for favorable legislation and carried on mobile rehabilitation clinics around the state.

One day, while passing through Greenfield, Gregg was stopped by a local resident who suggested that he consider the property on top of Crotched Mountain for expanding his children’s programs. Gregg was thrilled with the idea.

Crotched Mountain opened its doors 1953. The hallmark of its near 60-year history has been an ability to adapt to meet the needs of many populations, many of whom have unique challenges and disabilities."

NH Sen Judd Greg is the founder's grandson, so it has high political visibility in NH, 98% to its benefit I'd say from 40 years following NH politics.

GOP governor Sununu has eagerly been seeking and spending Federal money, and working hard to source PPEs and test kits for NH care facilities and hospitals, using the national guard to handle logistics, assisted by NH business leaders dealing with import logistics and fronting the money.

Lots of workers work at multiple facilities to "cut costs" because more that 35 hours triggers full time benefits which are needed for managers, but too costly to provide to health care workers at risk of needing health care due to their jobs delivering health care. Thus cutting costs by not paying for PPEs and other medical supplies and then forcing workers to work multiple jobs without sick pay, disease is spread to lots of staff and patients.

The more disease spreads, the lower the costs!

"New Hampshire is one of the worst [hit] states adjusted for population."

No, it's not.

Look at the Worldometer coronavirus site. New Hampshire has the 19th-highest fatality rate among states, with a fatality rate ~10% that of the highest state (New York) and ~1/6 that of the neighboring state of Massachusetts (which has the 4th-highest fatality rate of any state).

GOP governor Sununu

When are we going to admit that the US isn't a faux democracy or even a republic but rather a hereditary oligarchy?

Some people seem to be drawing the conclusion from this that it was pointless for all the young healthy people to stay home. But in countries with no or poorly observed stay at home orders, the mortality rate among younger adults is quite high:

https://tinyurl.com/yctals7l

"In Brazil, 15 percent of deaths have been people under 50 — a rate more than 10 times greater than in Italy or Spain. In Mexico, the trend is even more stark: Nearly one-fourth of the dead have been between 25 and 49. In India, officials reported this month that nearly half of the dead were younger than 60. In Rio de Janeiro state, more than two-thirds of hospitalizations are for people younger than 49."

Still need to look at denominators.

Looking at just one of these: 15% of Brazilian deaths totals about 3,300 people. That compares to a total population of ~150 million people under age 50 ( https://en.wikipedia.org/wiki/Demographics_of_Brazil ).

NO VACCINE FOR YOU!!

"A final observation: why are new cases becoming rare, when countries like the U.K. and the U.S. haven’t had anywhere near enough coronavirus infections to approach herd immunity (at least, as far as we know)? Why do viruses die out? Epidemics follow a bell curve; they disappear long before they infect everyone in a population. Why? Am I the only one who feels like epidemiologists know less than I had always assumed?"
https://www.powerlineblog.com/archives/2020/05/is-covid-19-dying-out.php

The epidemiologists belong to the same fraternity as the eco-maniacs and pseudo-science climate modellers. Having 3 parts per billion of mercury in a particular lake trout means that if more than one meal of other lake trout is consumed per week death is an inevitable result. A model of the stratosphere and CFC molecules has changed HVAC for the worse at enormous expense with no evident benefit, except to chemical companies. Computer climate models are predicting that South Flamingo Rd. in Pembroke Pines, FL will be under water any time now. South Floridians should keep a boat tied up in the front yard. The epidemiologists are using the same methodology.

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